Screening mammography: increasing the effort toward breast cancer detection

Mammography is the only modality with the potential for detecting a breast cancer while it is non-palpable and at a stage of high curability. Early detection of breast cancer is important because survival is directly related to tumor size and lymph node status, and prognosis is best for small lesions without axillary node metastasis. Many studies have indicated that screening mammography is tremendously underused. This article focuses on the effectiveness of mammography and the importance of detecting a breast cancer at an early stage. Health care providers have a responsibility to inform their clients about the benefits of mammography. In addition, women need to be taught breast self-examination and undergo regular clinical breast examinations by a health care professional. The American Cancer Society guidelines for screening breast cancer are given.     

上海市妇女对乳腺癌及其早期筛查认知情况的调查

目的了解上海市妇女对于乳腺癌及早期筛查的认知情况和获取相关信息的来源。方法采用乳腺癌及其早期筛查的知识问卷和有关信息来源的问卷对739名妇女进行调查。结果92%的妇女知道乳房肿块是乳腺癌的早期症状,有98.1%和95.7%的妇女认为乳腺自我检测和乳腺临床检查可以早期发现乳腺癌,只有26.7%和24.6%的妇女知道肥胖和年龄是乳腺癌的高危因素。居住在市区、文化程度高的妇女,乳腺癌的认知情况较好(P<0.01)。目前妇女了解乳腺癌早期筛查知识的渠道主要是通过报纸或杂志(43.3%),55.2%的人最想从医师或护士处得到相关信息,同时也有45.3%的人认为从医师或护士处得到的信息最有助于她们做出早期筛查的决定。结论妇女对于乳腺癌及早期筛查知识的掌握程度分布不均,传媒要加强对乳腺癌早期筛查的宣传,护理人员要加强有关的健康教育,针对不同人群实施有效的健康指导,以提高妇女的认知水平。     

Breast health practices and South Asian women

Breast cancer is an important women's health issue in all communities. To detect breast cancer early, all women should practise monthly breast self-examination, have regular clinical breast examinations and attend mammography screening at suggested intervals. Participation in these breast health practices is influenced by a wide variety of factors, including how women define health and health practices, priorities in women's lives and their explanations of the causes of diseases such as cancer.     

Jordanian nurses' knowledge and practice of breast self-examination

Title.  Jordanian nurses' knowledge and practice of breast self-examination.
Aim.  This paper is a report of a study to evaluate the knowledge and practice of Jordanian nurses in relation to breast self-examination.
Background.  Studies have shown that women who have learned about breast self-examination have positive attitudes toward breast cancer and practise breast self-examination more frequently, and that nurses who teach their clients about methods of early detection and breast self-examination are more knowledgeable about breast cancer screening and breast self-examination techniques than those who do not. Therefore, it is important to understand nurses' knowledge about breast cancer and its early detection.
Methods.  A cross-sectional design was used, with a convenience sample of 347 Registered Nurses at three large cities in Jordan (response rate 95%). Data collection took place in 2005 using a self-administrated questionnaire with three parts and based on the American Cancer Society's guidelines: demographics, knowledge, and practice of breast self-examination.
Results.  Nurses reported high levels of knowledge of breast self-examination (M = 7·6, sd . 2·7). A high proportion of nurses reported doing breast self-examination in the past 12 months (85%), but only 17·7% reported doing so on a monthly basis. None of the demographic characteristics was found to be associated with the practice of breast self-examination.
Conclusion.  More health education about monthly breast self-examination and prevention strategies is needed for nurses and their women patients, especially for Arabic women.     

Nuclear matrix proteins as biomarkers for breast cancer

Breast cancer remains a leading cause of cancer death in women despite widespread screening, in part because screening mammography has high rates of false-negative results and because many women decline to have routine mammograms. The development of sensitive and specific assays for breast tumor markers would improve detection and facilitate screening, diagnosis, therapeutic monitoring and surveillance for recurrence. Nuclear matrix proteins (NMPs) are promising candidates for tumor markers because they are involved in malignant transformation. Therefore, they may be useful for screening and early diagnosis of small tumors. Proteomic analysis was used to demonstrate that a 28.3 kD serum protein, designated NMP66, can distinguish malignant disease from benign conditions and normal controls. NMP66 is now being evaluated as a potential biomarker for early breast cancer detection in large-scale clinical trials.     

