Utilization of screening mammography by primary care physicians.

Although mammography is the primary modality for the detection of early breast cancer, routine screening of asymptomatic women in the U.S. has not occurred. A survey of the referral practices for breast cancer screening of 513 Virginia primary care physicians was conducted. An average percentage of 39% of women age 35 to 40, 55% of women age 40 to 50, and 57% of women over age 50 were referred for screening mammography. Gynecologists referred the greatest number of women for screening. An increase of mammography referrals was repeated by 81% of physicians; 21% of physicians stated that they referred all women over 50 for screening. Half of the physicians believed that women in their community were unaware of the benefits of mammography screening. Major deterrents were the cost of mammography and the lack of third-party coverage.     

Breast cancer screening by mammography: an overview

Given the differences between the nine studies in design and execution alone, it is remarkable that they all support the same general conclusion that mammographic screening for breast cancer is capable of reducing mortality from the disease. There are also differences between them in the screening technique (age range, interval between screens, number of mammographic views) and treatment but this does not provide a simple guide to what we can expect in the National Health Service Breast Cancer Screening Programme which is now underway in this country. The new national programme recruits women in the age range 50-64 and Table 3 shows the result from five of the studies in which separate data for a 'middle-age' group can be derived: the total Utrecht study group was aged 50-69 and the other three cannot be divided in this way. In each study, apart from the HIP study, the magnitude of the benefit is greater than in the total group. It is possible that these differences will decrease with longer follow-up (it took longer for an effect to emerge in the youngest age group in the HIP study) but the relative risks in Table 3 give a better guide than those in Table 2 in the short term. The specific effects of different intervals between screens and mammographic views are currently being investigated in randomized clinical trials. In the meantime our best estimate of what is likely to happen in the national programme is probably provided by the two-counties study which, like us, used single-view mammography and in the 50-64 age group had an average screening interval of 33 months-close to the 3 years we have adopted.     

CAD in screening mammography

OBJECTIVE: The benefit and cost of computer-assisted detection (CAD) mammography screening remains a topic of great interest in breast imaging. Our purpose is to reflect on and interleave two articles in this issue of the AJR that highlight the difficulty in assessing the actual benefit of using CAD from either retrospective or prospective studies. CONCLUSION: This commentary describes the possible benefit and some of the issues associated with the clinical use of current CAD technology while emphasizing the expectation of and need for future improvements in CAD performance.     

Impact of low-cost mammography screening on nearby mammography practices

Data derived from the first 30 months of operation of a low-cost mammography screening program demonstrate the impact of the introduction of low-cost screening on nearby mammography practices. Low-cost screening attracts a very different group of women than traditionally populate existing practices, and 93% represent "new business" rather than established mammography patients seeking examination at a lower price. Although low-cost screening does divert some women away from more expensive nearby practices, it also generates an approximately equal number of breast imaging cases for these neighbor practices, including problem-solving examinations to further evaluate screening-detected abnormalities and subsequent screening examinations for women who prefer more full-featured albeit costlier screening. Finally, a survey of nearby practices indicates that the introduction of low-cost screening had no measurable impact on the steadily increasing mammography case loads observed during the study period. Low-cost screening does not appear to be much of an economic threat to existing mammography practices, at least under the conditions in effect in the study area. It can indeed coexist successfully with traditional mammography practices that make no distinction in features and price between screening and problem-solving examinations.     

Adverse effects of screening mammography

The main risks and other adverse consequences from screening mammography include discomfort from breast compression, patient recall for additional imaging, and false positive biopsies. Although these risks affect a larger number of women than those who benefit from screening, the risks are less consequential than the life-sparing benefits from early detection. Radiation risk, even for multiple screenings, is negligible at current mammography doses. Anxiety before screening or resulting from supplementary imaging work-up, short-term follow-up, cyst aspiration, and biopsy has not dampened the enthusiasm of most women for the value of early detection.     

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.