Mammography Practice Research Articles

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

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

Response: Re: Effectiveness of Computer-Aided Detection in Community Mammography Practice

Response: Re: Effectiveness of Computer-Aided Detection in Community Mammography Practice

Re: Effectiveness of Computer-Aided Detection in Community Mammography Practice

Re: Effectiveness of Computer-Aided Detection in Community Mammography Practice

Re: Effectiveness of Computer-Aided Detection in Community Mammography Practice

Measuring the clinical benefits of computer-aided detection (CAD) in mammographic screening is challenging, in part because metrics used to quantify the effectiveness of mammographic screening do not always apply in a straightforward way to comparisons of screening with and without CAD. This was illustrated in a recent article in the Journal by Fenton et al. (1) on the effect of introducing CAD to mammographic screening in the community setting. One of the principal conclusions of Fenton et al. (1) was that CAD increases detection of ductal carcinoma in situ (DCIS). Fenton et al. imply that this is an undesired result because DCIS may lead to overdiagnosis. However, their data showed that the increased rate of detection of DCIS in women whose mammograms included CAD was accompanied by a decrease in the rate of detection of invasive breast cancers. This result is consistent with the goal of CAD, the use of which should lead to the detection of DCIS that might ultimately progress to invasive cancer. Thus, the increased detection of DCIS by CAD should not be considered overdiagnosis, but rather earlier detection, which is an important goal of screening mammography. More importantly, perhaps, the detection of DCIS by CAD (in a CAD vs no CAD comparison) is not the same as mammographic detection of DCIS (in a screening vs no screening comparison). All cancers detected by CAD are mammographically detectable; hence, if the radiologists does not detect the DCIS (with or without using CAD), it will eventually be detected at a future screening exam. Therefore, CAD will not lead to potentially more overdiagnoses, as the authors imply, but rather to earlier treatment of women with CAD-detected DCIS who would be treated even if CAD were not used. The downside is that women with indolent DCIS will be treated one or two years earlier. The upside is that some of the additional treated women will have DCIS that would have progressed to invasive cancer if it were not for CAD. Fenton et al. (1) used the accepted standard method to calculate sensitivity of screening mammography. When CAD was used, both the numerator and the denominator of the sensitivity calculation appropriately included cancers that were detected only with the aid of CAD. However, that method introduces bias when CAD is compared with no CAD because without CAD, the estimated number of cancers in the screened population (the denominator in any calculation of sensitivity) included only cancers detected by screening and interval cancers, those cancers that were detected in the interval between routine screening. Although some other cancers are likely to have been missed, they were not counted in the denominator of the sensitivity calculation without CAD because there was no way of determining their number. Whether CAD is an effective clinical tool is an important question that remains unanswered. Careful attention must be given to the methodology used in the evaluation and interpretation of results. The article by Fenton et al. (1) presents a snapshot of the effect of CAD at the introduction of the technology. Improvements in the performance of CAD systems, radiologists who have gained more experience in using CAD, and the introduction of full-field digital mammography have greatly changed the landscape.

Health Beliefs and Illness Perceptions as Related to Mammography Uptake in Randomly Selected Women in Greece

Previous research has shown that, although routine mammography screening can reduce mortality from breast cancer, the use of annual mammography screening remains well under 65%. In an effort to determine the factors that are associated with women's mammography behaviors, this study used the health belief model and the common-sense model of self-regulation as the theoretical frameworks to explore health beliefs, illness representations, and women's mammography practice. Data were obtained from a nationally representative sample of 408 Greek women, 40 years of age or older, with no personal history of cancer. Three dependent variables were considered: recent mammography, repeat mammography, and no mammogram during lifetime. Predictors included socio-demographic and medical variables, perceived benefits of mammography screening, perceived barriers to mammography screening, self-efficacy, as well as illness perceptions. Multivariate analyzes indicated that never having had a mammogram was more likely for women who perceived fewer benefits and more barriers to mammography screening, had more negative emotional representations of breast cancer, and had no private health insurance coverage. Factors associated with recent mammography were younger age, a good knowledge of the recommended mammography screening interval, a family history of breast cancer, and use of patient reminders for next mammogram. Adequate knowledge about the recommended mammography screening interval and higher values for breast cancer worry were associated with an increased number of repeat lifetime mammograms. Implications of the results and suggestions for future research are outlined.