Screening for breast cancer: current recommendations and future directions

Breast cancer is one of the most significant health concerns in the United States. Recent reviews have questioned the value of traditional breast cancer screening methods. Breast self-examination has been shown not to improve cancer-specific or all-cause mortality in large studies, but it is commonly advocated as a noninvasive screen. Patients who choose to perform self-examination should be trained in appropriate technique and follow-up. The contribution of the clinical breast examination to early detection is difficult to determine, but studies show that sensitivity is highly dependent on time taken to do the examination. Up to 10 percent of cancers are mammographically silent but evident on clinical breast examination. The U.S. Preventive Services Task Force recommends mammography for women older than 40 years who are in good health, but physicians should consider that sensitivity is lower for younger women. Digital mammography is somewhat more sensitive in younger women and women with dense breasts, but outcome studies are lacking. Although magnetic resonance imaging shows promise as a screening tool in some high-risk women, it is not currently recommended for general screening because of high false-positive rates and cost. The American Cancer Society recommends annual magnetic resonance imaging as an adjunct to screening mammography in high-risk women 30 years and older.     

1502名社区女性钼靶筛查行为现状及影响因素研究The status and influencing factors of mammography screening behavior for 1502 women in community 陈乐英 吴怡颖 郁骐襄 沈坤炜 方琼*

目的 调查社区女性实施乳腺钼靶筛查行为的现状,并分析影响其实施的相关因素。方法 2012年对上海16个社区共1502名女性进行问卷调查。结果 调查中≥40岁的女性中,有544人（占49.5%）从未做过乳腺钼靶检查,仅有284人（占25.8%）每年参与乳腺钼靶检查;乳腺疾病史、是否有机会参加乳腺健康检查、是否知道乳腺自我检查方法、医院是否有专业检查人员及设备是重要影响因素（F=34.427 P＜0.001 R2=0.468）。结论 目前社区女性参与乳腺钼靶筛查行为处于较低水平,医护人员需要从其影响因素着手,探索并研究如何提高女性参与乳腺癌早期筛查率的方法。     

The nurse's role in promoting breast awareness to women

Breast awareness is now a recognised part of health promotion and has replaced previous guidance on breast self-examination for women. Since it was introduced in the early 1990s, along with the breast awareness five-point code, it has become a key element in the strategy to detect breast cancer at an early stage. Despite this, confusion about breast awareness persists, with women still wanting to know how to examine their breasts properly.     

Breast cancer screening in a biracial community: the Charleston tricounty experience

Breast cancer remains a major cause of death among women in South Carolina. Mammography, breast self-examination, and clinical breast examination are effective methods for early detection and subsequent mortality reduction. The Tricounty Breast Cancer Screening Survey assessed knowledge of these methods and recommendations among 503 women in the Charleston area. While 57% of all respondents reported performing breast self-examination at least once per month, 13% of blacks and 6% of whites reported that they do not know how to perform the procedure. Clinical breast examinations within the past year were reported by 69%, yet 11% of blacks and 4% of whites reported that they had never had the examination. More than one third (40%) of all 503 women reported ever having had a mammogram, and 22% reported having had one within the past year. However, 18% of the blacks and 5% of whites reported never having heard of the procedure. The major barriers to mammography appear to be the belief that women do not need regular mammograms and the lack of recommendations by their physicians. Survey results support the need for educating women about what the procedures are, the importance of using them regularly, and the means to comply with them.     

