Mammography Program Research Articles

Bone health in breast cancer survivors

The objective of this paper is to carry out a systemic review of the literature investigating issues related to bone health in survivors of breast cancer. Given the fact that only a fraction of women with breast cancer receive appropriate assessment of their bone health, it is hoped that this review will help raise awareness of bone health concerns in this patient population. Articles published in the English language addressing issues related to bone health in breast cancer were accessed using Pubmed database. Studies were searched using keywords like: "Osteoporosis", "osteopenia", "bone health", "breast cancer", "denosumab" and "bisphosphonates". Current evidence suggests that women who survive their breast cancer are at high risk for significant bone loss. Recent clinical guidelines recommend assessment of bone mineral density (BMD) in high-risk patients. Nonpharmacologic interventions including lifestyle changes, vitamin D and calcium supplements are extremely important. Bisphosphonates, in both oral and parenteral formulations, are increasingly used while new agents, like denosumab, have recently been approved. Due to the widespread use of screening mammography and early detection programs leading to breast cancer diagnosis at a much earlier stage and the recent introduction of more effective anticancer therapy, more women are surviving their breast cancer, which highlights the need for survivorship programs that address issues like bone health. Many recent professional societies are addressing these issues and updating their recommendations and guidelines.

Designing a Tailored Web-Based Educational Mammography Program

Breast cancer has become increasingly prevalent in Taiwanese women, especially in younger women. Unfortunately, early breast cancer detection may be hampered by Taiwanese women's beliefs about breast cancer, risk factors, and mammography. The Internet has become a powerful way to disseminate health information, but health education Web sites are frequently neither patient-centered nor theoretically based. We used the Transtheoretical Model as the theoretical basis for the design of a tailored Web-based educational program aimed at correcting Taiwanese women's misconceptions about breast cancer and mammography and increasing their intent to obtain routine mammography. In this article, we describe the Web-based educational intervention and the results of an initial preliminary evaluation study.

Abstract P2-04-02: Increased Risk of Breast Cancer in Women Who Receive False Positive Test Results from Mammography Screening

Abstract Background: Copenhagen has the longest running organised screening programme for breast cancer in Denmark. The programme started in 1991. One of the possible consequences when screening for breast cancer with mammography is a false positive test result. We assessed the relative risk of developing breast cancer among women who had received false positive test results compared to women who had not. Method: The mammography programme provided data on participation and test results from 1991 -2005. Oncological data was retrieved from the National Cancer Register. Follow-up ended on 17 April 2008. Data were linked using the Danish unique personal identity number. Relative risks were estimated using Poisson regression, age adjusted. The exposure was categorised as a) false-positive Type1 = negative after further assessment with mammography, ultrasound and fine needle aspiration, and b) Type 2 = negative after surgery. Results: A total of 59.392 women participated in the mammography programme, representing 650.218 person-years at risk. The relative risk (RR) of breast cancer after any type of false positive (FP) was 1.33 (95% CI, 1.18-1.50), the RR for breast cancer after a Type 1 FP was 1.34 (95% CI, 1.18 — 1.52) and after a Type 2 FP the RR was 1.24 (95% CI, 0.85-1.82). The RR of interval cancer, i.e. breast cancer within the two years following the test result, was 1.73 (95% CI, 1.13-2.66) for women who had received a FP test result as compared to those who had not. Conclusion: Women who have received a false positive test result from mammography screening had a 73% increased risk of developing interval cancer compared to women who had not, and a 33% increased risk of developing breast cancer at any time after a false positive test result. There was an increased risk for both Type 1 (34%) and Type 2 (24%) FP test results, though data was only significant for Type 1 results. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-04-02.

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

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

Complementary approaches to assessing risk factors for interval breast cancer

To examine risk factors for interval breast cancer among women screened in a population-based mammography program. Risk for interval cancer was assessed in terms of both the incidence per 10,000 negative screens and the proportion of all breast cancers diagnosed among screened women. Interval (N=557) and screen-detected cancers (N=1,545) were identified among 208,667 women receiving mammography in Colorado (1994-2001). Logistic regression was used to assess independent effects of multiple factors. Overall risk of interval cancer was 29.5/10,000 women screened. Incidence was higher in women >50years (OR: 2.28, 1.86-2.80), with family history (OR: 2.23, 1.85-2.70), with dense breasts (OR: 3.84, 2.76-5.35), and using hormones (OR: 1.54, 1.20-1.97). Hispanics had lower incidence than Whites (OR: 0.52, 0.34-0.81). Interval cancers represented 26% of all cancers diagnosed. This proportion was higher in women <50 (OR: 1.41, 1.09-1.82) and in women with dense breasts (OR: 2.95, 1.94-4.48). Incidence of interval cancer increases with age, breast density, hormone use, and family history. Attempts to reduce occurrence of these cancers through more sensitive and/or intensive screening should focus on these subgroups. The disproportionate number of interval cancers associated with young age and dense breasts suggests these cancers result from both rapid growth and difficulties in detection.

