Use Of Mammograms Research Articles

Breast cancer screening among Chamorro women in California

Background: This study evaluated breast cancer-related knowledge, attitudes and behaviors among Chamorros in San Diego, California and compared mammogram use between those affiliated with the military and others. Methods: A survey was administered to 110 self-reported Chamorro women. Inclusion criteria included being self-reported Chamorro woman >40 years with no history of breast cancer. Approximately equal proportions of participants with (52%) and without (48%) military affiliation were recruited to test the assumption that use of mammography differed between the two groups. Descriptive statistics and bivarate analyses were conducted. Results: Of the 110 respondents, 42% had at least some college education, 41% had household incomes of at least $50,000, and 87% reported having health insurance. Approximately 93% reporting ever having a mammogram and 75% reported having it within the past 2 years. The difference between mammography use among women with and without military affiliation was not significant (85% versus 72%; p = 0.11). However, women with military insurance (95%) were more likely than others (74%) to have had a mammogram within that time frame ( p = .05). Other factors associated with higher mammography use included reporting better access to medical care ( p = .03), receiving a recommendation for mammography from a health care provider ( p = .002), and knowledge that cancer can be cured if detected early ( p = .01) and that women should get a mammogram yearly ( p = .01). Conclusion: Chamorro women in San Diego have relatively high rates of mammography use. This finding may be due, in part, to the relatively high rates of health insurance coverage (particularly military insurance) among these women.

Results of a Randomized Trial to Increase Mammogram Usage among Samoan Women

There are no effective breast cancer education programs targeting Samoan women. We tested the effectiveness of a theory-guided, culturally appropriate breast cancer education program (the intervention) designed to increase mammography use among Samoan women. This community-based participatory cluster-randomized controlled intervention trial used a parallel two-group design. The sample consisted of 776 women aged 42 and older who had not had a mammogram in the preceding 2 years. The primary outcome was self-reported mammogram use between pretest and posttest. Overall, there was no statistically significant intervention effect, although the odds of self-reported mammogram use were higher in the intervention than the control group (odds ratio (OR), 1.26; 95% confidence interval (95% CI), 0.74, 2.14; P = 0.39). Exploratory subgroup analyses found that the intervention was effective only among women who were aware of mammograms but had never previously obtained one (OR, 1.99; 95% CI, 1.03, 3.85; P = 0.04). Low need for social support and lack of endorsement of culture-specific beliefs about breast cancer were associated with mammogram use in this group. In women unaware of mammography at pretest, high perceived susceptibility to breast cancer and endorsement of culture-specific beliefs were associated with mammogram use. For women who had previously obtained a mammogram, lower self-efficacy was associated with mammogram use. Intervention compared with control group women had significantly higher levels of knowledge of risk factors and lower endorsement of culture-specific beliefs at posttest. Results suggest that a multifaceted education intervention may improve mammogram usage for certain subgroups of Samoan women.

The Impact of Education and Literacy Levels on Cancer Screening among Older Latin American and Caribbean Adults

There is limited information related to the effects of education and literacy on cancer screening practices among older adults in Latin American and Caribbean countries. To determine the association between education and cancer screening use, we developed a cross-sectional study using data from the Health, Well-Being and Aging in Latin America and the Caribbean Study. The sample included 4,183 men and 6,708 women aged 60 years and older from seven cities. The outcomes are mammogram and Pap smear use in women and prostate examination use in men within the last 2 years. In general, illiterate or lower-educated older men and women have the lowest rates of cancer screening use compared with higher-educated counterparts. Multivariate logistic models, by city and in a combined sample of six cities showed that high education is associated with higher odds of having a mammogram or a Pap smear in women and a prostate examination in men. Older adults with low educational or literacy levels should be targeted for screening programs in these populations.

Use of Mammograms among Women Over 40—United States, 2000–2005

Use of Mammograms among Women Over 40—United States, 2000–2005

Stat Bite: Mammogram Use Among U.S. Women

Stat Bite: Mammogram Use Among U.S. Women

Obesity and recent mammography use among black and white women in the Southern Community Cohort Study (United States).

