Mammographic Screening For Early Detection Research Articles

Divergent Patterns and Trends in Breast Cancer Incidence, Mortality and Survival Among Older Women in Germany and the United States.

Background: Breast cancer treatment has changed tremendously over the last decades. In addition, the use of mammography screening for early detection has increased strongly. To evaluate the impact of these developments, long-term trends in incidence, mortality, stage distribution and survival were investigated for Germany and the United States (US). Methods: Using population-based cancer registry data, long-term incidence and mortality trends (1975–2015), shifts in stage distributions (1998–2015), and trends in five-year relative survival (1979–2015) were estimated. Additionally, trends in five-year relative survival after standardization for stage were explored (2004–2015). Results: Age-standardized breast cancer incidence rates were much higher in the US than in Germany in all periods, whereas age-standardized mortality began to lower in the US from the 1990s on. The largest and increasing differences were observed for patients aged 70+ years with a 19% lower incidence but 45% higher mortality in Germany in 2015. For this age group, large differences in stage distributions were observed, with 29% (Germany) compared to 15% (US) stage III and IV patients. Age-standardized five-year relative survival increased strongly between 1979–1983 and 2013–2015 in Germany (+17% units) and the US (+19% units) but was 9% units lower in German patients aged 70+ years in 2013–2015. This difference was entirely explained by differences in stage distributions. Conclusions: Overall, our results are in line with a later uptake and less extensive utilization of mammography screening in Germany. Further studies and efforts are highly needed to further explore and overcome the increased breast cancer mortality among elderly women in Germany.

Mammographic Screening at Age 40 or 45? What Difference Does it Make? the Potential Impact of American Cancer Society Mammography Screening Guidelines

this is a 10-year retrospective chart review evaluating the potential impact of the most recent American Cancer Society mammography screening guidelines which excludes female patients aged 40 to 44 years from routine annual screening mammography. Instead they recommend screening mammography starting at age 45 with the option to begin screening earlier if the patient desires. The institutional cancer registry was systematically searched to identify all women aged 40 to 44 years treated for breast cancer over a 10-year period. These women were separated into two cohorts: screening mammography detected cancer (SMDC) and nonscreening mammography detected cancer (NSMDC). Statistical analysis of the cohorts was performed for lymph node status (SLN), five-year disease-free survival, and five-year overall survival. Women with SMDC had a significantly lower incidence of SLN positive cancer than the NSMDC group, 9 of 63 (14.3%) versus 36 of 81 (44 %; P < 0.001). The five-year disease-free survival for both groups was 84 per cent for SMDC and 80 per cent for NSMDC; this was not statistically significant. The five-year overall survival was statistically significant at 94 per cent for the SMDC group and 80 per cent for the NSMDC group (P < 0.05). This review demonstrates the significance of mammographic screening for early detection and treatment of breast cancer. Mammographic screening in women aged 40 to 44 detected tumors with fewer nodal metastases, resulting in improved survival and reaffirming the need for annual mammographic screening in this age group.

Reproductive Health of Women: An Attempt to Define Prevention of Breast Cancer

Background. On the evidence-based information of breast cancer as a preventable disease, an attempt is made for definition of primary, non-chemical prevention of the epidemic breast cancer. The battle over healthcare reform, besides other priorities, is revolving around women’s issues and health protection too. Aim. To add to the knowledge and to advance the tested concept of the potential for primary (non-chemical) prevention of breast cancer as an epidemic disease. Ultimately, to present from a medical point of view the attempted definition of a preventive contraception against the epidemic breast cancer. Justification. The number of cases and the incidence of breast cancer is in a steady increase worldwide and in our country, Macedonia, (with more than 800 cases, or 76.2 crude rate per 100,000 female population, in 2008), followed by great losses and expenses in human lives, individual and familial sufferings and disasters, and material resources. It could be assessed that no healthcare reform could be achieved successfully as long as the half of the population, women of all ages, is threatened by a real risk of breast cancer as an epidemic disease. The changes in the biological micro-environment and ecosystem of the intimate (sexual) woman-man relations, which is still unknown, reflect gravely upon the health and lives of people, especially women of all ages. Primary (non-chemical) prevention of breast cancer is neither mentioned nor considered in the ongoing debate of healthcare reform, in the scientific literature, and at the conference meeting. Evidence and Discussion. The results of the initial field study and other ecological and experimental studies showed and corroborated the evidence that the mass condomization of women’s sexuality is the root cause of the perplexing emergence and rapid rise of the breast cancer epidemic all over the world along with the occurrence of the AIDS epidemic, after 1981. Prevention of breast cancer rather than programs of mass mammographic screening for early detection of cases of the disease are discussed. The views on contraception and marriage of the main religious denominations in the Western world, which were relevant to the aim of this study, are briefly presented. The negative consequences of screening of the disease and the recent debate of questioning the breast screening programs is discussed.Conclusion. From a medical standpoint, to achieve the suggested primary prevention of the breast cancer epidemic it is necessary to eliminate completely the barrier devices and methods of contraception, the condom use and withdrawal practice. Instead of use of barrier methods, a replacement is to be done by shifting to use of other, non-barrier methods and techniques for fertility-control and family-planning purposes during the reproductive life-span of women, which include: abstention, rhythm, IUDs, OC pills, and tubal ligation.