Assessment of patient doses during mammography practice at Kenyatta National Hospital

Background Breast cancer constitutes 21% of all cancer cases and ranks third according to cancer type in Kenya. Mammography therefore remains a powerful radiographic imaging technique for detecting and managing breast cancer. However, the active and radiosensitive glandular tissue calls for the need of an effective quality assurance program. Materials and Methods A questionnaire method was developed and used in recording the displayed patient dose, compressed breast thickness and exposure factors. The average glandular dose, device performance, and film quality grading were also carried out. Results There were 3264 films taken from 1252 women between 25 to 90 years old. The AGD per film was 2.14 (range 0.27-9.43) mGy for the cranio-caudal (CC) projection and 2.44 (range 0.20-10.12) mGy for the medio-lateral oblique (MLO) projection. In this study 17% of CC and 30% of MLO films recorded doses above the 3 mGy American College of Radiology using grid diagnostic reference level. Conclusion In view of the diagnostic dose finding of this study, the variation of mammography imaging techniques revealed the need for imaging guidelines, quality assurance and optimization of mammography practice in Kenya.

A survey of the state of mammography practice in Bulgaria

The purpose of this work is to compare the state of a representative number of mammography systems in Bulgaria in terms of incident air kerma (IAK) and film optical density (OD) and to propose the optimisation measures where appropriate. IAK with a standard phantom and OD of the exposed films were measured on 22 % of all units in the country. IAK values ranged from 2 to 24.3 mGy, with the median being 7.9 mGy, first and third quartiles respectively being 5 and 11.2 mGy and the mean 8.6 mGy. OD values ranged from 0.5 to 2.4. Only 36 % of all units had OD within the recommended range. Only 27 % were satisfactorily set with OD within the recommended range and IAK below the third quartile. Full quality control (QC) measurements on 12 units showed a lot of problems. The observed big variations of IAK, with а factor of 12, are due to the non-optimised settings and film processing, the lack of standardisation and periodical QC. Corrective actions were recommended to optimise the settings of some systems and to improve the practice.

Effectiveness of Computer-Aided Detection in Community Mammography Practice

Computer-aided detection (CAD) is applied during screening mammography for millions of US women annually, although it is uncertain whether CAD improves breast cancer detection when used by community radiologists. We investigated the association between CAD use during film-screen screening mammography and specificity, sensitivity, positive predictive value, cancer detection rates, and prognostic characteristics of breast cancers (stage, size, and node involvement). Records from 684 956 women who received more than 1.6 million film-screen mammograms at Breast Cancer Surveillance Consortium facilities in seven states in the United States from 1998 to 2006 were analyzed. We used random-effects logistic regression to estimate associations between CAD and specificity (true-negative examinations among women without breast cancer), sensitivity (true-positive examinations among women with breast cancer diagnosed within 1 year of mammography), and positive predictive value (breast cancer diagnosed after positive mammograms) while adjusting for mammography registry, patient age, time since previous mammography, breast density, use of hormone replacement therapy, and year of examination (1998-2002 vs 2003-2006). All statistical tests were two-sided. Of 90 total facilities, 25 (27.8%) adopted CAD and used it for an average of 27.5 study months. In adjusted analyses, CAD use was associated with statistically significantly lower specificity (OR = 0.87, 95% confidence interval [CI] = 0.85 to 0.89, P < .001) and positive predictive value (OR = 0.89, 95% CI = 0.80 to 0.99, P = .03). A non-statistically significant increase in overall sensitivity with CAD (OR = 1.06, 95% CI = 0.84 to 1.33, P = .62) was attributed to increased sensitivity for ductal carcinoma in situ (OR = 1.55, 95% CI = 0.83 to 2.91; P = .17), although sensitivity for invasive cancer was similar with or without CAD (OR = 0.96, 95% CI = 0.75 to 1.24; P = .77). CAD was not associated with higher breast cancer detection rates or more favorable stage, size, or lymph node status of invasive breast cancer. CAD use during film-screen screening mammography in the United States is associated with decreased specificity but not with improvement in the detection rate or prognostic characteristics of invasive breast cancer.