First organized screening mammography programme in Saudi Arabia: preliminary analysis of pilot round

The aim of this study was to analyse results of the pilot screening round for Al-Qassim Screening Mammography Programme and compare with international standards. Analysis was conducted in the central screening office in Prince Faisal Oncology Centre, which coordinates activities of various screening units. Data were collected during the period 1 January 2007 to 30 June 2008. Organizational and functional information was obtained from policy and procedure manuals of the programme. Out of 9812 eligible women, 1766 (18%) participated and data were available for 1628 (16.6%). The median age of participants was 47 (standard deviation 8.12) years. The low uptake rate (18%) and a high recall rate (31.6%) characterized the pilot screening round. Biopsy rate was 1.5% and cancer detection rate was 0.24%. Many performance indicators in this pilot screening round were not available. Many of the available indicators did not meet international standards.

A Monte Carlo tool to simulate breast cancer screening programmes

A Monte Carlo tool which permits the simulation of screening mammography programmes is developed. Various statistical distributions describing different parameters involved in the problem are used: the characteristics of the population under study, a tumour growth model and a model for tumour detection based on parameters such as sensitivity and specificity which depends on the woman's age. We reproduce results of different actual programmes. The model enables us to find out the configuration (the age of the women who attend the screening trials and screening frequency) which produces maximum benefits with minimum risks. In addition, the model has permitted us to validate some of the assumed hypothesis, such as the probability distribution of the tumour detection as a function of the tumour size, the frequency of the histological types and the transition probability between different histological types.

Microcalcificações Mamárias Suspeitas de Malignidade

O câncer de mama ocupa lugar de destaque no mundo ocidental por ser a maior causa de morte por câncer na população feminina. Medidas específicas para a prevenção primária do câncer de mama são de aplicação limitada na população em geral. Na prevenção secundária, esforços têm sido direcionados ao diagnóstico precoce. Neste cenário, encontra-se a mamografia, considerada o método mais sensível para detectar precocemente o câncer de mama. Microcalcificações mamárias são frequentemente detectadas nas mamografias de rastreamento e, embora a maioria seja benigna, algumas podem representar câncer. Assim, muitas biópsias originadas do rastreamento mamográfico visam a investigar microcalcificações suspeitas de malignidade. Neste sentido, há necessidade de caracterizá-las adequadamente, já que a conduta a ser seguida baseia-se na análise precisa destas. Diante disso, desenvolveu-se este trabalho na perspectiva de revisar as características dessas microcalcificações, contribuindo para a melhora na interpretação diagnóstica e na conduta clínica frente ao encontro destas na mamografia. Os artigos que serviram de sustentação para o presente estudo foram localizados por meio das bases de dados Medline, Lilacs, e Pubmed, utilizando os descritores “mamografia”, “neoplasia mamaria” e “calcinose”. Concluiu-se que, nas calcificações tipicamente malignas, os segmentos da mama devem ser biopsiados. Naquelas suspeitas de malignidade, se mesmo após exaustivo estudo de suas características pela mamografia não apresentarem sinais suficientes que indiquem doença benigna, devem ser investigadas a partir de um estudo anatomopatológico. Entretanto, inconsistências na classificação das microcalcificações de acordo com a morfologia, o nível de suspeição e a recomendação final do BI-RADS™ persistem e mais estudos da relação radiológicopatológica serão importantes na melhora da especificidade dessas variáveis.

Quality Assurance of an Organised Screening Programme for Breast Cancer in Denmark 1991-2008.

