Mammography History Research Articles

Vitamin D‐effective solar UV radiation, dietary vitamin D and breast cancer risk

Vitamin D is well known for its important role in calcium and phosphor homeostasis. Recent research suggests that vitamin D also prevent some type of cancers. We studied solar vitamin D effective UV radiation (VD dose), dietary vitamin D, sun-seeking holidays, use of solarium, frequency of sunburn and breast cancer risk in a large population-based cohort study. A total of 41,811 women from the prospective Norwegian Women and Cancer Study, aged 40-70 years at baseline, were followed from 1997/1998 to 2007. Dietary vitamin D intake was calculated at baseline. Information on historical VD dose was used as a proxy for cutaneously obtained vitamin D status. Cox proportional hazards model was used. We adjusted for age, height, BMI, baseline menopausal status, use of hormone replacement therapy, use of oral contraception, alcohol, mother's history of breast cancer, mammography and parity. During 8.5 years of follow-up, 948 new cases of breast cancer were registered using data from the Norwegian Cancer Registry. We found no significant associations between VD dose, or vitamin D intake, or sun-seeking holidays, or use of solarium, or frequency of sunburn, and breast cancer risk. Relative risks (95% confidence intervals) for highest versus lowest category were 1.17 (0.95-1.44), 0.95 (0.75-1.21), 1.07 (0.87-1.32), 0.93 (0.76-1.14) and 1.10 (0.89-1.36), respectively. Our results do not support an association between vitamin D status, and breast cancer risk.

Association of diagnostic work-up with subsequent attendance in a breast cancer screening program for false-positive cases

The objective of this study is to determine whether the likelihood of returning for routine breast cancer screening differed for false-positive cases depending on the diagnostic work-up. Using the original data from a French population-based breast cancer screening program, we compared the attendance rates at the subsequent round of screening for 16,946 and 1,127 participants who received negative (i.e., American College of Radiology, ACR, categories 1-2) and false-positive mammograms, respectively. False-positive mammograms were categorized ACR 0 (i.e., warranting additional imaging evaluation), 3 (i.e., warranting clinical and imaging follow-up), and 4-5 (i.e., warranting biopsy). We estimated the odds ratios of attendance at subsequent screening round using logistic regression, adjusting for age and history of previous mammography. The attendance rates at the subsequent screening round were 80.6% for women who received negative mammograms versus 69.6, 74.3, and 70.1% for women who received false-positive mammograms warranting additional imaging evaluation, clinical and imaging follow-up, or biopsy, respectively. In comparison to women who received negative mammograms, the corresponding adjusted odds ratios of returning for routine screening were 0.6 [95% confidence interval (CI) 0.4-0.8], 0.8 (95% CI 0.6-0.9), and 0.6 (95% CI 0.4-0.8). No significant differences were found in odds ratios of attendance across ACR categories among women who received false-positive mammograms. Similar figures were observed for attending at least one of the two subsequent screening rounds. In conclusion, in comparison to women with normal or benign findings on index mammograms, false-positive cases warranting additional imaging evaluation, clinical and imaging follow-up, or biopsy had uniformly decreased odds of attending subsequent routine screening rounds.

A Comparison of Two Educational Methods on Immigrant Latinas Breast Cancer Knowledge and Screening Behaviors

Underutilization of screening mammography by Latinas continues unabated and may contribute to disparities in disease-free survival and mortality. Comparison of two discussion group-centered educational interventions at enhancing breast cancer knowledge, breast self-exams (BSE), and screening mammography. Pre-test post-test study design. Two cohorts of 200 Latinas each participated in survey screening and discussion groups at baseline. One cohort also viewed an animated video and had BSE training. Breast cancer knowledge, self-reported BSE and mammography history were measured at baseline and three months post-intervention. Breast cancer knowledge scores were good for both groups at baseline, and significantly increased at three month follow-up for both groups (p<.05) but no significant difference was observed between groups at baseline or post-intervention. Community-based discussion groups are a cost-effective method for improving breast cancer knowledge and promoting screening behaviors.