To examine the relationship between obesity and mammography use in a large population of black and white women. Baseline data from 18,756 black and 6,304 white women enrolled in the Southern Community Cohort Study were used to examine the association between body mass index categories (healthy weight: 18.5-24.9 kg/m(2), overweight: 25-29.9 kg/m(2), and obesity classes I: 30-34.9 kg/m(2), II: 35-39.9 kg/m(2), and III: 40+ kg/m(2)) and mammogram use in the past two years. Cross-sectional analyses were conducted using logistic regression controlling for socioeconomic measures, medical conditions, insurance coverage, and lifestyle factors. Among white women, obesity class III was associated with a reduced likelihood of recent mammography compared to healthy weight women (OR = 0.70, 95% CI 0.56-0.87) that appeared unrelated to income and insurance coverage. A deterring effect of obesity was not evident among black women; instead, overweight and obesity were associated with small elevations in mammography use compared to healthy weight. In light of rising obesity rates and known associations between obesity and breast cancer risk and prognosis, a deterring effect of extreme obesity on mammography screening for white women is a concern that should be addressed by screening programs and by further directed research into the factors underlying this association.

A Computed Tomography-based Protocol vs Conventional Clinical Mark-up for Breast Electron Boost

Aims Computed tomography planning of whole breast radiotherapy (WBRT) improves breast coverage and reduces the normal tissue dose. Computed tomography planning may increase tumour bed boost treatment accuracy. The aims of this investigation were (1) to compare the breast boost volume treated with clinical mark-up with the volume delineated with computed tomography planning and (2) to study tumour bed volume changes between the initial planning computed tomography scan and a second computed tomography scan at the time of breast boost mark-up. Materials and methods Women receiving adjuvant WBRT and an electron boost after breast-conserving surgery were eligible. As per standard practice, WBRT was computed tomography planned while the boost electron portal was clinically defined. Electron field borders were then traced with wire and a second computed tomography scan was carried out in the boost treatment position. Post-surgical radiological abnormalities were contoured to create a tumour bed clinical target volume (CTV) on both scans (CTV1 and CTV2). A 1 cm margin to CTV2 defined the planning target volume (PTV). The proportions of the CTV2 and PTV receiving 90% (V90) and 80% (V80) of the dose were calculated. Changes in volume between CTV1 and CTV2 were analysed. Results Data from 47 eligible patients were analysed. The mean V90 for the PTV was 61%. Lower electron energy ( P < 0.001) and small field sizes ( P = 0.004) were associated with a low V90. The mean CTV decreased by 4.3 cm 3 ( P = 0.014) and was smaller in those with a long surgery to computed tomography interval ( P = 0.008). On average, the 90% isodose covered 61 cm 3 of normal tissue. Conclusions Conventional clinical breast boost planning is inaccurate. Electron boost computed tomography planning together with appropriate surgical clip placement and the use of mammograms and pathological information should provide optimal coverage of the tumour site. The boost could usually be planned from the initial computed tomography scan.

Use of Mammograms Among Women Aged ≥40 Years—United States, 2000-2005Use of Mammograms Among Women Aged ≥40 Years—United States, 2000-2005

Use of Mammograms Among Women Aged ≥40 Years—United States, 2000-2005Use of Mammograms Among Women Aged ≥40 Years—United States, 2000-2005

4–26 Use of Prior Mammograms in the Classification of Benign and Malignant Masses

4–26 Use of Prior Mammograms in the Classification of Benign and Malignant Masses

Religious Attendance, Health Maintenance Beliefs, and Mammography Utilization: Findings from a Nationwide Survey of Presbyterian Women

Preventive health services, such as mammography, play an increasingly important role in maintaining women's health. Social factors, such as religion, may influence utilization rates by expanding access, offering information, and increasing motivation. The current study examines the relationship between religious involvement, religious beliefs, and mammography usage in a nationally representative sample of Presbyterian women (N= 1,070). We use multivariate logistic regression models to estimate the influence of religious service attendance and two health‐related religious beliefs on self‐reported mammography use. The findings show that religious attendance is significantly associated with mammogram use. Women who attend services nearly every week are almost twice as likely to use mammograms compared to women who attend services less frequently or never. Furthermore, the belief that spiritual health is related to physical health is also associated with the use of mammograms.