Utilization of Screening Mammography Among Middle-Aged and Older Women

This study examines patterns of screening mammogram use, investigating the relationship of screening with demographic, health status, and healthcare factors. Data from 1242 women aged ?41 were obtained from a random sample of mailed surveys to community households in an eight-county region in Central Texas in 2010. The dependent variable was the timing of the participants' most recent screening mammography (in the past 12 months, between 1 and 2 years, or >2 years). Predictor variables included demographic, health status, and healthcare access factors. Multinomial logistic regression identified variables associated with screening mammography practices. The majority of women reported having at least one mammogram during their lifetime (93.0%) and having a mammography within the past 2 years (76.2%). Participants who reported not having a routine checkup in the past 12 months (odds ratio [OR] 0.12, p<0.001), having a lapse of insurance in the past 3 years (OR 2.95, p<0.05), and living in a health provider shortage area (OR 1.42, p<0.05) were less likely to be screened within the past 2 years. Routine healthcare plays a major role in preventive screening, which indicates screening mammography practices can be enhanced by improving participation in routine checkups with medical providers, continuity of insurance coverage, and women's access to healthcare. Interventions to encourage screening mammography may be particularly needed for women who have experienced a lapse in insurance or have not had a checkup in the past year.

Image quality and dose in mammography in 17 countries in Africa, Asia and Eastern Europe: Results from IAEA projects

PurposeThe objective is to study mammography practice from an optimisation point of view by assessing the impact of simple and immediately implementable corrective actions on image quality. Materials and methodsThis prospective multinational study included 54 mammography units in 17 countries. More than 21,000 mammography images were evaluated using a three-level image quality scoring system. Following initial assessment, appropriate corrective actions were implemented and image quality was re-assessed in 24 units. ResultsThe fraction of images that were considered acceptable without any remark in the first phase (before the implementation of corrective actions) was 70% and 75% for cranio-caudal and medio-lateral oblique projections, respectively. The main causes for poor image quality before corrective actions were related to film processing, damaged or scratched image receptors, or film-screen combinations that are not spectrally matched, inappropriate radiographic techniques and lack of training. Average glandular dose to a standard breast was 1.5mGy (mean and range 0.59–3.2mGy). After optimisation the frequency of poor quality images decreased, but the relative contributions of the various causes remained similar. Image quality improvements following appropriate corrective actions were up to 50 percentage points in some facilities. ConclusionsPoor image quality is a major source of unnecessary radiation dose to the breast. An increased awareness of good quality mammograms is of particular importance for countries that are moving towards introduction of population-based screening programmes. The study demonstrated how simple and low-cost measures can be a valuable tool in improving of image quality in mammography.

Variation in performance in low-volume mammography screening programmes: Experience from Switzerland

Background: Reading volume and mammography screening performance appear positively correlated. Quality and effectiveness were compared across low-volume screening programmes targeting relatively small populations and operating under the same decentralised healthcare system. Except for accreditation of 2nd readers (restrictive vs non-restrictive strategy), these organised programmes had similar screening regimen/procedures and duration, which maximises comparability. Variation in performance and its determinants were explored in order to improve mammography practice and optimise screening performance. Methods: Circa 200,000 screens performed between 1999 and 2006 (4 rounds) in 3 longest standing Swiss cantonal programmes (of Vaud, Geneva and Valais) were assessed. Indicators of quality and effectiveness were assessed according to European standards. Interval cancers were identified through linkage with cancer registries records. Results: Swiss programmes met most European standards of performance with a substantial, favourable cancer stage shift. Up to a two-fold variation occurred for several performance indicators. In subsequent rounds, compared with programmes (Vaud and Geneva) that applied a restrictive selection strategy for 2nd readers, proportions of in situ lesions and of small cancers (≤1 cm) were one third lower and halved, respectively, and the proportion of advanced lesions (stage II+) nearly 50% higher in the programme without a restrictive selection strategy. Discrepancy in second-year proportional incidence of interval cancers appears to be multicausal. Conclusion: Differences in performance could partly be explained by a selective strategy for second readers and a prior experience in service screening, but not by the levels of opportunistic screening and programme attendance. This study provides clues for enhancing mammography screening performance in low-volume programmes.

Inconsistent mammography perceptions and practices among women at risk of breast cancer following a pediatric malignancy: a report from the Childhood Cancer Survivor Study

Women treated with chest radiation for a pediatric cancer have low mammography screening rates despite their high risk for breast cancer. This study characterized the relationship between perceptions of mammography and screening practices. A cross-sectional survey was administered to 523 women in North America who were treated with chest radiation before 21years of age. Women with inconsistent mammography perceptions and practices were identified using the Pros and Cons of Mammography for perceptions and Transtheoretical Model stages of adoption for prior and intended screening practices. Classification and regression tree (CART) analysis was used to identify barriers to and facilitators of screening among women with positive and negative perceptions. Nearly one-third of the cohort had inconsistent perceptions and practices: 37.4% had positive perceptions and were not having mammograms; 27.6% had negative/neutral perceptions and were having mammograms. Regardless of perceptions, a recent physician's recommendation for mammography, age≥40, and interest in routine health care were universally associated with mammography practices. For women with positive perceptions and a physician's recommendation, barriers to screening included high acceptance coping, low active-planning coping, and high internal health locus of control. For women with negative perceptions, acknowledging the importance of asymptomatic screening was associated with mammography.

