Decreasing rate of fatty involution at screening mammography

RATIONALE AND OBJECTIVES: This study was performed to document the perceived decrease in fatty involution at screening mammography during the past decade and evaluate the influence of hormone replacement therapy (HRT). MATERIALS AND METHODS: In December 1996, the mammograms of 261 consecutive screening patients with a comparison study obtained 5 years earlier were evaluated, and their breasts were categorized according to Breast Imaging Reporting and Data System categories for breast density. The women, aged 50-59 years, included 119 who had been receiving HRT for 0.25-15 years (mean, 3 years). From the files, 261 age-matched screening mammograms from 1986 were obtained; these patients also had comparison mammograms from 1981. Analysis of variance was used to determine differences between the 1980s group, the 1990s group receiving HRT, and the 1990s group not receiving HRT. Scheffé tests were used for post hoc comparisons. Stepwise regression analysis was used to evaluate the relative influence of age, decade, score of the first mammogram, and HRT. RESULTS: Breast density for the 1991 mammograms did not differ significantly from that in 1981 (P < .05). Initial breast density was the best predictor of final breast density in both decades (P < .001), regardless of HRT status. The change in breast density (toward fatty) over the 5-year interval in the 1980s (mean, 0.48) was significantly greater than that in both 1990s groups (mean for HRT group, 0.11; no HRT, 0.30; P < .05). CONCLUSION: These results confirm that breast density at screening mammography in the 1990s did not decrease with age at the same rate as in the 1980s, even in patients not receiving HRT.     

The incremental contribution of clinical breast examination to invasive cancer detection in a mammography screening program

OBJECTIVE: The objective of this study was to determine the potential added contribution of clinical breast examination (CBE) to invasive breast cancer detection in a mammography screening program, by categories of age and breast density. SUBJECTS AND METHODS: We prospectively followed 61,688 women aged 40 years or older who had undergone at least one screening examination with mammography and CBE between January 1, 1996, and December 31, 2000, for 1 year after their mammogram for invasive cancer. We computed the incremental sensitivity, specificity, and positive predictive value of CBE over mammography alone for combinations of age and breast density (predominantly fatty or dense). RESULTS: Mammography sensitivity was 78% and combined mammography-CBE sensitivity was 82%, thus CBE detected an additional 4% of invasive cancers. CBE detected a minority of invasive cancers compared with mammography for all age groups and all breast densities. Sensitivity increased from adding CBE to screening mammography for all ages, from 6.8% in women ages 50-59 with dense breasts to 1.8% in women ages 60-69 years with fatty breasts. CBE generally added incrementally more to sensitivity among women with dense breasts. Specificity and positive predictive value declined when CBE was used in conjunction with mammography, and this decrement was more pronounced in women with dense breasts. CONCLUSION: CBE had modest incremental benefit to invasive cancer detection over mammography alone in a screening program, but also led to greater risk of false-positive results. These risks and benefits were greater in women with dense breasts. The balance of risks and benefits must be weighed carefully when evaluating the inclusion of CBE in a screening examination.     

Compliance With Screening Mammography Guidelines After a False-Positive Mammogram

PurposeTo assess whether women with a false-positive mammogram who do return for screening are less likely to be compliant with screening mammography guidelines than are women with a negative mammogram.MethodsThis institutional review board-approved, HIPAA-compliant retrospective cohort study includes women >40 years old who received 9,385 consecutive, nonbaseline screening mammograms between December 1, 2012 and December 31, 2013. Using linear regression, we evaluated differences in time between mammograms by prior recall status, after adjusting for location of current mammogram (outpatient office versus mobile unit) and age. Using Fisher's exact test, we evaluated the association between compliance with screening guidelines and the recall status on prior mammogram, and compared by location the proportions of noncompliant women who were recalled from prior mammogram.ResultsTime between mammograms does not differ based on prior recall status (P = .83). There is no association between compliance with screening mammography guidelines and recall status on prior mammogram (ACR guidelines P = .398, United States Preventive Services Task Force guidelines P = .416). Noncompliant women recalled on prior mammogram are more likely to undergo mammography at the outpatient office rather than the mobile unit (ACR guidelines P = .0004, United States Preventive Services Task Force guidelines P = .0032).ConclusionsA prior false-positive mammogram is not a significant deterrent to compliance with screening guidelines in those women who return for screening.     