Computer-Aided Diagnosis Scheme for Identifying Histological Classification of Clustered Microcalcifications by Use of Follow-up Magnification Mammograms

Our purpose in this study was to investigate the usefulness of follow-up magnification mammograms (i.e., both current and previous magnification mammograms) in a computer-aided diagnosis (CAD) scheme for identifying the histological classification of clustered microcalcifications. Our database consisted of current and previous magnification mammograms obtained from 93 patients before and after 3-month follow-up: 11 invasive carcinomas, 19 noninvasive carcinomas of the comedo type, 25 noninvasive carcinomas of the noncomedo type, 23 mastopathies, and 15 fibroadenomas. In our CAD scheme, we extracted five objective features of clustered microcalcifications from each of the current and previous magnification mammograms by taking into account image features that experienced radiologists commonly use to identify histological classifications. These features were then merged by a modified Bayes discriminant function for distinguishing among five histological classifications. For the input of the modified Bayes discriminant function, we used five objective features obtained from the previous magnification mammogram (previous features), five objective features obtained from the current magnification mammogram (current features), and the set of the five previous features and the five current features. The classification accuracies with the five current features were higher than those with the five previous features. These classification accuracies were improved substantially by using the set of the five previous features and the five current features. For the set of the five previous features and the five current features, the classification accuracies of our CAD scheme were 81.8% (9 of 11) for invasive carcinoma, 84.2% (16 of 19) for noninvasive carcinoma of the comedo type, 76.0% (19 of 25) for noninvasive carcinoma of the noncomedo type, 73.9% (17 of 23) for mastopathy, and 86.8% (13 of 15) for fibroadenoma. Our CAD scheme with use of follow-up magnification mammograms improved classification performance for mammographic clustered microcalcifications.

Health Care Access and Utilization among Women Who Have Sex with Women: Sexual Behavior and Identity

Past research has shown that women who either have sex with women or who identify as lesbian access less preventive health care than other women. However, previous studies have generally relied on convenience samples and have not examined the multiple associations of sexual identity, behavior and health care access/utilization. Unlike other studies, we used a multi-lingual population-based survey in New York City to examine the use of Pap tests and mammograms, as well as health care coverage and the use of primary care providers, among women who have sex with women and by sexual identity status. We found that women who had sex with women (WSW) were less likely to have had a Pap test in the past 3 years (66 vs. 80%, p<0.0001) or a mammogram in the past 2 years (53 vs. 73%, p=0.0009) than other women. After adjusting for health insurance coverage and other factors, WSW were ten times [adjusted odds ratio (AOR), 9.8, 95% confidence interval (CI), 4.2, 22.9] and four times (AOR, 4.0, 95% CI 1.3, 12.0) more likely than non-WSW to not have received a timely Pap test or mammogram, respectively. Women whose behavior and identity were concordant were more likely to access Pap tests and mammograms than those whose behavior and identity were discordant. For example, WSW who identified as lesbians were more likely to have received timely Pap tests (97 vs. 48%, p<0.0001) and mammograms (86 vs. 42%, p=0.0007) than those who identified as heterosexual. Given the current screening recommendations for Pap tests and mammograms, provider counseling and public health messages should be inclusive of women who have sex with women, including those who have sex with women but identify as heterosexual.

Celebremos La Salud! A Community Randomized Trial of Cancer Prevention (United States)

Compared to non-Hispanic whites, Hispanics in the United States are at higher risk for certain types of cancer. In a randomized controlled trial of 20 communities, we examined whether a comprehensive intervention influenced cancer screening behaviors and lifestyle practices in rural communities in Eastern Washington State. Cross-sectional surveys at baseline and post-intervention included interviews with a random sample of approximately 100 households per community. The interview included questions on ever use and recent use of Pap test, mammogram, and fecal occult blood test (FOBT) and sigmoidoscopy/colonoscopy, fruit and vegetable consumption and smoking practices. We found few significant changes in use of screening services for cervical (Pap test), breast (mammogram) or colorectal cancer (fecal occult blood test (FOBT) or sigmoidoscopy/colonoscopy) between intervention and control communities. We found no significant differences in fruit and vegetable consumption nor in smoking prevalence between the two groups. We found more awareness of and participation in intervention activities in the treatment communities than the control communities. Our null findings might be attributable to the low dose of the intervention, a cohort effect, or contamination of the effect in non-intervention communities. Further research to identify effective strategies to improve cancer prevention lifestyle behaviors and screening practices are needed.