Abstract Background: The capital city of Copenhagen, Denmark, has had an organised programme for screening with mammography since 1991. All women resident within the area of uptake and aged 50-69, representing around 45000 women, are invited biennially, unless they actively have asked not to be invited. We have evaluated the programme with regard to the European guidelines for quality assurance in breast cancer screening and diagnosis, to assess performance and impact.Methods: The target population was identified through the national population register, identifying all women meeting the inclusion criteria in terms of age and place of residence, migration and death. The mammography programme supplied data on all invited women, participation and screening test results. Oncological data was retrieved from the National Cancer Register and the Danish Breast Cancer Group. Data was linked using the Danish unique personal identity number.Results: In the first invitation round (1991-1992) the invasive cancer detection rate was 10/1000 and was by the 8th invitation round (2006-2007) 8/1000. The in situ detection rate has been 1/1000 throughout the period. The programme sensitivity is approximately 70%. The detection rate of small tumours (≤ 10mm) was, on average, 39% over the first 4 invitation rounds and 62% by the 8th invitation round. The benign to malign ratio changed from 1:1.6 to 1:11.4, from the first to the 8th invitation round. Recall rates at initial screen dropped from 7% to 4% in the period, and for subsequent screens from 4% to 2%. The false positive rate was 5.5% in the first invitation round and had by the 8th invitation round dropped to 1.3%, with a cumulative risk of 15% over 8 rounds. In the 8th invitation round, there was 82% coverage, a participation rate of 61% and a long term adherence of 50%.Conclusions: The results for the majority of indicators were well within the recommended levels. There had been a significant improvement in the benign to malign ratio, despite that the false positive rate at assessment had decreased. The detection of small tumours had also improved significantly. Participation rates were, however, lower than recommended. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4005.

Évaluation du tout numérique dans le dépistage organisé du cancer du sein à travers une expérience dans le département de la Vienne

To evaluate a fully integrated digital screening mammography program (image acquisition, transfer and over-read). between april 2005 and December 2007, two imaging sites were authorized by the Department of Health to use digital mammography units (Senographe 2000D and 2000DS, GEMS) for screening mammography. the initial interpretation was made on a workstation with accompanying digital films. The images were also transmitted via the internet on the same day for over-read on a workstation. In addition, a <<classical>> over-read was also performed from printed mammographic images using a viewbox. Differences in interpretation and BIRADS classification as well as economical considerations were analyzed between the types of interpretation setups. A total of 7008 screening mammograms were included. No significant problem was reported with regards to internet image transfers. No significant interpretation difference was noted related to the fully integrated digital imaging process. This technology could generate cost savings estimated in 2007 at 3.793/year (mailing fee). A fully integrated digital screening mammography program results in improved organisational processes and significant cost reductions without reduced diagnostic accuracy.

Sci-Fri AM(1): Imaging-02: Estimation of Patient Dose in a Provincial Screening Mammography Program

PURPOSE: To estimate the radiation dose delivered to women in an organized provincial breast screening program. METHOD AND MATERIALS: Volunteer technologists from 39 screening sites were asked to record the techniques factors of the four bilateral mammograms of 50 consecutive women who underwent screening in April of 2007. Volunteers from 31 sites responded to this request (80%). Data collected were then analyzed statistically for each site as well as collectively. Three methods were used to assess mean glandular dose (MGD): 1) parameterization of tables published by Wu et al (W.T. Sobol and X. Wu, Med. Phys. 1997), 2) conversion factors tables based on data established by Dance (D. Dance, C. Skinner, K. Young, Phys. Med. Biol 2000), and 3) interpolation of lookup tables provided by Boone (J. Boone, Radiology 1999). Radiation output data needed for the calculations were obtained from the annual physics surveys. RESULTS The mean values of all 6200 exposures were 26.9 (±0.8) kVp, 130 (±30) mAs and 54 (±5) mm breast thickness and 2.6 (±0.5) mGy. The average of MGD for film/screen sites ranged 1.8 – 3.7 mGy whereas for the only digital site it was 1.6 mGy. Comparisons of the three dose calculation methods showed that estimates obtained from Dance data were 9% greater than those suggested by Wu and 19% greater than suggested by Boone. CONCLUSION Average patient MGD for the 31 screening site participated ranged from 1.6–3.7 mGy with lowest being a digital mammography site.