False-positive screening mammograms: effect of immediate versus later work-up on patient stress

PURPOSE: To compare the stress experienced by women who had false-positive screening mammograms and had undergone immediate on-site diagnostic imaging evaluation with that experienced by those who had been recalled for subsequent imaging. MATERIALS AND METHODS: A retrospective survey was mailed to women with false-positive screening mammograms that had proved negative or benign at diagnostic imaging. The women were divided into (a) those who had undergone diagnostic imaging during the same appointment as their screening examination and (b) those who had returned at a later date for work-up. The survey included questions about stress that was related to the screening and diagnostic experiences, how subjects had been notified about screening results, and their breast health histories. RESULTS: From the group that had undergone immediate work-up (n = 100), 50 eligible surveys were received; 71 were received from women who had undergone later work-ups (n = 176). The self-reported overall stress was significantly greater (P =.027) in the group recalled for subsequent diagnostic imaging. Among all respondents, stress from a false-positive screening result was greatest in women younger than 50 years of age with a positive first-degree family history of breast cancer. CONCLUSION: Providing immediate on-site diagnostic evaluation can reduce the stress of a false-positive screening mammogram.     

Primary Care Providers Underutilize Breast Screening MRI for High-Risk Women

ObjectiveSupplemental MRI screening for women at high risk for breast cancer is underutilized. Our study assessed how primary care providers in our healthcare network identify high-risk women and recommend high-risk screening breast MRI.MethodsAn electronic survey was distributed to providers in OB/GYN, family, and internal medicine departments between 1/14/19 and 3/22/19. The survey inquired about methods used to assess breast cancer risk, familiarity with the American Cancer Society's definition of high-risk, and whether screening breast MRI is recommended for high-risk women.ResultsResponse rate was 17% (89/524). After excluding providers who ordered ≤10 mammograms per year, the study included 75 respondents, who mostly ordered 10-1000 mammograms per year and supported annual/biennial screening mammogram starting at age 40-50 years. More providers reported estimating breast cancer risk qualitatively (with family, clinical history, and/or breast density) than quantitatively with risk calculators (73/75, 97% vs 22/75, 29%). A minority of providers (23/75, 31%) correctly defined high lifetime risk. Only 9/75 (12%) providers recommended screening MRI for high-risk women. Use of quantitative risk calculators or ability to correctly define high-risk were not associated with likelihood of recommending MRI screening. More providers had recommended MRI for screening in the setting of dense breasts than for high-risk screening (23/75, 31% vs 9/75, 12%).ConclusionPrimary care providers at our institution did not routinely recommend screening MRI for high-risk women. Risk assessment and reporting at the time of mammography may improve MRI utilization and is an opportunity for radiologists to add value and directly participate in patient-centered care.     

American College of Radiology Imaging Network digital mammographic imaging screening trial: objectives and methodology

This study was approved by the Institutional Review Board (IRB) of the American College of Radiology Imaging Network (ACRIN) and each participating site and by the IRB and the Cancer Therapy Evaluation Program at the National Cancer Institute. The study was monitored by an independent Data Safety and Monitoring Board, which received interim analyses of data to ensure that the study would be terminated early if indicated by trends in the outcomes. The ACRIN, which is funded by the National Cancer Institute, conducted the Digital Mammographic Imaging Screening Trial (DMIST) primarily to compare the diagnostic accuracy of digital and screen-film mammography in asymptomatic women presenting for screening for breast cancer. Over the 25.5 months of enrollment, a total of 49 528 women were included at the 33 participating sites, which used five different types of digital mammography equipment. All participants underwent both screen-film and digital mammography. The digital and screen-film mammograms of each subject were independently interpreted by two radiologists. If findings of either examination were interpreted as abnormal, subsequent work-up occurred according to the recommendations of the interpreting radiologist. Breast cancer status was determined at biopsy or follow-up mammography 11-15 months after study entry. In addition to the measurement of diagnostic accuracy by using the interpretations of mammograms at the study sites, DMIST included evaluations of the relative cost-effectiveness and quality-of-life effects of digital versus screen-film mammography. Six separate reader studies using the de-identified archived DMIST mammograms will also assess the diagnostic accuracy of each of the individual digital mammography machines versus screen-film mammography machines, the effect of breast density on diagnostic accuracy of digital and screen-film mammography, and the effect of different rates of breast cancer on the diagnostic accuracy in a reader study.     