Mammography practice in Serbia: evaluation and optimisation of image quality and the technical aspects of the mammographic imaging chain

The purpose of this work was to assess mammography practice in Serbia and its appropriateness for both diagnostic service and potential screening by implementing quality control (QC) protocol in three large teaching hospitals. Corrective actions were suggested, accordingly. In addition to technical aspects of QC, image quality was assessed using image grading before and after the introduction of corrective measures. The survey demonstrated considerable variations in technical parameters that affect image quality and patients doses. Average glandular doses ranged from 1.8 to 2.8 mGy, while reference optical density (OD) ranged from 1.0 to 2.6. Image grading resulted in a very high percentage of images with poor quality (12-70 % for cranio-caudal projection and 8-66 % for medio-lateral oblique projection). Main problems were associated with film processing, viewing conditions and OD control. Following introduction of corrective measures, the image grading results were improved in some hospitals, so the percentage of images without any remarks has been increased.

Technical aspects of quality assurance in mammography: Preliminary results from Serbia

Mammography is the method of choice for early detection of breast cancer. In Serbia, mammography is performed only clinically, although there is a plan to introduce mammography as a screening method. Currently, there are 60 mammographic units in practice, resulting in 70 000 mammographies annually. The survey was conducted in order to investigate mammographic practice in Serbia, identify weak points and suggest appropriate corrective measures. Basic technical parameters of the X-ray tube and generator, processing, image quality, and patient doses in 20 mammographic units were studied. The survey demonstrated considerable variations in technical parameters that affect image quality, and patients doses. Patient dose levels, in terms of the mean glandular dose, were fairly consistent with current European reference levels: 1.8 (0.40-4.3) mGy. However, due to inappropriate image receptors, image processing and viewing conditions and automatic exposure control adjustment, suboptimal image quality was a common finding. Simple improvements of the radiographic technique and maintenance procedure, along with the rigid implementation of the quality control procedure and training of the operating staff, would improve the performance levels of mammographic practice in Serbia, i. e. result in the production of high quality images with a reasonably low radiation risk to patients.

The ACR BI-RADS® Experience: Learning From History

The Breast Imaging Reporting and Data System (BI-RADS) initiative, instituted by the ACR, was begun in the late 1980s to address a lack of standardization and uniformity in mammography practice reporting. An important component of the BI-RADS initiative is the lexicon, a dictionary of descriptors of specific imaging features. The BI-RADS lexicon has always been data driven, using descriptors that previously had been shown in the literature to be predictive of benign and malignant disease. Once established, the BI-RADS lexicon provided new opportunities for quality assurance, communication, research, and improved patient care. The history of this lexicon illustrates a series of challenges and instructive successes that provide a valuable guide for other groups that aspire to develop similar lexicons in the future.

Good reasons to implement quality assurance in nationwide breast cancer screening programs in Croatia and Serbia: Results from a pilot study

The purpose of this study is to investigate the need for and the possible achievements of a comprehensive QA programme and to look at effects of simple corrective actions on image quality in Croatia and in Serbia. The paper focuses on activities related to the technical and radiological aspects of QA. The methodology consisted of two phases. The aim of the first phase was the initial assessment of mammography practice in terms of image quality, patient dose and equipment performance in selected number of mammography units in Croatia and Serbia. Subsequently, corrective actions were suggested and implemented. Then the same parameters were re-assessed. Most of the suggested corrective actions were simple, low-cost and possible to implement immediately, as these were related to working habits in mammography units, such as film processing and darkroom conditions. It has been demonstrated how simple quantitative assessment of image quality can be used for optimisation purposes. Analysis of image quality parameters as OD, gradient and contrast demonstrated general similarities between mammography practices in Croatia and Serbia. The applied methodology should be expanded to larger number of hospitals and applied on a regular basis.