Mammary Artery Calcification a Useful Marker for Coronary Artery Disease

Introduction: The prevalence of ischemic heart disease is steadily increasing, causing huge morbidity and mortality around the world [1]. The scenario is worse in Indian subcontinent [2]. Atherosclerosis is a generalized disease process [3]. Presence of atherosclerotic changes at one place is indicative of possible involvement of another region. Diabetes which is considered to be coronary equivalent is also rising in epidemic proportions, contributing to rise in coronary artery disease (CAD) [4]. It is therefore imperative to look carefully for all possible markers of atherosclerosis and prevent its life threatening complications. Case Presentation: A 62-year-old lady, known diabetic and chronic renal disease patient for last 15 years and hypothyroidism for 5 years presented with acute onset chest pain. ECG revealed ST-T inversions suggesting acute coronary syndrome. Chest radiograph was taken which was unremarkable except for aortic knuckle calcification (Image 1). She was managed on the lines of acute coronary syndrome. During her course of stay she also complained of breast discharge. On examination, a small firm lump was palpated in breast and red coloured discharge was observed. Mammogram was advised for the same, which revealed a spiculated mass and axillary lymph node. Incidentally calcification of bilateral mammary arteries was also noted (Image 2). Carotid intima media thickness (CIMT) measurement was also done (Image 3). Increased CIMT measuring approx. 18 mm was observed in mid common carotid artery. A calcified plaque was noted in left carotid bulb. Discussion: Association of increased coronary artery disease with increased CIMT is well established. Assessment of CIMT is a routine protocol at many Centres in CAD patients [5-7]. Few studies have been published which have suggested that association exists between intramammary arterial calcifications and coronary artery disease [8-10]. Screening mammography is a common procedure for early detection of breast cancer. As the evidence supporting mammary artery calcification as a possible marker for CAD grows, this would establish as an additional utilization of commonly used mammography screening for early detection of breast cancer. This case further supports the belief that presence of mammary artery calcification and CAD coexist. It is therefore essential that mammary artery calcifications and /or aortic calcification must always be reported in radiology reports and the clinicians must not ignore the presence of these calcifications and assess for possible coronary artery disease.

Comment on: ‘Screening’ for Breast Cancer: Misguided Research Misinforming Public Policies, by O. S. Miettinen

AbstractOur commentary of the article “‘Screening’ for Breast Cancer: Misguided Research Misinforming Public Policies” has two main parts. First we address some of the methodological points raised by Professor Miettinen. Then we review more specific aspects of the Swiss Medical Board statement on mammography screening for early detection of breast cancer.