Does biopsy, aspiration or six-month follow-up of a false-positive mammogram reduce future screening or have large psychosocial effects?

RATIONALE AND OBJECTIVES: To determine the differences in the psychosocial effects and future mammography screening behavior between women who had an abnormal mammogram followed either by percutaneous or open surgical breast biopsy or cyst aspiration, or by short-term follow-up mammography to provide insight to radiologists making decisions regarding work-up. MATERIALS AND METHODS: A structured interview was administered to women who recently had abnormal mammograms, leading to biopsy or aspiration (170 cases), or short-term follow-up (176 controls), by telephone within a month of the eligibility event and again approximately 15 months later. Information was collected on perceived pain/discomfort, interactions with medical staff, emotional impact, general breast cancer knowledge, patient attitude towards early diagnosis of breast cancer, perceived risk, previous and intended screening behavior, and subjective health status. Wilcoxon rank sum statistical test was used to compare the two groups at the time of both interviews. RESULTS: Cases and controls had similar demographics. There were no significant differences in the examined psychosocial effects and reported intention to undergo future screening mammography between cases and controls. The overwhelming majority of both cases and controls both reported intention to and underwent routine screening 15 months after the eligibility event. CONCLUSION: Undergoing a biopsy, cyst aspiration, or 6-month follow-up after a positive mammogram does not have large psychosocial effects, nor does it deter women from undergoing screening mammography in the future.     

Prevalence of breast arterial calcification in hypertensive patients

AIM: To determine the age-specific prevalence of breast arterial calcifications in patients with systemic hypertension. METHODS: The mammograms and patient records of 2406 women who underwent screening or diagnostic mammography were reviewed retrospectively. Mammograms were evaluated for the presence of arterial calcification and results were coded. Hypertension was defined as use of anti-hypertensive agents and diabetes was defined as use of oral hypoglycaemic agents or insulin. RESULTS: The prevalence of breast arterial calcification among hypertensives (17.6%) was lower than among diabetics (25.4%). The prevalence in the non-diabetic, non-hypertensive group was lowest (7.3%). The prevalence increased with age in all three groups. The highest prevalence was found in diabetics older than 60 years (81.8%). Breast arterial calcification was not found among women younger than 40 years. CONCLUSION: Breast arterial calcification is associated with hypertension and prevalence increases with age. Breast arterial calcification on mammograms may indicate unsuspected hypertension especially in non-diabetic patients.     

Between-Race Differences in Supplemental Breast Cancer Screening Before and After Breast Density Notification Law

Guidelines recommend supplemental breast cancer screening for women at increased breast cancer risk; however, the passage of breast density notification laws may lead to supplemental screening that is incongruent with women’s risk. We examined supplemental screening (ie, MRI, ultrasound, or tomosynthesis within 6 months of screening mammogram) among a sample of 2,764 African American (AA) and 691 European American (EA) women with negative or benign screening mammograms for whom we had data from both before and after implementation of breast density notification laws in the state of Michigan. Results indicated a 5-fold increase (from 0.14% to 0.7% of women) in supplemental screening among screen-negative women after passage of the law, driven in large part by an increase in supplemental screening among AA women. Breast density was more predictive of supplemental screening and had a marginally greater explanatory role in between-race differences in supplemental screening after passage of the law. Subgroup analyses (n = 250) indicated that whereas 5-year breast cancer risk was positively associated with supplemental screening before the law and negatively associated after the law for EA women, 5-year risk was not associated with supplemental screening either before or after passage of the law for AA women. Our findings suggest that whereas passage of the breast density notification laws may have motivated supplemental screening among AA women in particular, it lessened the consideration of breast cancer risk in supplemental screening decision making.     

