Completion of colorectal cancer screening in women attending screening mammography

RATIONALE AND OBJECTIVES: The American Cancer Society (ACS) and the United States Preventive Services Task Force (USPSTF) recommend colorectal cancer (CRC) screening to begin at age 50 in individuals at average risk for CRC. To estimate rate at which women eligible for CRC screening at the time of screening mammography attendance later completed in CRC screening, we retrospectively evaluated CRC screening utilization in women who underwent screening mammography at our institution. MATERIALS AND METHODS: We retrospectively identified 3357 women between the ages of 50 to 75 who received screening mammography in 1998 at a single academic medical center using the institution's Radiology Information System (RIS). Additional information collected from the institution's Health System Data Warehouse and the Radiology department's mammography quality assurance data included mammography results, Breast Imaging Reporting and Database System (BI-RADS) classification of mammography findings, recommendation for screening mammography follow-up, insurance status, and CRC screening utilization after screening mammography. After excluding women who were current with CRC screening at the time of mammography, we determined the proportion of eligible women who completed CRC screening after mammography. Age, insurance type, BI-RADS code, and recommendation code were evaluated as potential predictors of CRC screening completion in eligible women. RESULTS: Of the 3357 women between the ages of 50 and 75 who received screening mammography in 1998, only 414 (12.3%) were current with CRC screening at the time of screening mammography. Of the remaining 2943 women who were eligible for CRC screening at the time of screening mammography, 142 (4.8%) subsequently completed CRC screening. Average time to completion of CRC screening after screening mammography is 35.4 months (range, 0.27-64.9). Managed care insurance was the only significant predictor of CRC screening completion after screening mammography in eligible women after adjusting for other variables (adjusted OR 1.73, 95% CI 1.21-2.47, P < .0001). Neither BI-RADS classification nor postmammography recommendations were significantly associated with CRC screening completion. CONCLUSIONS: Prevalence studies have demonstrated that women who were compliant with screening mammography were more compliant with CRC screening. Our data suggest that despite this increased compliance, overall incidence of CRC screening is low in the screening mammography population.     

Factors affecting radiologist inconsistency in screening mammography

RATIONALE AND OBJECTIVES: Although research has successfully documented variability in radiologists' interpretation of mammograms, it has failed to determine the relative contributions of case-specific features and reader inconsistency. Training interventions to improve consistency will be ineffectual if they do not target the principal determinants of disagreement among radiologists. The current study assessed the relative contributions of the case and the interpreter to the problem of inconsistent interpretation. MATERIALS AND METHODS: One hundred ten radiologists independently interpreted mammograms from the same 148 screening cases (43% with biopsy-proved cancers) and reported the presence or absence of calcifications, mass, architectural distortion, and asymmetric density in each of 296 breasts. The radiologists were blinded to disease status (established at biopsy or follow-up). RESULTS: Case-related differences accounted for a greater proportion of interpretation disagreement than did differences between interpreters. The presence of cancer was associated with increased disagreement, perhaps because of the multiplicity of findings. Patient age was also associated with increased disagreement in the reporting of calcifications. CONCLUSION: For screening mammography, increased consistency between radiologists in their recognition and reporting of clinically important findings will best be achieved by reducing disagreement in difficult cases. Current training in the United States addresses difficult cases only as they have been defined intuitively or experientially. The authors' population-based method provides an objective metric to measure case difficulty and basis from which to identify difficult cases for targeted training.     

Why women resist screening mammography: patient-related barriers

Mammography utilization remains below the level needed to achieve the National Cancer Institute's year-2000 goals for reducing breast cancer mortality by 50%. Previous research has identified both patient and physician barriers. The authors interviewed 600 randomly selected women who were offered a free mammographic examination. Interviews were conducted by professional interviewers using a brief, structured questionnaire. Data were analyzed with chi 2 Wilcoxon and Kruskal-Wallis rank-sum statistics and discriminant analysis. Noncompliant subjects reported more barriers than compliant subjects. The former were more likely to believe that mammography is unnecessary in the absence of symptoms and that it is inconvenient. In both the bivariate and multivariate analyses, the woman's belief that her doctor believes in regular mammography was an important predictor of compliance.     