Ethnic differences in the use of regular mammography: the multiethnic cohort

Women's regular use of mammography over a 6 year interval was examined among women aged 45-75 in the Hawaii and Los Angeles Multiethnic Cohort (MEC). The analyses included 81,722 African American, Japanese, Latina, Native Hawaiian, and White females using self-reported mammography history from 1993 to 1998. Ninety-one percent of MEC women reported ever having a mammogram, however only 36% reported regular annual and 48% reported regular biennial mammography over the interval. Mammography was lowest among women who were obese, had a high school education or less, or who were aged 70 and over. Regular mammography use during follow-up was low compared to prior studies reporting on recent mammography. African American, Latina, and Native Hawaiian women had significantly lower annual and biennial mammography use compared to White women even after controlling for age, education, family history, body mass index and hormone therapy indicating that gaps exist in mammography that remain unexplained by known predictors of screening behavior.

Factors Associated with Advanced Disease Stage at Diagnosis in a Population-based Study of Patients with Newly Diagnosed Breast Cancer

Breast cancer is diagnosed at a younger age and a more advanced stage in African-American women than in White women. The authors investigated the effects of several factors, including race, on stage of breast cancer in women aged 20-54 years living in Atlanta, Georgia, and diagnosed between 1990 and 1992. A total of 251 African-American and 580 White women were interviewed and their medical records reviewed. By use of polytomous logistic regression, factors possibly influencing stage and racial differences in stage were studied. In African-American women, the odds of stage III/IV breast cancer at diagnosis were almost four times the odds in White women (odds ratio = 3.79, 95% confidence interval: 2.45, 5.89) and approximately two and one-half times for stage IIA or stage IIB disease (odds ratio = 2.57, 95% confidence interval: 1.66, 3.99; odds ratio = 1.94, 95% confidence interval: 1.31, 2.86, respectively). These racial differences appeared to be largely explained by insurance status, poverty, history of mammography, method of tumor detection, and obesity. Interventions targeting these factors could potentially lower the stage at diagnosis for African-American breast cancer patients and, in doing so, improve their survival and other outcomes.

Variation in the Use of Percutaneous Biopsy for Diagnosis of Breast Abnormalities in Ontario

Preoperative diagnosis of breast abnormalities is currently the standard of care. A population-based study to determine the use of percutaneous needle biopsy for breast diagnosis in Ontario was performed. A total of 17,068 women undergoing breast tissue sampling (percutaneous needle biopsy or surgical excision) for diagnosis between April 1, 2002, and December 31, 2002, and without a previous cancer diagnosis were identified. Univariate and multivariate analyses examined the association of age, residence in a particular local health integration network (LHIN), income quintile, urban or rural residence, primary care provider, any prior mammogram, and prior regular screening mammography, as well as whether the biopsy was initiated by a screening mammogram with different methods of tissue diagnosis. A total of 10,459 women (61%) underwent percutaneous biopsy for diagnosis. A total of 10,131 women underwent surgery, of whom 6,637 received a benign diagnosis and 3,494 had cancer, for a benign-to-malignant ratio of 1.9:1. Women with cancer were slightly more likely to undergo percutaneous biopsy than women without (64.7% vs. 60.3%). There was variation among LHINs in the use of percutaneous biopsy (range, 24%-72%). Women with the highest incomes, urban residence, a primary care provider, or history of any prior mammography were more likely to receive percutaneous biopsy. On multivariate analysis, age 50 to 69 years, LHIN, urban residence, primary care provider, and screen-initiated evaluation were associated with percutaneous biopsy. Variation in the use of percutaneous biopsy by factors unrelated to indications for biopsy indicate that strategies to identify and overcome barriers to its use are needed.

Mammography screening after breast cancer diagnosis in a first degree female relative: age group differences (United States)

To examine age group differences in predictors of mammography screening in women with a first-degree female relative (FDFR) with recent diagnosis of breast cancer. A cohort study of 577 women ages 18 and over with a FDFR diagnosed with incident stage 0-III breast cancer was conducted. Telephone interviews were conducted at baseline, 6 months and 12 months. Logistic regression was used to model factors associated with mammography screening since diagnosis. Mammography rates were 32%, 71% and 75% for women aged 18-39, 40-49 and 50 and above, respectively. Among the youngest group, belief in cancer screening effectiveness, mammography history and MD recommendation predicted mammography. For those 40-49, excellent self-rated health, perceived similarity of personality to the patient and higher intrusive thoughts predicted mammography. Perceived similarity of health care utilization to the patient and higher risk perceptions were associated with mammography among women aged 50 and above. Mammography rates were high among women aged 40-49 and 50 and above, and considerable among women aged 18-30, even in view of the lack of evidence-based guidelines. Continued attention should be paid to the 25-30% of older women who do not report screening.