Breast cancer screening: the underuse of mammography

The early detection of breast cancer is promoted by the American Cancer Society (ACS) and the American College of Radiology (ACR) by encouraging the regular use of three types of screening: breast self-examination (BSE), the clinical breast examination, and mammography. In August 1983, the ACS publicized seven recommendations pertaining to screening, including a revised statement about the routine use of mammography for women between the ages of 40 and 49 years. In response to the ACS statement, the present study assessed compliance with the updated recommendations for all three types of screening. The results show reasonable rates of compliance for the BSE (53%-69%) and clinical examination (70%-78%). In contrast, only 19% of the women between the ages of 35 and 49 and 25% of the women older than 50 reported complying with the recommendation to undergo one baseline screening mammogram. In addition, only 9% of the mammograms were obtained for the early detection of disease, which is the rationale for the recommendation. In fact, it appears that mammography is being performed mainly for the diagnosis of symptomatic women instead of the screening of asymptomatic women. Some implications for health education by physicians and the professional education by physicians and the professional education of physicians in the use of mammography are discussed.     

Mammographic detection of breast cancer in women under the age of 35

There have been few studies of the radiographic findings of breast cancer in young women. We report our series of 42 cancers in 39 women under the age of 35 who had a mammogram prior to biopsy. Abnormal findings were present on 86% of the mammograms with 94% of the abnormalities classified as high or intermediate suspicion. Mammographic findings were: mass in 50%, calcifications in 31%, diffuse inflammatory changes in 11%, and an asymmetric density in 8%. Six of the mammograms were normal. While young women are usually expected to have dense breasts, 23 mammograms showed either entirely fatty or mixed fatty/glandular tissue. Dense parenchyma infrequently obscured a palpable malignancy. We conclude that mammography can provide important diagnostic information in young women with breast cancer.     

Mammographic screening of TRAM flap breast reconstructions for detection of nonpalpable recurrent cancer

PURPOSE: To evaluate findings from routine mammographic screenings in patients with transverse rectus abdominis musculocutaneous (TRAM) flap reconstructions. MATERIALS AND METHODS: During a 25-month study period, 214 consecutive screening mammograms in 113 asymptomatic women (mean age, 51 years) with TRAM flap reconstructions were obtained. Mastectomies were performed for cancer in 106 (94%) of the 113 women and for prophylaxis in seven (6%). Prospectively, a Breast Imaging Reporting and Data System (BI-RADS) assessment category 1-5 was assigned to each mammogram. Surgical, medical, pathologic, and radiographic records were retrospectively reviewed. CIs were determined by the normal approximation to the binomial distribution. RESULTS: Seven (3%) of 214 examinations were BI-RADS category 4 or 5. Six (86%) of seven patients underwent biopsy. Two (33%) of these six biopsies demonstrated invasive ductal carcinoma. Cancer detection rate for mammography was 1.9% (two of 106) (95% CI: 0.33%, 7.32%) for women with reconstruction for breast cancer during the 2-year period. One (6%) of 16 BI-RADS category 3 examinations later proved to be invasive ductal carcinoma at follow-up. No interval cancer was discovered in 171 cases of BI-RADS category 1 or 2 examinations with 1-year follow-up. No cancers occurred in women who underwent prophylactic mastectomy. A biopsy positive predictive value of 33% (95% CI: 6%, 76%) was observed. CONCLUSION: Screening mammography of TRAM flap-reconstructed breasts enables detection of nonpalpable cancer before clinical examination.     

Baseline Mammography: What Is It and Why Is It Important? A Cross-Sectional Survey of Women Undergoing Screening Mammography

Objectives

Studies have shown that having a baseline mammogram, the first screening mammogram, available for comparison at the time of interpreting a subsequent mammogram significantly decreases the potential of a false-positive examination. Our aim was to evaluate knowledge of and perception about the significance of baseline mammograms in those women undergoing screening mammography.

Ten years of breast screening in the Nova Scotia Breast Screening Program, 1991-2001. experience: use of an adaptable stereotactic device in the diagnosis of screening-detected abnormalities.