TREATMENT OF ELDERLY CANCER PATIENTS: A PLANET IN EVOLUTION

To the Editor: There is an outstanding interest in the treatment of elderly cancer patients, and many things have changed in the last decades in this setting. The number of studies conducted in elderly cancer patients has increased. New “elderly friendly” drugs have been added to our armamentarium, and we have better supportive treatments to reduce toxicity. Considering the three “big killer” cancers, older patients are better treated today than they were a few years ago.1 For example, the approach to the management of breast cancer in older people is slowly being reassessed. As far as surgery is concerned, mastectomy has been used as a standard treatment for older women, because it was believed that changes in body image would not bother them, although evidence shows that older women also suffer problems with body image after mastectomy. Moreover, several studies have examined the consequences of omitting axillary surgery in older women with breast cancer,2, 3 and in most of these studies, the results are in favor of axillary dissection. Given the considerable improvements in the detection and treatment of early breast cancer, several factors compel the clinician to assess the benefits and risks of adjuvant treatment in older patients with breast cancer.4 The wider use of screening mammograms is causing the tumor stage at diagnosis to shift toward increasingly smaller, low-risk tumors. Consequently, clinicians are increasingly treating older patients with small tumors and must determine whether an adjuvant treatment should be prescribed and, if so, what kind. Studies of women with metastatic breast cancer have shown that older women in good health tolerate chemotherapy reasonably well compared with younger women.5 Surgical resection offers the only hope of cure in patients with colorectal cancer. Therefore, older patients with colorectal cancer should not be denied surgery on the basis of age alone.6, 7 Most people aged 75 and older are independent, and their life expectancy without cancer is 10 to 12 years. Because colorectal cancer typically recurs within 5 years after diagnosis, it is reasonable to consider adjuvant chemotherapy to prevent recurrence whenever needed, irrespective of age, considering that elderly patients have no more toxic effects than younger patients, except for leukopenia.8 Despite the observation that no age-related difference was found in the effectiveness of chemotherapy, the number of elderly patients receiving palliative chemotherapy for colorectal cancer is still limited because of the still-diffuse concern about adherence to and tolerability of chemotherapy in such patients. Age is sometimes still used as an excuse not to resect lung cancer, although lung cancer resection in elderly patients is justified and has shown decreasing morbidity and mortality rates. During the last few years, there has been a revolution in the development of minimally invasive chest surgery, with smaller incisions and dramatic reductions in the overall operative risk. Elderly patients with lung cancer may benefit the most from these new techniques. The evaluation of cytotoxic therapies for older patients with non-small-cell lung cancer has recently become a major focus of clinical research and randomized controlled trials have established that single-agent chemotherapy is the standard treatment for non-small-cell lung cancer in older people. Although randomized trials are not available in older people that directly compare more-aggressive with less-aggressive chemotherapy, retrospective specific subgroup analyses of cisplatin combinations have been performed with results comparable with those in younger age groups.9 On the hematological malignancies side, studies on the treatment of aggressive non-Hodgkin's lymphoma have been conducted according to two opposite approaches: the first focused on minimizing toxicity, using regimens specifically designed for elderly patients, the second in favor of standard treatments.10 Lately, it has been shown that cyclophosphamide, doxorubicin, vincristine, and prednisone, with the addition of rituximab, is the standard treatment for non-Hodgkin's lymphoma in older people. In conclusion, despite the perceived barriers to including elderly cancer patients in clinical trials, there are few data to support excluding them. The increasing use of a complete geriatric assessment can lead to a more individualized patient treatment plan. Furthermore, the enormous advances in supportive treatments over recent years enable adverse effects to be minimized. Moreover, the implementation of prospective trials is strongly recommended to assess properly the quality of life of elderly patients undergoing chemotherapy. In this way, it could be possible to counteract an unjustified “ageism”: a prejudice that denies opportunities of treatment or even cure for patients that, as far as we know, may have the same chance as younger patients. Financial Disclosures: There are no grants or any financial ties with any of the authors of this letter. Author Contributions: All authors participated in the design and the preparation of this letter. Sponsor's Role: There was no sponsor for this letter.