Mammography screening from the perspective of quality of life: a review of the literature

The purpose of this literature review was to explore how women attending a national mammography screening programme reacted to the screening process on quality of life (QoL). The research question was what implications regarding true-negative results and false-positive results from mammography screening were found among women? Quality of life including life domains as psychological, physical and social was the theoretical reference in the study. Guided by the concept of QoL on mammography screening a database search of Medline, Cinahl and Cochrane was carried out. Search terms such as QoL, anxiety and mammography have been used. A review of studies between 1995 and 2007 showed that the implications regarding a negative result were less than those regarding false-positive one. It was found that women with negative results after mammography screening experience minor negative psychological consequences, and some women have even measured less anxiety following mammography than before because of the reassurance given by a clear negative result. False-positive result and recalls were a problem for many women. The process following recalls do affect women emotionally, decrease their wellbeing and QoL for weeks and even months. Future research should be directed at measuring the short-term outcomes in representative populations for whom screening and prevention are indicated. This knowledge would be useful for the organisation of the mammography programmes and for communication with the general population, the women coming for screening and those who do not attend.

Analysis of interval cancers observed in an Italian mammography screening programme (2000–2006)

The purpose of this study was to assess the interval cancer (IC) proportional incidence and review IC cases observed in an Italian mammography screening programme during 2000-2006. ICs were identified through linkage of a screening database with the local cancer registry and hospital discharge records to calculate proportional (observed/expected) incidence. Negatively reported mammograms preceding ICs underwent blind review (randomly mixed with negative controls in a 2:1 ratio) by three expert radiologists and classified according to European guidelines criteria (OC=occult, MS=minimal sign, SE=screening error) according to majority report. Proportional IC incidence and rate of reviewed IC classified as SE were compared with European guideline standards. Proportional IC incidence was 10.8% in the first and 40.0% in the second year of the interval (European standard=30% or 50%, respectively). Sensitivity estimate for the 2-year interval was 74.6%. ICs were reviewed as SE, MS or OC in 15.0%, 14.0% or 71.0% of cases, respectively. Corresponding review results for negative controls were 7.0%, 25.0% or 68.0%, respectively. Positive predictive value for IC was 51.7% for SE and 21.8% for MS reporting category, respectively (p=0.008). European standard (<20% reviewed as SE) was reached. The study shows that the sensitivity of the mammography programme was good, complying with European guideline recommendations. Assessment of IC-based early indicators of screening efficacy is feasible in a current screening programme and should become a routine procedure.

CancerScope

CancerScope

Educational Parties as a Strategy to Promote Breast Health Awareness and Screening in Underserved Female Populations

Nursing professionals involved in institutional and community outreach efforts to improve breast health are experiencing an increasing need for innovative strategies to attract women to participate in early-detection and screening programs. Specifically, many programs have been developed in an attempt to increase participation rates among women in community breastscreening activities or mammography programs (Borrayo, 2004; Bonfill, Marzo, & Pladevall, 2001; Synder et al., 2003). The programs have involved methods such as letters of invitation, educational material by mail, telephone recruitment and follow-up, and educational activities including lectures and video presentations. However, despite such efforts, a need still exists to educate and motivate disadvantaged women (who are affected by health disparities or inequities related to early detection of breast cancer) to engage in breast cancer screening to reduce their risk of mortality resulting from late detection. With this in mind, a program was designed and implemented to meet the needs of underserved and uninsured women residing in a targeted county of New Jersey. The six largest municipalities in Camden County, NJ, are home to 80% of African Americans in the county and 82% of people of Hispanic and Latino ethnicity (Robenolt, 2006). Freda (2004) wrote that the multicultural milieu of the United States mandates that providers consider culture when delivering patient education and services. Multiple factors such as sociodemographics influence healthcare behaviors, interest in learning, and participation in available services. The Camden County Cancer Screening Project (CCCSP) sought a creative way to deliver ethnically based community education about breast health and breast cancer screening. The result was the use of gaming strategies incorporated into a party format to reach the intended comEducational Parties as a Strategy to Promote Breast Health Awareness and Screening in Underserved Female Populations

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

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

Impact of changing from annual to biennial mammographic screening on breast cancer outcomes in women aged 50–79 in British Columbia