Breast Cancer Screening Preferences Among Hospitalized Women

Efforts to increase mammographic screening for early detection of breast cancer among women of lower socioeconomic class and ethnic minorities have been largely unsuccessful. This study explores the receptivity of hospitalized women to inpatient mammography as a novel approach to enhance breast cancer screening. A cross-sectional study was conducted among 210 hospitalized women, aged 50-75 years, admitted to the medicine services at Johns Hopkins Bayview Medical Center in early 2012. Unpaired t-test and Chi-square tests were used to compare characteristics, barriers, and receptivity to inpatient mammography among women adherent and non-adherent to screening guidelines. One-third of women enrolled were African American, and 60% of study participants reported an annual household income of <$20,000. Thirty-nine percent were overdue for screening, of which, 13% never had a mammogram and 28% were at high risk for breast cancer (Gail score ≥1.7%). The commonly reported barriers to screening mammograms were failure to remember appointments and lack of transportation. Most women (91%) believed that it is important for healthcare providers to discuss breast cancer screening while patients are in the hospital. Sixty-eight percent of non-adherent women would agree to have an inpatient screening mammogram if it was due and offered. A significant number of hospitalized women from lower socioeconomic class are at high risk of developing breast cancer and non-adherent to mammographic screening. Inpatient hospital stay may be a feasible time for screening and education to ensure adequate breast care and promote screening among these women.

Abstract SY14-01: Preventable exposures associated with human cancer.

Abstract SY14-01: Preventable exposures associated with human cancer.

Mammography in 40-Year-Old Women: What Difference Does It Make? The Potential Impact of the U.S. Preventative Services Task Force (USPSTF) Mammography Guidelines

This 10-year retrospective chart review evaluates the potential impact the most recent U.S. Preventative Services Task Force (USPSTF) report recommending against annual mammographic screening of women aged 40-49 years. The medical record database was systematically searched to discover all women aged 40-49 years treated for breast cancer over a 10-year period. These women were separated into 2 cohorts-mammographically detected cancer (MDC) and nonmammographically detected cancer (NMDC). Statistical analysis of the cohorts was performed for family history (FH), sentinel lymph node (SLN) status, tumor size at presentation, and disease-free and overall survival. A total of 1581 women were treated for breast cancer; of these, 311 were between the ages of 40 and 49 years with complete diagnostic information, 145 were MDC, and 166 were NMDC. The average tumor diameter of the MDC group was 20.68 mm, which was significantly smaller than that of the NMDC group at 30.38 mm (P < .0001). Women with MDC had a significantly lower incidence of SLN positive cancer than the NMDC group, 28 of 113 (24.78%) vs. 85 of 152 (55.92%; P < .0001), respectively. The 5-year disease-free survival for both groups was MDC 94% (95% confidence interval [95% CI], 87-97%) and NMDC 71% (95% CI 62-78%). The overall 5-year survival estimates were MDC 97% (95% CI 92-99%) and NMDC 78% (95% CI 69-85%), respectively. This review demonstrates the significance of mammographic screening for early detection and treatment of breast cancer. Mammographic screening in women aged 40-49 detected smaller tumors with less nodal metastasis, resulting in improved survival, which supports annual mammographic screening in this age group.

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.

Reproductive Health of Women: An Attempt to Define Prevention of Breast Cancer

Background. On the evidence-based information of breast cancer as a preventable disease, an attempt is made for definition of primary, non-chemical prevention of the epidemic breast cancer. The battle over healthcare reform, besides other priorities, is revolving around women’s issues and health protection too. Aim. To add to the knowledge and to advance the tested concept of the potential for primary (non-chemical) prevention of breast cancer as an epidemic disease. Ultimately, to present from a medical point of view the attempted definition of a preventive contraception against the epidemic breast cancer. Justification. The number of cases and the incidence of breast cancer is in a steady increase worldwide and in our country, Macedonia, (with more than 800 cases, or 76.2 crude rate per 100,000 female population, in 2008), followed by great losses and expenses in human lives, individual and familial sufferings and disasters, and material resources. It could be assessed that no healthcare reform could be achieved successfully as long as the half of the population, women of all ages, is threatened by a real risk of breast cancer as an epidemic disease. The changes in the biological micro-environment and ecosystem of the intimate (sexual) woman-man relations, which is still unknown, reflect gravely upon the health and lives of people, especially women of all ages. Primary (non-chemical) prevention of breast cancer is neither mentioned nor considered in the ongoing debate of healthcare reform, in the scientific literature, and at the conference meeting. Evidence and Discussion. The results of the initial field study and other ecological and experimental studies showed and corroborated the evidence that the mass condomization of women’s sexuality is the root cause of the perplexing emergence and rapid rise of the breast cancer epidemic all over the world along with the occurrence of the AIDS epidemic, after 1981. Prevention of breast cancer rather than programs of mass mammographic screening for early detection of cases of the disease are discussed. The views on contraception and marriage of the main religious denominations in the Western world, which were relevant to the aim of this study, are briefly presented. The negative consequences of screening of the disease and the recent debate of questioning the breast screening programs is discussed. Conclusion. From a medical standpoint, to achieve the suggested primary prevention of the breast cancer epidemic it is necessary to eliminate completely the barrier devices and methods of contraception, the condom use and withdrawal practice. Instead of use of barrier methods, a replacement is to be done by shifting to use of other, non-barrier methods and techniques for fertility-control and family-planning purposes during the reproductive life-span of women, which include: abstention, rhythm, IUDs, OC pills, and tubal ligation.