Re-evaluating lipoplasty-only breast reduction

The author still performs lipoplasty-only breast reduction in 85% of patients, but he now offers all patients a vertical mastopexy performed in the same session rather than the possibility of a 2-stage procedure. Further refinements to the patient evaluation process include the use of preoperative mammograms to assess breast fat volume and consideration of conventional breast reduction in several specific patient subsets.

The Relation Between Projected Breast Cancer Risk, Perceived Cancer Risk, and Mammography Use. Results from the National Health Interview Survey

Although the use of mammography on at regular intervals can save lives, not all women obtain the repeat mammography recommended in guidelines. To assess the associations between routine mammography use, perceived cancer risk, and actual projected cancer risk. We include women who were 45 to 75 years of age and who had responded to the 2000 National Health Interview Survey. Women who reported that they believed their risk of getting cancer in the future was "medium" or "high" were considered jointly as "medium/high-risk perception.""Routine mammography use" was defined as having > or =3 mammograms in the previous 6 years. We used logistic regression to determine the independent relation between cancer risk perception, projected breast cancer risk, and routine mammography use. Of the 6,002 women who met our inclusion criteria, 63.1% reported routine mammography use. About 76% of women in the highest quartile of projected breast cancer risk reported routine mammography use, compared with only 68%, 64%, and 51% in the third, second, and first quartiles, respectively (P<.001 chi-square test for trend). After adjusting for indicators of access to care, sociodemographic and behavioral factors, and perceived cancer risk, women in the highest quartiles of projected cancer risk were significantly more likely to report routine mammogram use than women in the lowest quartile (odds ratio [OR] of women in third and fourth quartiles were 1.57 [1.24 to 1.99], and 2.23 [1.73 to 2.87] vs the lowest quartile, respectively). Women with a higher perceived cancer risk were significantly more likely to undergo routine mammography (adjusted OR: 1.29 [1.12 to 1.48] P=.001). Cancer risk perceptions tended to be higher among women who were younger age, obese, smokers, depressed, or reported one of the following breast cancer risk factors: family breast cancer history, prior abnormal mammogram, and early age at menarche. Actual and perceived risk were independent predictors of routine mammography use, suggesting that efforts to incorporate risk profiles into clinical decision making may need to involve more than just relaying information about projected risks to patients, but also to explore how risk perceptions can be affected by this information.

1091 PUBLICATION Combined modality for treatment of buccal cancer

Computed tomography planning of whole breast radiotherapy (WBRT) improves breast coverage and reduces the normal tissue dose. Computed tomography planning may increase tumour bed boost treatment accuracy. The aims of this investigation were (1) to compare the breast boost volume treated with clinical mark-up with the volume delineated with computed tomography planning and (2) to study tumour bed volume changes between the initial planning computed tomography scan and a second computed tomography scan at the time of breast boost mark-up.Women receiving adjuvant WBRT and an electron boost after breast-conserving surgery were eligible. As per standard practice, WBRT was computed tomography planned while the boost electron portal was clinically defined. Electron field borders were then traced with wire and a second computed tomography scan was carried out in the boost treatment position. Post-surgical radiological abnormalities were contoured to create a tumour bed clinical target volume (CTV) on both scans (CTV1 and CTV2). A 1 cm margin to CTV2 defined the planning target volume (PTV). The proportions of the CTV2 and PTV receiving 90% (V90) and 80% (V80) of the dose were calculated. Changes in volume between CTV1 and CTV2 were analysed.Data from 47 eligible patients were analysed. The mean V90 for the PTV was 61%. Lower electron energy (P < 0.001) and small field sizes (P = 0.004) were associated with a low V90. The mean CTV decreased by 4.3 cm3 (P = 0.014) and was smaller in those with a long surgery to computed tomography interval (P = 0.008). On average, the 90% isodose covered 61 cm3 of normal tissue.Conventional clinical breast boost planning is inaccurate. Electron boost computed tomography planning together with appropriate surgical clip placement and the use of mammograms and pathological information should provide optimal coverage of the tumour site. The boost could usually be planned from the initial computed tomography scan.