OBJECTIVE: To evaluate and present 10-year outcomes of the Nova Scotia Breast Screening Program (NSBSP), a population-based screening program in the province of Nova Scotia, Canada, total population 900 000. SETTING: Organized Breast Screening Program in Nova Scotia, Canada. METHODS: Rates of participation, abnormal referrals, cancer detection rates, and benign:malignant (B:M) rates for core biopsy and surgical biopsy were calculated for asymptomatic women receiving a mammogram through the NSBSP 1991-2001. RESULTS: Of 192 454 mammograms performed on 71 317 women, 33% were aged 40 to 49 years, 39% aged 50 to 59 years, 23% aged 60 to 69 years, and 5% aged 70 years and over. Cancer detection rate increased in each age group respectively: 3.7, 5.8, 9.7, and 13.5 per 1000 population on first-time screens. The positive predictive value of an abnormal screen increased with increasing age groups. Benign breast surgery decreased with increased use of needle core breast biopsy (NCBB). Open surgery decreased from 25 to 6 surgeries per 1000 screens. Of 1519 open surgical procedures (1328 women), 878 cancers were removed, with 37% 10 mm or less, and 61% 15 mm or less. In 613 women in whom the node status was assessed, 79% were negative. CONCLUSION: A quality screening program incorporating NCBB in the diagnostic work-up is effective in the early detection of breast cancer and results in less open surgery, particularly in younger women.     

Effect of Arrival of Prior Mammograms on Recall Negation for Screening Mammograms Performed With Digital Breast Tomosynthesis in a Clinical Setting

PurposeThis retrospective study evaluates the effect of comparison with prior mammograms on recall negation for screening mammography performed with digital breast tomosynthesis (DBT) in a clinical setting and compares it with that performed without DBT.MethodsThis is an Institutional Review Board–approved, HIPAA-compliant retrospective review of the electronic medical record for all nonbaseline screening mammograms performed in clinical practice over 13 months. For each mammogram, we recorded if DBT were used, the BI-RADS assigned at initial interpretation, and whether prior mammograms were available at initial interpretation. If prior mammograms arrived later for comparison, the final BI-RADS assigned after comparison was recorded. A mammogram assigned a BI-RADS 0 at initial interpretation and assigned a BI-RADS 1 or BI-RADS 2 after prior mammograms arrived for comparison was labeled as a recall that was negated by the arrival of prior mammograms. The number of recalls negated for mammograms that used DBT was compared with that for mammograms that did not use DBT.ResultsArrival of prior mammograms for comparison negated the need for recall for mammograms performed with DBT by 67.67% and negated the need for recall for mammograms performed without DBT by 55.80%. After adjusting for age, density, and time between mammograms, the percentage of recalls negated by comparison with prior mammograms was not significantly different for mammograms performed with DBT than it was for those performed without DBT.ConclusionComparison with prior mammograms remains important for the minimization of recall rates during the use of DBT for screening mammography in the clinical setting.     

Screening Sensitivity According to Breast Cancer Location

PurposeTo examine the relation between breast cancer location and screening mammogram sensitivity, and assess whether this association is modified by body mass index (BMI) or breast density.MethodsThis study is based on all interval cancers (n = 481) and a random sample of screen-detected cancers (n = 481) diagnosed in Quebec Breast Cancer Screening Program participants in 2007. Film-screening mammograms, diagnostic mammograms, and ultrasound reports (when available) were requested for these cases. The breast cancer was then localised in mediolateral oblique (MLO) and craniocaudal (CC) projections of the breast by 1 experienced radiologist. The association between cancer location and screening sensitivity was assessed by logistic regression. Adjusted sensitivity and sensitivity ratios were obtained by marginal standardisation.ResultsA total of 369 screen-detected and 268 interval cancers could be localised in MLO and/or CC projections. The 2-year sensitivity reached 68%. Overall, sensitivity was not statistically associated with location of the cancer. However, sensitivity seems lower in MLO posterior inferior area for women with BMI ≥ 25 kg/m² compared to sensitivity in central area for women with lower BMI (adjusted sensitivity ratio: 0.58, 95% confidence interval [CI]: 0.17–0.98). Lower sensitivity was also observed in subareolar areas for women with breast density ≥ 50% compared to the central areas for women with lower breast density (for MLO and CC projections, adjusted sensitivity ratio and 95% CI of, respectively, 0.54 [0.13–0.96] and 0.46 [0.01–0.93]).ConclusionsScreening sensitivity seems lower in MLO posterior inferior area in women with higher BMI and in subareolar areas in women with higher breast density. When interpreting screening mammograms, radiologists need to pay special attention to these areas.     