Characteristics and screening outcome of women referred twice at screening mammography

Objectives

To determine the characteristics and screening outcome of women referred twice at screening mammography.

Methods

We included 424,703 consecutive screening mammograms and collected imaging, biopsy and surgery reports of women with screen-detected breast cancer. Review of screening mammograms was performed to determine whether or not an initial and second referral comprised the same lesion.

Results

The overall positive predictive value of referral for cancer was 38.6% (95% CI 37.3-39.8%). Of 147 (2.6%) women referred twice, 86 had been referred for a different lesion at second referral and 32 of these proved malignant (37.2%, 95% CI 27.0-47.4%). Sixty-one women had been referred twice for the same lesion, of which 22 proved malignant (36.1%, 95% CI 24.1-48.0%). Characteristics of these women were comparable to women with cancer diagnosed after first referral. Compared with women without cancer at second referral for the same lesion, women with cancer more frequently showed suspicious densities at screening mammography (86.4% vs 53.8%, P?=?0.02) and work-up at first referral had less frequently included biopsy (22.7% vs 61.5%, P?=?0.004).

Conclusions

Cancer risk in women referred twice for the same lesion is similar to that observed in women referred once, or referred for a second time but for a different lesion.

Key Points

? Cancer risk was 36% for lesions referred twice at screening mammography ? The cancer risk was similar for lesions referred only once at screening ? Densities at first referral were associated with increased cancer risk at second referral ? No biopsy at first referral was associated with increased cancer risk at second referral ? Patient and tumour characteristics were similar for women with and without diagnostic delay     

再次进行乳腺摄影筛查女性的特点与筛查结果

目的研究再次进行乳腺摄影筛查女性的特点和筛查结果。方法回顾性收集424703例连续的乳腺摄影筛查影像资料,以及发现乳腺癌的活检结果和手术报告。研究乳腺摄影情况,确定首次与二次检查是否存在相同的病变。结果总体的乳腺癌阳性预测值为38.6%(95%CI:37.3%～39.8%)。147例(2.6%)进行再次筛查的病人中,86例再次检查时存在不同的病变,其中32例为恶性(37.2%,95%CI:27.0%～47.4%)。61例女性再次检查的目的为相同病变,其中22例为恶性(36.1%,95%CI:24.1%～48.0%)。比较这些女性与首次乳腺摄影诊断为癌症的特点。与再次检查时相同病灶不为肿瘤者相比,患癌症者通常在乳腺摄影中表现为可疑高密度影(86.4%与53.8%,P=0.02),首次检查工作流程中的活检率较低(22.7%与61.5%,P=0.004)。结论对于再次进行乳腺筛查的女性,无论是由于相同病灶还是不同病灶而进行,再次筛查的恶性肿瘤风险与首次筛查者相当。     

Clinical breast examination practices among women undergoing screening mammography

In this prospective multicenter study, the authors evaluated the utility of magnetic resonance (MR) cisternography after intrathecal administration of gadopentetate dimeglumine in 15 patients clinically suspected of having cerebrospinal fluid (CSF) rhinorrhea. By means of lumbar puncture, a single dose of 0.5 mL of gadopentetate dimeglumine was injected into the lumbar subarachnoid space. Thirteen patients showed leakage of contrast material through the cribriform plate into the ethmoid or sphenoid air cells. No leakage was observed in two patients. The study results show the relative safety and feasibility of low-dose gadolinium-enhanced MR cisternography in confirming the presence and determining the focus of active CSF leaks.     