Does Utilization of Screening Mammography Explain Racial and Ethnic Differences in Breast Cancer?

Reasons for persistent differences in breast cancer mortality rates among various racial and ethnic groups have been difficult to ascertain. To determine reasons for disparities in breast cancer outcomes across racial and ethnic groups. Prospective cohort. The authors pooled data from 7 mammography registries that participate in the National Cancer Institute-funded Breast Cancer Surveillance Consortium. Cancer diagnoses were ascertained through linkage with pathology databases; Surveillance, Epidemiology, and End Results programs; and state tumor registries. 1,010,515 women 40 years of age and older who had at least 1 mammogram between 1996 and 2002; 17,558 of these women had diagnosed breast cancer. Patterns of mammography and the probability of inadequate mammography screening were examined. The authors evaluated whether overall and advanced cancer rates were similar across racial and ethnic groups and whether these rates were affected by the use of mammography. African-American, Hispanic, Asian, and Native American women were more likely than white women to have received inadequate mammographic screening (relative risk, 1.2 [95% CI, 1.2 to 1.2], 1.3 [CI, 1.2 to 1.3], 1.4 [CI, 1.3 to 1.4], and 1.2 [CI, 1.1 to 1.2] respectively). African-American women were more likely than white, Asian, and Native American women to have large, advanced-stage, high-grade, and lymph node-positive tumors of the breast. The observed differences in advanced cancer rates between African American and white women were attenuated or eliminated after the cohort was stratified by screening history. Among women who were previously screened at intervals of 4 to 41 months, African-American women were no more likely to have large, advanced-stage tumors or lymph node involvement than white women with the same screening history. African-American women had higher rates of high-grade tumors than white women regardless of screening history. The lower rates of advanced cancer among Asian and Native American women persisted when the cohort was stratified by mammography history. Results are based on a cohort of women who had received mammographic evaluations. African-American women are less likely to receive adequate mammographic screening than white women, which may explain the higher prevalence of advanced breast tumors among African-American women. Tumor characteristics may also contribute to differences in cancer outcomes because African-American women have higher-grade tumors than white women regardless of screening. These results suggest that adherence to recommended mammography screening intervals may reduce breast cancer mortality rates.

Knowledge of breast cancer and screening practices

Objective To assess young women's breast health knowledge and explore its relation to the use of screening mammography. Methods A convenience sample of 180 women aged 25-45 residing in Toronto, Canada, with no history of breast cancer and mammography received an information brochure and four questionnaires which assessed their knowledge of breast health, sociodemographic/clinical character istics, and intended decision to use screening mammography. Results Women's overall baseline knowledge score ranged from 0-18 with a mean of 10 and SD of 3.9. About half of the participants had a low score (0-9), 31 per cent did not know that the risk of breast cancer increases with age, 43 per cent did not know what was the appropriate age to start breast self examination (BSE), and 48 per cent did not know how frequently BSE should be performed. The overall knowledge score was significantly higher for those women who intended to use screening than those who did not (10.8 vs. 8.4, p&lt;0.001). The intended use of screening was associated with women's knowledge ( p&lt;0.001), self-perceived health ( p=0.02), perceived susceptibility to breast cancer ( p=0.04) and perceived usefulness of information ( p=0.001). Conclusion The study demonstrates that breast health knowledge is limited even among highly educated young women. This finding suggests the need for providing breast health education to women at earlier stage in their life when they have ample time to go through a logical series of decision stages on their way to adopting a new behaviour.