Correlates of recent and regular mammography screening among Asian‐American women

Correlates of recent and regular mammography screening among Asian-American women. This paper is a report of a study of the health beliefs, knowledge and selected demographic variables that influence mammography utilization among Asian-American women. Breast cancer is the most frequently occurring cancer in Asian-American women and its incidence is increasing at a greater rate than for other racial and ethnic groups in the United States of America (USA). Compared to White women, breast cancer also is more likely to be diagnosed at a later stage with larger tumours in Asian-Americans. A self-administered questionnaire was used with Asian-American women residing in the USA. Data were collected in 2005 and 315 women participated in the study. Fifty-five per cent of participants reported having their last mammogram within the past 13 months, and 33% reported having annual mammograms in each of the past 5 years. Based on multivariate logistic regression analyses, clinical breast examination, barriers and knowledge of recommendations of the frequency of mammography screening were associated with both recent and regular mammography practice after controlling for all other demographic, psychosocial and behavioural variables in the model. Intervention strategies tailored to knowledge, language and cultural factors associated with mammography use should target at-risk subgroups, particularly those who are recent immigrants and those with limited English language ability. Culturally appropriate strategies should be developed to promote lifelong mammography screening for this rapidly growing and diverse population.

Knowledge, attitudes and practice of breast cancer screening among female health workers in a Nigerian urban city.

BackgroundLate presentation has been observed as the hallmark of breast cancer in Nigerian women and an earlier onset has been reported in this population. This study was designed to assess the awareness of female health workers about risk factors and screening methods for early detection of breast cancer.MethodsA cross-sectional descriptive study was carried out among female health workers in the two major government health institutions in Benin City, Edo State capital in Nigeria.Data analysis was by SPSS version 10 and test of significance was done with differences considered significant at p < 0.05.ResultsThree hundred and ninety-three (393) female health workers out of five hundred and five eligible subjects completed and returned the questionnaires, giving a response rate of 77.8%. One hundred and two (26%) were Doctors, two hundred and fifty-four (64.6%) Nurses, and thirty-seven (9.4%) were Radiographers, Laboratory Scientists and Pharmacists. A high proportion of our respondents had very poor knowledge about risk factors for breast cancer (55%). The awareness of mammography as a diagnostic method was very high (80.7%), but an extremely low knowledge of mammography as a screening method was found. Mammography practice of only 3.1% was found among those above 40 years of age who qualify for routine annual screening. Relatively low knowledge (45.5%) about Breast Self Examination (BSE) as a screening method was found.ConclusionThese female health workers who are expected to act as role models and educate the public had poor knowledge of risk factors for breast cancer and practice of breast cancer screening. There is very urgent need for regular update courses for health workers concerning breast cancer education including screening methods.

Rare Breast Lesions: Correlation of Imaging and Histologic Features with WHO Classification

Mammographers occasionally are surprised by the diagnosis of a rare lesion at breast biopsy. The imaging features of some breast lesions are unfamiliar because they are rarely seen in routine mammographic practice and they are not well described or well documented in the radiologic literature. Moreover, there may be wide variation in the appearances of rare breast lesions at mammography and ultrasonography (US). In addition, although a few rare breast lesions have a typical imaging appearance, most have mammographic and US features similar to those of breast carcinomas, and a needle biopsy is almost always necessary to obtain a diagnosis. However, even when a rare breast lesion is diagnosed on the basis of a needle biopsy, knowledge of the imaging features of such lesions may help the radiologist decide whether the results of pathologic analysis concur with the imaging findings and whether surgical excision is necessary. It is therefore important that radiologists be familiar with the broad spectrum of imaging features of rare breast lesions as well as with the correlation between their histopathologic features and their current classification according to the World Health Organization classification system.

The impact of family history of breast cancer and cancer death on women's mammography practices and beliefs

PurposeTo summarize the impact of a family history of breast cancer on mammography practices and beliefs. MethodSurvey data concerning breast health practices and beliefs were utilized for a cross-sectional analysis. Participants were 899 racially diverse nonpregnant women 40 years and older without breast cancer. The impact of various aspects of cancer family history on mammography, perceived barriers to and benefits of screening, and perceived breast cancer risk was assessed. ResultsMore women with a first-degree relative with breast cancer reported a mammogram within the past year and rated their breast cancer risk higher. Death of a first-degree relative impacted the belief that breast cancer can be cured with early detection. Degree of relatedness of affected relative impacted mammography practice and risk perceptions. ConclusionFamily history of breast cancer impacted mammography adherence, beliefs about outcomes with early detection, and risk perceptions. Breast cancer death in a family may be a better predictor of beliefs about breast cancer detection and cure than family history of cancer alone. These findings have implications for how screening recommendations and risk information are communicated to patients with different familial cancer experiences.