Factors contributing to low participation in mammography screening in Papua New Guinea

AimThe aim of this paper is to describe the current state of mammography screening services in Papua New Guinea (PNG) and to document factors thought to contribute to low participation in the free mammography screening service at the Pacific International Hospital (PIH), Port Moresby.MethodWomen attending for mammography screening at PIH between August 2006 and July 2010 were invited to complete a survey investigating environmental, political, social, financial, cultural and health factors thought to be contributing to low participation in the mammography screening service.Ethics approval and permission to collect data was granted through the University of Papua New Guinea, School of Medicine and Health Sciences Research and Ethics Committee and by the Medical Director and Chief Operating Officer of PIH.ResultsThe reasons for low participation were found to be multifactorial; difficult environmental factors 42.86%; financial dependency factors 40.54%; cultural factors related to exposing the body 50.03%, social factors (sexual harassment) 77.6%, political factors 4.29% and health factors including poor health 54.54%.ConclusionThe study demonstrated that in this snapshot of PNG women, the low participation rate in the free mammography screening program at PIH was influenced by various interrelated factors inherent in both the PNG environment and culture, in particular lack of transport infrastructure, financial burden and sexual harassment. As low participation directly impacts upon the high breast cancer mortality in PNG women, a more comprehensive study of the women of PNG is required to validate this research.     

Lesion conspicuity on synthetic screening mammography compared to full field digital screening mammography

ObjectiveTo compare lesion conspicuity on synthetic screening mammography (SM) plus digital breast tomosynthesis (DBT) versus full field digital mammography (FFDM) plus DBT.Materials and methodsSeven breast imagers each prospectively evaluated 107–228 screening mammograms (FFDM, DBT, and SM; total 1206 examinations) over 12 weeks in sets of 10–50 consecutive examinations. Interpretation sessions alternated as follows: SM + DBT, then FFDM, or FFDM + DBT, then SM. Lesion conspicuity on SM versus FFDM (equal/better versus less) was assessed using proportions with 95% confidence intervals. DBT-only findings were excluded.ResultsOverall 1082 of 1206 (89.7%) examinations were assessed BI-RADS 1/2, and 124 of 1206 (10.3%) assessed BI-RADS 0. There were 409 evaluated findings, including 134 masses, 119 calcifications, 72 asymmetries, 49 architectural distortion, and 35 focal asymmetries. SM conspicuity compared to FFDM conspicuity for lesions was rated 1) masses: 77 (57%) equal or more conspicuous, 57 (43%) less conspicuous; 2) asymmetries/focal asymmetries: 61 (57%) equal or more conspicuous, and 46 (43%) less conspicuous; 3) architectural distortion: 46 (94%) equal or more conspicuous, 3 (6%) less conspicuous; 4) calcifications: 115 (97%) equal or more conspicuous, 4 (3%) less conspicuous. SM had better conspicuity than FFDM for calcifications and architectural distortion and similar conspicuity for most masses and asymmetries.ConclusionCompared to FFDM, SM has better conspicuity for calcifications and architectural distortion and similar conspicuity for most masses and asymmetries.     

Provider efforts to increase mammography screening

This article examines barriers to mammography screening and reviews the professional literature on provider interventions to increase screening. Interventions appropriate for radiologic technologists are evaluated and discussed in an effort to expand R.T.s' role in improving mammography screening rates.     

钼靶X线、超声组合BI-RADS分类法指导农村妇女乳腺普查

目的:探讨应用钼钯X线(MAM)、超声(US)组合BI-RADS分类法确定农村妇女乳腺癌普查年龄的可行性。方法:954例本地区农村妇女,年龄35～60岁,平均(47.5±5.8)岁。所有妇女均接受US和MAM检查并行BI-RADS分类,US+MAM组合分类结果为每例受检者US与MAM分类结果中的最高级别,US+MAM分类Ⅲ类以上结果判定为高危人群并随访。将954例农村妇女及所检出的高危妇女划分为35～40岁、41～50岁、51～60岁3个年龄段,计算高危妇女在其相应年龄段所占比率,统计学分析其差异。结果:44例农村妇女被组合BI-RADS分类法评价为高危妇女,其随访结果与BI-RADS要求相符,35～40岁、41～50岁、51～60岁3个年龄段高危妇女所占比率分别为8.21%、5.32%、1.70%,其差异有统计学意义(P<0.05)。结论:应用US+MAM组合法BI-RADS分类可准确判定农村妇女乳腺癌的普查年龄。