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

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

Hormone replacement therapy, percent mammographic density and the sensitivity of mammography

We examined the extent to which the lower mammographic sensitivity found in hormone replacement therapy (HRT) users could be explained by any association of HRT use with higher density and more difficult to detect cancers (e.g. lobular cancers). Eligible women included women aged 55 years and older who attended BreastScreen Victoria for first-round screening mammography in 1994 and 1995 (1086 breast cancers) and for subsequent-round screening (471 breast cancers) in 1995 and 1996. Percent density was measured on a continuous scale, blinded, using a reliable, computer-assisted method. True positive cancers were invasive breast cancers diagnosed at screening and false negative cancers were cancer diagnosed within 24 months of a negative screening examination. After adjusting for age, symptom status, family history, past history of mammography (at first round) and time since screen (at subsequent round), HRT users had higher risk of having a false negative (first round: odds ratio [OR], 1.99; 95% confidence interval [CI], 1.4–2.9 and subsequent round: OR, 2.29; 95% CI, 1.4–3.8). This effect was attentuated by adjusting for mammographic density (first round: OR, 1.54; 95% CI, 1.0–2.3 and subsequent round: OR, 1.97; 95% CI, 1.2–3.3), indicating the density only partly explains the effect of HRT on sensitivity.

Practical MR mammographyUwe Fischer 6collab: Ulrich Brinck9 Stuttgart?New York, Thieme 2004, 223 pages, 398 illustrations, US$dollar;99.00.

In the Preface the author says that “in recent years dynamic MR mammography has increasingly established itself as an imaging modality in the diagnostic workup of the female breast.” In the current book the author successfully presents, evaluates and discusses the use of MR in the imaging of the breast. The text is subdivided into 16 chapters. The first and second deal with History of MR Mammography and Preparing and Informing the Patient, respectively. In the third, discussed are the Technique and Methods, from the basic principles of magnetic resonance imaging, diagnostic units, breast compression, to 2-D and 3-D techniques, T2-weighted sequences, paramagnetic contrast material and automated image postprocessing and analysis, to mention only a few of the basic principles. Chapter 4 clearly presents the topic of Tumor Angiogenesis and its important correlation with dynamic MR mammography. In Chapter 5, the Diagnostic Criteria are illustrated, from precontrast examination, contrast-enhanced T1-weighted examinations, criteria of malignancy, to evaluation score. Each material is clearly presented. Chapter 6 deals with Artifacts and Sources of Error, from incorrect positioning, motion artifacts, to incorrect region of interest and signal alteration after diagnostic procedures. Normal Findings in MR Mammography are discussed in Chapter 7. Chapter 8 deals in depth with Benign Changes. Discussed in particular are radial scar and postoperative changes. Malignant Changes, from intraductal tumor forms to metastases to the breast, are presented in Chapter 9. Clearly evaluated are ductal and lobular carcinoma in situ and invasive ductal and lobular carcinoma. MR Mammography in Men, dealing with simple gynecomastia or cancer, is discussed in Chapter 10. The important matter of Indications for MR Mammography is clearly and thoroughly discussed in Chapter 11, with particular analysis on MR mammography in patients with ambiguous findings, and on the role of MRI in the postoperative staging and follow-up after lumpectomy. Briefly but accurately reviewed are, in the indications for MR mammography after lumpectomy, the differentiation between tumor recurrence, the postoperative effects and the interval of time between the lumpectomy and the MR mammography. In Chapter 12, well reviewed are the Differential Diagnoses and Strategic Consideration, with clear drawings and tables of the findings related to focal and diffuse enhancement. Appreciated is Chapter 13, on Prosthesis Diagnostic, where the reader will be first introduced to the examination technique, then through a review of the normal findings to the different complications following the various procedures. Chapter 14 is dedicated to MR-Guided Interventions, where reviewed and critically analyzed are the indications for various MR-guided interventions. Chapter 15 briefly reviews Quality Assessment, such as the checklist for MR Mammography, and Chapter 16 closes this interesting and instructive book by critically evaluating the Present Standing and Perspective of MR Mammography.

A Polymorphic Locus in the Promoter Region of the IGFBP3 Gene Is Related to Mammographic Breast Density