Computer-aided detection (CAD) in screening mammography: sensitivity of commercial CAD systems for detecting architectural distortion

OBJECTIVE: Computer-aided detection (CAD) algorithms have successfully revealed breast masses and microcalcifications on screening mammography. The purpose of our study was to evaluate the sensitivity of commercially available CAD systems for revealing architectural distortion, the third most common appearance of breast cancer. MATERIALS AND METHODS: Two commercially available CAD systems were used to evaluate screening mammograms obtained in 43 patients with 45 mammographically detected regions of architectural distortion. For each CAD system, we determined the sensitivity for revealing architectural distortion on at least one image of the two-view mammographic examination (case sensitivity) and for each individual mammogram (image sensitivity). Surgical biopsy results were available for each case of architectural distortion. RESULTS: Architectural distortion was deemed present and actionable by a panel of expert breast imagers in 80 views of the 45 cases. One CAD system detected distortion in 22 of 45 cases of distortion (case sensitivity, 49%) and in 30 of 80 mammograms (image sensitivity, 38%); it displayed 0.7 false-positive marks per image. Another CAD system identified distortion in 15 of 45 cases (case sensitivity, 33%) and 17 of 80 mammograms (image sensitivity, 21%); it displayed 1.27 false-positive marks per image. Sensitivity for malignancy-caused distortion was similar to or lower than sensitivity for all causes of distortion. CONCLUSION: Fewer than one half of the cases of architectural distortion were detected by the two most widely available CAD systems used for interpretations of screening mammograms. Considerable improvement in the sensitivity of CAD systems is needed for detecting this type of lesion. Practicing breast imagers who use CAD systems should remain vigilant for architectural distortion.     

Bahcesehir long-term population-based screening compared to National Breast Cancer Registry Data: effectiveness of screening in an emerging country

PURPOSEWe aimed to show the effects of long-term screening on clinical, pathologic, and survival outcomes in patients with screen-detected breast cancer and compare these findings with breast cancer patients registered in the National Breast Cancer Registry Data (NBCRD).METHODSWomen aged 40–69 years, living in Bahcesehir county, Istanbul, Turkey, were screened every 2 years using bilateral mammography. The Bahcesehir National Breast Cancer Registry Data (BMSP) data were collected during a 10-year screening period (five rounds of screening). BMSP data were compared with the NBCRD regarding age, cancer stage, types of surgery, tumor size, lymph node status, molecular subtypes, and survival rates.RESULTSDuring the 10-year screening period, 8758 women were screened with 22621 mammograms. Breast cancer was detected in 130 patients; 51 (39.2%) were aged 40–49 years. The comparison of breast cancer patients in the two programs revealed that BMSP patients had earlier stages, higher breast-conserving surgery rates, smaller tumor size, more frequent negative axillary nodal status, lower histologic grade, and higher ductal carcinoma in situ rates than NBCRD patients (p = 0.001, for all).CONCLUSIONThese results indicate the feasibility of successful population-based screening in middle-income countries.