Equidad en la Detección del Cáncer de Seno en Colombia

Evaluating equity regarding early breast cancer detection by comparing real access to and opportunity for mammography screening according to women's social health insurance status. A retrospective follow-up study was conducted on women receiving breast cancer treatment in Bogotá, Cali, Medellin, Bucaramanga and Barranquilla between January 2005 and June 2006. A survey was carried out for collecting data about real access to and the opportunity of having mammography screening. OR and 95% confidence intervals were calculated (adjusted by multivariate logistical regression models) for establishing differences according to health insurance status. Possible interactions were investigated through verisimilarity log-like test. Women belonging to the contributory regime had a lower probability of real access to mammography screening for early detection of breast cancer than those affiliated to the subsidised regimen (OR=0,46; 0,26-0,72 95 %CI) and poor uninsured women (OR=0,36; 0,13-0,65 95 %CI). Educational level was also associated with real access to mammography, illiterate women having a lower probability of receiving mammography screening than literate women (OR=0,13; 0,02-0,30 95 %CI). Women having government-subsidised health insurance had a lower probability of accessing timely mammography screening (OR=0,10; 0,04-0,41 95 %CI). Mammography screening for the early detection of breast cancer is not equitable and such inequality particularly affects the most vulnerable women.

Optical transillumination spectroscopy to quantify parenchymal tissue density: an indicator for breast cancer risk

Mammographic screening for early detection of breast cancer has proven valuable in improving breast cancer survival. However, breast cancer incidence is still increasing, and thus preventative oncology needs to receive more attention, with the goal of identifying women with increased risk of developing breast cancer in the future and offering them risk reduction interventions. Mammogram derived parenchymal density pattern has been shown by various authors to provide a high odds ratio for breast cancer. Near-infrared optical transillumination spectroscopy was employed to determine physiological properties of the breast tissue to quantify differences in women with low or high breast cancer risk. Specifically in this study, women who had a recent mammogram underwent examination of their breast tissue by optical transillumination spectroscopy. Areas of adipose and glandular tissues which give rise to mammographic density patterns also have characteristic optical transillumination spectra. Correlation between optical transillumination spectroscopy and mammographic density pattern was established using partial least squares analysis. Results show that predicted tissue density based on optical transillumination spectroscopy correlates with mammographic observed tissue density, with a Spearman Rank correlation coefficient of 0.72. This suggests that optical transillumination spectroscopy may be a promising tool to quantify and monitor changes in breast cancer risk.

Advances in Screening, Diagnosis, and Treatment of Breast Cancer

Advances in Screening, Diagnosis, and Treatment of Breast Cancer

THE MEANING OF HEALTH IN MAMMOGRAPHY SCREENING FOR AFRICAN AMERICAN WOMEN

Inadequate use of mammography screening for early detection of breast cancer is an important factor associated with the disproportionate breast cancer death rates in African American women. To improve understanding of the mammography screening experience and health for African Americans, focus groups were held with 30~African American women. Seven categories emerged: (a) the mind, body, and spirit connection; (b) living your life; (c) looking good; (d) good health–bad health; (e) prevention–detection confusion; (f) being afraid of cancer; and (g) what gets in the way. Implications for developing tailored messages and for addressing system barriers are discussed.