Abstract Background: Mammographic breast density is a significant risk factor for breast cancer. Women with dense tissue accounting for more than 60–75% of the area of the breast have a 4- to 6-fold increase in their risk of breast cancer, compared to women with little or no breast density. A high circulating level of insulin-like growth factor-I (IGF-I) and low IGF binding protein 3 (IGFBP-3) level have been associated with increased breast density in premenopausal women. Genetic polymorphisms in the IGF1 and IGFBP3 genes may influence breast and serum levels of these growth factors. The aims of this study were to determine whether polymorphic variations in the IGF1 and IGFBP3 genes are associated with breast density, and serum IGF-I and IGFBP-3 levels, and whether serum IGF-I and IGFBP-3 levels are associated with mammographic density. Methods: A total of 441 white women, recruited from Women's College Hospital (Toronto, Ontario), enrolled in this study. Each woman completed a questionnaire, detailing information on age, menstrual history, hormone use, diet, and medical and mammography history. Blood samples were taken for DNA extraction to genotype the subjects for polymorphic variants in the two candidate genes, and for measurement of circulating levels of IGF-I and IGFBP-3. Mammographic films were retrieved from Women's College Hospital and digitized using a laser film scanner. The digitized images were assessed for breast density using a computer-assisted method. Results: There was a positive association between serum IGFBP-3 levels and the number of A alleles at a previously described polymorphic locus in the promoter region of the IGFBP3 gene among premenopausal women (P = 0.01). There was also a positive trend in the mean percentage of breast density by the number of A alleles of the IGFBP3 gene among premenopausal women (P = 0.0005). Women with two A alleles had a 5-fold increase in the odds of having a percentage of breast density greater or equal to 28%, compared with women with no A allele (P = 0.002). However, there was no association between serum IGF-I and IGFBP-3 levels and breast density among premenopausal women (P &amp;gt; 0.05). Conclusions: This is the first study to report a strong relationship between a polymorphic gene locus (IGFBP3) and mammographic breast density. However, we could not confirm an association between serum IGF-I levels and breast density among premenopausal women, as demonstrated in previous studies.

"To see today with the eyes of tomorrow": A history of screening mammography.

Mammography represents an interesting chapter in the history of American medical technology. Throughout much of the 20th century, physicians showed little interesting in using x-rays to help diagnose breast cancer. But beginning in the 1960s, with the growing interest in early detection, the professionalization of radiology and cancer activism, and the increasing allure of visual imagery in medicine, screening mammograms became the centerpiece of efforts to lower mortality from breast cancer. Despite its popularity, however, mammography remains highly controversial as physicians, statisticians and the public have continued to debate its actual clinical value. Mammography well exemplifies how cultural, ideological and political factors influence both the dissemination and evaluation of medical technologies.

Socioeconomic status & returning for a second screen in the Ontario breast screening program

In a retrospective cohort study involving 57902 women initially screened between January 1, 1995 and December 31 1997 by the Ontario Breast Screening Program (OBSP), we examined the relationship between geographically derived socioeconomic status (SES) and returning for a second screen. We controlled for age, rurality, preferred language, initial mammography results, previous mammography history, and referral by a health professional. Although SES was related to returning, rurality was an effect modifier of this relationship, a finding not previously reported. Compared to women in the highest (‘richest’) quintile, urban women in the first and second quintile were less likely to return; this relationship was not found in rural women. Low SES women, particularly in urban areas, should be specifically targeted to increase their likelihood of re-attendance for breast cancer screening within an organized program.

Use of Mammographic Screening by HIV-Infected Women in the Women's Interagency HIV Study (WIHS)

Background. Although HIV-positive women may be less likely than women in general to receive mammography due to socioeconomic disadvantage, HIV diagnosis may increase opportunities for medical interactions which encourage mammography.Methods. HIV-positive (2,059) and HIV-negative (569) Women's Interagency HIV Study (WIHS) participants reported ever/never history of mammography at baseline (in 1994, 1995) and, at each 6-month follow-up visit, if they had been screened since their last visit. National Health Interview Survey (NHIS) data for 1994 were used to compare WIHS participants to U.S. women. Factors independently related to mammography were determined using logistic regression for baseline data and proportional hazards for follow-up data. Results were adjusted for age.Results. Among women ≥40, fewer WIHS women, regardless of HIV status, reported screening than U.S. women (67% HIV-positive, 62% HIV-negative, 79% NHIS; P < 0.0001). First-time screening while on study was associated with being HIV-positive [rate ratio (95% confidence interval) = 1.6 (1.1, 2.3)]. Factors independently associated with screening were related to health care access and usage.Conclusions. WIHS women, a disadvantaged population, reported less mammography than the general population. HIV-positive women reported more screening than HIV-negative women, possibly because of greater opportunity to interact with the health care system.

Risk of breast cancer in young women in relation to body size and weight gain in adolescence and early adulthood.