The objective of this study was to compare breast cancer outcomes among women subject to different policies on mammography screening frequency. Data were obtained for women participating in the Screening Mammography Programme of British Columbia (SMPBC) for 1988--2005. The SMPBC changed its policy for women aged 50-79 years from annual to biennial mammography in 1997, but retained an annual recommendation for women aged 40-49 years. Breast cancer outcomes were compared for women participating in the programme before and after 1997 for two groups: ages 40-49 and 50-79 years. There were data on 658,151 women. Comparing pre-1997 and post-1997, the median interscreen interval increased by 11.1 months in women 50-79 but by only 0.3 months in women aged 40-49. Excluding those detected at initial screen, 6291 breast cancers were identified. Comparing pre-1997 and post-1997: the relative rates (RR) of screen detected cancer increased in women aged 40-49 (RR = 1.32) and the rate of invasive cancers > or =20 mm at diagnosis decreased (RR = 0.83); the rate of cancers with axillary node involvement increased in women aged 50-79 (RR = 1.23). Cancer survival improved after 1997 for women diagnosed at ages 40-49 (hazard ratio = 0.62), but was unchanged for women aged 50-79. Breast cancer mortality rates did not change between the periods in either age group. The proximal cancer outcomes considered (staging and survival) improved in women aged 40-49 but this was offset in women aged 50-79 associated with the change in screen frequency. These changes did not result in alterations in breast cancer mortality rates in either age group.

Determinants of non attendance to mammography program in a region with high voluntary health insurance coverage

BackgroundHigh participation rates are needed to ensure that breast cancer screening programs effectively reduce mortality. We identified the determinants of non-participation in a public breast cancer screening program.MethodsIn this case-control study, 274 women aged 50 to 64 years included in a population-based mammography screening program were personally interviewed. Socio-demographic characteristics, health beliefs, health service utilization, insurance coverage, prior mammography and other preventive activities were examined.ResultsOf the 192 cases and 194 controls contacted, 101 and 173, respectively, were subsequently interviewed. Factors related to non-participation in the breast cancer screening program included higher education (odds ratio [OR] = 5.28; 95% confidence interval [CI95%] = 1.57–17.68), annual dental checks-ups (OR = 1.81; CI95%1.08–3.03), prior mammography at a private health center (OR = 7.27; CI95% 3.97–13.32), gynecologist recommendation of mammography (OR = 2.2; CI95%1.3–3.8), number of visits to a gynecologist (median visits by cases = 1.2, versus controls = 0.92, P = 0.001), and supplemental private insurance (OR = 5.62; CI95% = 3.28–9.6). Among women who had not received a prior mammogram or who had done so at a public center, perceived barriers were the main factors related to non-participation. Among women who had previously received mammograms at a private center, supplemental private health insurance also influenced non-participation. Benign breast symptoms increased the likelihood of participation.ConclusionOur data indicate that factors related to the type of insurance coverage (such as prior mammography at a private health center and supplemental private insurance) influenced non-participation in the screening program.

Predictors of mammography uptake in Korean women aged 40 years and over

This paper is a report of a study performed to identify the predictors of mammography uptake for Korean women according to the stage of change, as determined by the transtheoretical model. Although breast cancer is the most common female cancer in South Korea, its early detection rate here is low when compared with other developed countries. The transtheoretical model can be used to facilitate health promotion based on individual health behaviour and to devise stage-tailored interventions. The participants were a convenience sample of 920 women aged > or =40 years between December 2005 and February 2006. A cross-sectional design was used in which participants completed a questionnaire that consisted of measures of the transtheoretical model. To provide a standard of measure, the variables were converted from raw scores to standard scores and then to T scores (mean = 50, sd = 10). Logistic regression analysis was then used to estimate predictors of the stage of maintenance of mammography uptake. The most frequent stage of mammography uptake was 'contemplation'. Predictors of mammography uptake included decisional balance, commitment to regular screening and avoiding contact with the healthcare system. Commitment to regular screening and breast self-examination were strongly related to mammography maintenance. The results of this study can be used for the development of theory-based and empirically supported mammography uptake intervention strategies and programmes directed towards women aged > or =40 years.

Comparison of Two Commercial CAD Systems for Digital Mammography

I n late 2006, an outpatient imaging center began its conversion to digital mammography (DM). Part of this transition was a plan to purchase software for computer-aided detection (CAD) to assist in analysis of the digital mammography images. The preparation to purchase one of two systems included a comparison of several specifications, including DICOM compatibility and the ability of the systems to fit well into the digital mammography program of the imaging center. A small study was designed to determine whether one of the two different commercially available systems being considered [R2 ImageChecker (version 8.3.17) and iCAD Second Look (version 7.2-H)] was superior to the other for assisting in interpretation of digital mammography images from screening mammograms obtained with the newly installed General Electric Senographe DS unit. Patient images included in this study were given retrospective approval from the Institutional Review Board with waiver of informed consent for publication of the study results.