Use of prior mammograms in the classification of benign and malignant masses

The purpose of this study was to determine the importance of using prior mammograms for classification of benign and malignant masses. Five radiologists and one resident classified mass lesions in 198 mammograms obtained from a population-based screening program. Cases were interpreted twice, once without and once with comparison of previous mammograms, in a sequential reading order using soft copy image display. The radiologists’ performances in classifying benign and malignant masses without and with previous mammograms were evaluated with receiver operating characteristic (ROC) analysis. The statistical significance of the difference in performances was calculated using analysis of variance. The use of prior mammograms improved the classification performance of all participants in the study. The mean area under the ROC curve of the readers increased from 0.763 to 0.796. This difference in performance was statistically significant ( P = 0.008).

Use of General Medical Services Among Medicaid Patients With Severe and Persistent Mental Illness

The aim of this study was to examine patterns of use of general medical services among persons with a severe and persistent mental illness enrolled in Medicaid from 1996 to 1998. A total of 669 persons with a severe and persistent mental illness were identified by using statewide clinical criteria. A three-year database of Medicaid claims was developed to examine service use. The main outcome measures were use of outpatient services for a general medical problem, use of dental and vision services, and use of screening tests for women. Service use was examined by primary psychiatric diagnosis (schizophrenic, affective, paranoid, and anxiety disorders), and analyses controlled for the presence of a chronic medical condition, age, race, and sex. This study found high levels of service use for outpatient services but very low levels for primary and preventive services. Although 78 percent of persons with a schizophrenic disorder had an office-based visit during the three-year period, all persons with an anxiety disorder had such a visit. Sixty-nine percent of persons with a schizophrenic disorder had at least one emergency department visit, whereas 83 percent of those with an anxiety disorder had such a visit. Dental and vision visits and the use of mammograms and pap tests followed the same pattern; persons with a schizophrenic disorder had fewer visits and had less overall use than the other diagnostic groups. The use patterns across the four groups were significantly different in outpatient service use, dental and vision service use, and screening tests for women. Compared with persons with a schizophrenic disorder, those with an anxiety disorder were more likely to have had an office-based visit and to have received vision services, those with a paranoid disorder were more likely to have used dental services or received a mammogram, and those with an affective disorder were more likely to have had a pap test. Although this group of Medicaid patients with severe and persistent mental illness had access to providers, they received an unacceptably low level of preventive care. Use of health services for general medical problems differed somewhat by primary psychiatric illness.

Global trends in breast cancer incidence and mortality 1973–1997

Worldwide, breast cancer is the most common cancer and is the leading cause of cancer death among women. To describe global trends, we compared age-adjusted incidence and mortality rates over three decades (from 1973-77 to 1993-97) and across several continents. Both breast cancer incidence and mortality rates varied 4-fold by geographic location between countries with the highest and lowest rates. Recent (1993-1997) incidence rates ranged from 27/100,000 in Asian countries to 97/100,000 among US white women. Overall, North American and northern European countries had the highest incidence rates of breast cancer; intermediate levels were reported in Western Europe, Oceania, Scandinavia, and Israel; and Eastern Europe, South and Latin America, and Asia had the lowest levels. Breast cancer incidence rose 30-40% from the 1970s to the 1990s in most countries, with the most marked increases among women aged > or =50 years. Mortality from breast cancer paralleled incidence: it was highest in the countries with the highest incidence rates (between 17/100,000 and 27/100,000), lowest in Latin America and Asia (7-14/100,000), and rose most rapidly in countries with the lowest rates. Breast cancer incidence and mortality rates remain highest in developed countries compared with developing countries, as a result of differential use of screening mammograms and disparities in lifestyle and hereditary factors. Future studies assessing the combined contributions of both environmental and hereditary factors may provide explanations for worldwide differences in incidence and mortality rates.