Findings have been inconsistent on effects of adolescent body size and adult weight gain on risk of breast cancer in young women. These relations were examined in a population-based case control study of 1590 women less than 45 years of age newly diagnosed with breast cancer during 1990–1992 in three areas of the US and an age-matched control group of 1390 women. Height and weight were measured at interview and participants asked to recall information about earlier body size. Logistic regression was used to estimate the relative risk of breast cancer adjusted for other risk factors. Women who were either much heavier or lighter than average in adolescence or at age 20 were at reduced risk. Weight gain after age 20 resulted in reduced risk, but the effect was confined to early-stage and, more specifically, lower grade breast cancer. Neither the risk reduction nor the variation by breast cancer stage or grade was explained by the method of cancer detection or by prior mammography history. These findings suggest that relations between breast cancer risk in young women and body weight at different ages is complex and that the risk reduction with adult weight gain is confined to less aggressive cancers. © 1999 Cancer Research Campaign

Breast cancer rescreening in low-income women

Introduction: Routine mammography screening with clinical breast examination is effective in reducing breast cancer mortality. The Breast and Cervical Health Program (BCHP) in Washington State provides free breast and cervical cancer screening for low-income women, with an emphasis on women of color. This study examined initial breast cancer rescreening and factors associated with rescreening for women enrolled in BCHP in King County, Washington. Methods: Data were obtained from the Washington State BCHP tracking system. We estimated the percentages who received breast cancer rescreening for women enrolled between July 1994 and December 1995 using survival analysis. Cox proportional regression was also used to examine factors associated with time-until-rescreening. Results: Survival analysis showed that the overall percentages rescreened at 15 and 27 months for women aged 50–69 were 25.7% and 45.0%, respectively. For women aged 40–49, the corresponding percentages were 26.0% and 40.3%. Rescreening differed by age groups, race/ethnicity, level of education, foreign born status, history of previous mammography, and enrollment clinic. Conclusions: Results from this study suggested that in addition to initial efforts for enrollment, screening programs should emphasize increased rescreening especially for women with certain demographic and screening history characteristics.

Breast Cancer Detection Rates by Screening Mammography in Elderly Women

: Breast-cancer risk factors, mammography history, and breast cancer detection rates were compared for women aged 50–64 years versus women 65 years and older. Mammographic screening examinations were performed on 936 women at least 65 years old and 1,926 women aged 50–64 years at a mobile van and an outpatient clinic of a tertiary referral university hospital. Breast-cancer risk factors and frequency and timing of previous mammograms were assessed on all women. Of the 2,862 women screened, 520 (18.2%) were black. Women aged 65 and older were significantly more likely to be nulliparous, and over 30 years old at first pregnancy than women aged 50–64 years. The proportion of women who reported ever having a mammogram did not differ by age. For women who reported a previous mammogram, the intervals of the previous screening did not differ significantly by age group. Cancer detection rates were higher among women aged 65 and over at both locations. Among age and race groupings, the highest cancer detection rate occurred in black women over 65 years (19.7/1,000). Cancer detection rates were high enough to suggest that screening elderly women is efficacious. Because elderly black women may be less aware of breast-cancer risk factors, relying on self-referral for screening this population may be inappropriate. Barriers to mammographic screening among elderly women warrant further study.

A comparison of the performance and impact of Breast Cancer Screening Programmes in East Anglia, U.K. and Bouches Du Rhône, France

The purpose of this study was to compare results from the first screening round of two breast cancer screening programmes of similar design implemented in different health care settings. The East Anglian programme is part of the U.K. National Health Service Breast Screening Programme, which is a centralised programme with a limited number of dedicated screening units. The Bouches du Rhône programme is one of 13 French programmes based on a decentralised model using existing radiology clinics. Compliance and cancer detection rates were lower in the Bouches du Rhône programme. Detection rates for small invasive cancers (⩽ 10 mm) were similar in the two programmes, although larger cancers (⩾20 mm) were detected in the Bouches du Rhône programme. Significantly, the shift towards more favourable distribution of prognostic characteristics associated with screen-detected breast cancers compared with those arising outside the programme is less marked in the Bouches du Rhône programme. This is probably due to the more favourable underlying disease status in the district resulting from a long history of breast awareness and spontaneous mammography.