Breast cancer is the most frequent cancer and cause of cancer-related deaths among Turkish women, as well as globally (1–5). Although the incidence of breast cancer increases every year, mortality rates are decreasing in developed countries because of nationwide screening programs and modern treatment options (5, 6). An invited mammography screening program for women aged between 40 and 69 years revealed a 60% reduction in cancer-related 10-year mortality in a landmark study (7). A systematic review of Myers et al. (8) showed that breast cancer screening reduced mortality by 20% in average-risk women of all age groups. However, this review did not evaluate the differences between annual and biannual mammographic screening.In 2004, the Cancer Control Department of Turkey recommended biannual mammographic screening for women aged 50–69 years, based on European Guidelines. The population of Turkey is relatively young, and almost half of all breast cancer patients in Turkey are younger than 50 years. According to and National Breast Cancer Registry Data (NBCRD) reports, the starting age for mammography screening was set as 40 years. The Bahcesehir Mammographic Screening Program (BMSP) was the first organized population-based 10-year (2009–2019) mammography screening program in Turkey, a middle-income country.Turkish Federation of Breast Diseases Societies started a voluntary data registry program that was provided by breast surgeons working in secondary or tertiary hospitals. This program aimed to collect detailed information of breast cancer patients and to pool comprehensive country-specific breast cancer data. This registry, namely the NBCRD, was the first specified database on breast cancer in the country and was started in 2005, before the BMSP (9). Data from 36 centers were collected for 10 years. However, the cancer registry is a standard database containing general information as defined by the International Agency for Research on Cancer standards.The aim of this study was to show the feasibility of a population-based breast cancer screening program in an emerging, middle-income country, Turkey. The objective of our study was to evaluate the effectiveness of a population-based breast cancer screening program by comparing it with NBCRD data.     

Reassessment of breast cancers missed during routine screening mammography: a community-based study

OBJECTIVE: The purpose of this study was to have a series of screening mammograms from routine practice, including false-negative results, reviewed by peer community-based experienced radiologists to determine the percentage of these false-negative findings that might be considered detectable. MATERIALS AND METHODS: All screening cases for 1997 and 1998 were identified from the Carolina Mammography Registry. Mammographic assessments from community mammography practices were linked with population-based cancer outcomes. The findings of four community-based radiologists who reviewed the mammograms of 339 asymptomatic women were 93 false-negatives, 180 true-negatives, and 66 false-positives. The percentage of false-negative, true-negative and false-positive findings on breast films that reviewers evaluated was determined. The findings of the reviewers were compared with the original interpreting radiologists' assessments. RESULTS: The overall breast-specific workup rate by the reviewing radiologists was 21%. The average workup rate for the false-negative findings was 42% (range, 35-51%). Adjusting for the 13% workup rate in the cancer-free breasts, the percentage of false-negative findings that were detectable was estimated to be 29%. CONCLUSION: This peer review of screening mammograms from a population-based screening registry estimated a missed detectable cancer rate of 29%. Thus, 71% of cancers missed at screening would not have been worked up by peers in the same community.     

Ductal carcinoma in situ: computer-aided detection in screening mammography

PURPOSE: To retrospectively evaluate the sensitivity of computer-aided detection (CAD) in depicting ductal carcinoma in situ (DCIS) on screening mammograms by using biopsy proved lesion location as the reference standard. MATERIALS AND METHODS: Institutional review board approval was obtained, with a waiver of patient informed consent for this HIPAA-compliant study. Findings of all image-guided biopsies with a pathologic diagnosis of DCIS during a 1-year period were reviewed. Fifty-eight lesions in 55 women (average age, 61.41 years +/- 12.89 [standard deviation]) were available for review. The screening mammogram of the affected breast and, if available, the prior screening mammogram were digitized by the CAD system. An assessment was then made as to whether the CAD system marked the area of DCIS on the current and prior mammograms. Patient age, location and mammographic size of the lesion, type of lesion, and breast density were recorded and were analyzed by using chi2, Fisher exact, or Cochran-Mantel-Haenzel tests, where applicable. RESULTS: CAD identified DCIS in 53 (91%) of 58 lesions on craniocaudal (CC) and mediolateral oblique (MLO) views of screening mammograms obtained in the year of the diagnosis. On screening mammograms obtained prior to the year of the diagnosis (34 patients), no radiologically or CAD-detected lesion was present on 11 (32%) of 34 mammograms. CAD identified DCIS in 16 (70%) of 23 lesions on one of the two views. Seven (30%) of 23 lesions had mammographic findings at retrospective review that were not identified with CAD. CONCLUSION: CAD had a high sensitivity in the depiction of DCIS.