THE MEANING OF HEALTH IN MAMMOGRAPHY SCREENING FOR AFRICAN AMERICAN WOMEN

Inadequate use of mammography screening for early detection of breast cancer is an important factor associated with the disproportionate breast cancer death rates in African American women. To improve understanding of the mammography screening experience and health for African Americans, focus groups were held with 30~African American women. Seven categories emerged: (a) the mind, body, and spirit connection; (b) living your life; (c) looking good; (d) good health–bad health; (e) prevention–detection confusion; (f) being afraid of cancer; and (g) what gets in the way. Implications for developing tailored messages and for addressing system barriers are discussed.

Detection of breast cancer cells in ductal lavage fluid by methylation-specific PCR

If detected early, breast cancer is curable. We tested cells collected from the breast ducts by methylation-specific PCR (MSP). Methylated alleles of Cyclin D2, RAR-beta, and Twist genes were frequently detected in fluid from mammary ducts containing endoscopically visualised carcinomas (17 cases of 20), and ductal carcinoma in situ (two of seven), but rarely in ductal lavage fluid from healthy ducts (five of 45). Two of the women with healthy mammograms whose ductal lavage fluid contained methylated markers and cytologically abnormal cells were subsequently diagnosed with breast cancer. Carrying out MSP in these fluid samples may provide a sensitive and powerful addition to mammographic screening for early detection of breast cancer.

Mammography utilization after a benign breast biopsy among Hispanic and non-Hispanic women.

In spite of the effectiveness of mammography screening for early detection of breast carcinoma, the use of screening mammography varies widely across racial and ethnic groups. Recently, concerns have been raised about the potential adverse effect a benign breast biopsy may have on subsequent mammography utilization, including subsequent use among minority women. Computerized health care claims data for 1991 through 1997 from a managed care organization were used to compare mammography use among Hispanic and non-Hispanic women who had had a mammogram followed by an incisional or excisional benign breast biopsy to women who had had a mammogram and no biopsy. Through survival analysis methods, the time-to-next mammogram was compared among these three groups. The sample included 693 (3.2%) and 289 (1.3%) women who had had a mammogram followed by an incisional biopsy or an excisional biopsy, respectively, and 20,540 (95.4%) women who had had a mammogram and no biopsy. Both Hispanic and non-Hispanic women with a biopsy returned sooner for subsequent mammograms than women without a biopsy (P < 0.0001). Hispanic women without a biopsy returned later than non-Hispanic women without a biopsy (P < 0.0001). However, Hispanic women with an excisional biopsy returned sooner than non-Hispanic women (P < 0.05). Within a managed care organization, both Hispanic and non-Hispanic women who had had a mammogram followed by a benign breast biopsy returned sooner for a subsequent mammogram than women who had had a mammogram and no biopsy. However, ethnic differences in time-to-next mammogram were observed for women without a biopsy and those with an excisional biopsy. Hispanic women without a biopsy returned later for a subsequent mammogram than non-Hispanic women in similar groups, but those with an excisional biopsy returned sooner.

Against Minimalism in Breast Cancer Follow-up

BREAST CANCER in 1990 continues to be a problem of major public health proportions. Approximately 10% of women in the United States (150 000) will be newly diagnosed in 1990 as having breast cancer. Breast cancer is the most common cancer in women and still one of the leading causes of death for adult American women. Approximately 44 000 women will die of breast cancer this year alone.1This number approaches the total number of American deaths in the Vietnam Conflict. These stark numbers mask a great deal of suffering and misery that statistics do not adequately portray and that neither clinical oncology nor public policy has been able to influence greatly. Effective prevention strategies are lacking, and research in this area is limited. The approach that has been taken to improve these grim statistics includes mammographic screening for early detection of disease, aggressive primary and adjuvant therapy, and

Against minimalism in breast cancer follow-up

BREAST CANCER in 1990 continues to be a problem of major public health proportions. Approximately 10% of women in the United States (150 000) will be newly diagnosed in 1990 as having breast cancer. Breast cancer is the most common cancer in women and still one of the leading causes of death for adult American women. Approximately 44 000 women will die of breast cancer this year alone.¹This number approaches the total number of American deaths in the Vietnam Conflict. These stark numbers mask a great deal of suffering and misery that statistics do not adequately portray and that neither clinical oncology nor public policy has been able to influence greatly. Effective prevention strategies are lacking, and research in this area is limited. The approach that has been taken to improve these grim statistics includes mammographic screening for early detection of disease, aggressive primary and adjuvant therapy, and