Supplemental Cancer Screening for Women With Dense Breasts: Guidance for Health Care Professionals

Mammography is the standard for breast cancer screening. The sensitivity of mammography in identifying breast cancer, however, is reduced for women with dense breasts. Thirty-eight states have passed laws requiring that all women be notified of breast tissue density results in their mammogram report. The notification includes a statement that differs by state, encouraging women to discuss supplemental screening options with their health care professionals (HCPs). Several supplemental screening tests are available for women with dense breast tissue, but no established guidelines exist to direct HCPs in their recommendation of preferred supplemental screening test. Tailored screening, which takes into consideration the patient’s mammographic breast density and lifetime breast cancer risk, can guide breast cancer screening strategies that are more comprehensive. This review describes the benefits and limitations of the various available supplemental screening tests to guide HCPs and patients in choosing the appropriate breast cancer screening.     

Fear of cancer recurrence in young women with a history of early-stage breast cancer: a cross-sectional study of prevalence and association with health behaviours

PURPOSE: Fear of cancer recurrence (FCR) is common and associated with younger age. This study aimed to explore the prevalence and correlates of FCR amongst younger survivors of early breast cancer. SUBJECTS: A total of 218 women aged 18-45 were diagnosed with stage 0-2 breast cancer at least 1?year earlier. METHODS: The participants completed a web-based survey including a validated measure of FCR and items exploring medical surveillance practices and health care use. RESULTS: A total of 70% of participants reported clinical levels of FCR. Higher FCR was associated with higher frequency of unscheduled visits to the GP, higher frequency of breast self-examination and other forms of self-examination for cancer, not having mammograms or ultrasounds or other forms of cancer screening in the past year, more complementary therapy use and the use of counselling and support groups. CONCLUSIONS: Young women with breast cancer are particularly vulnerable to FCR. The present study provides preliminary evidence that FCR is associated with higher health costs and lower surveillance rates which may compromise health outcomes. Routine screening for FCR in follow-up care is recommended.     

Breast imaging. A practical look at its capabilities and its limitations.

The film-screen technique is evolving as the standard for mammography. Sonography is the only other method that currently has a defined role in breast imaging. Mammography should be performed at facilities that have received American College of Radiology accreditation or its equivalent, because technical quality assurance is an important part of mammographic practice. Interpretive quality may be assured by outcome audits performed by mammography facilities. Primary care physicians are best suited to encouraging eligible women to undergo screening studies and should consider these recommendations: Refer patients for screening mammography to accredited facilities according to established guidelines. Educate patients about the need for regular screening. Provide annual breast physical examination. Refresh your knowledge on breast health and the techniques of physical examination if necessary. Teach patients breast self-examination techniques. Demand low-cost, high-quality screening mammography; be aware of local variability of charges and quality.     

磁共振成像在乳腺癌影像学筛查中的应用:2010ACR与SBI乳腺影像学筛查实践指南解读

影像学能够在临床出现可触及肿块之前早期发现乳腺癌已经成为不争的事实.在多种影像学检查中,乳腺X线摄影是惟一被偱证研究证实的能够早期发现乳腺癌而降低死亡率的影像学方法,但由于存在局限性,因而近年来大量临床研究致力于评估乳腺磁共振成像及乳腺超声在乳腺癌筛查中应用的可行性和效能.为进一步提高乳腺癌早期检出率,乳腺癌筛查方案日...     

The regulation of mammography

There has been a long history of public and professional concern about the safety and quality of mammography. Whereas concerns about radiation dose levels dominated the 1970s, the type of equipment used in mammography was the focus of the 1980s. In the early 1990s, there was a lack of confidence in the overall quality of mammography. These problems have stood in the way of the widespread utilization of mammography to reduce mortality from breast cancer. The Mammography Accreditation Program of the American College of Radiology, state regulations, and the Mammography Quality Standards Act of 1992 came about to ensure a minimum level of quality that would encourage women to participate in breast cancer screening programs. Designing regulations that ensure quality mammography for women, without burdening mammography facilities with unnecessary costs and depletion of their resources, is one of the most difficult challenges facing the U.S. Food and Drug Administration.     

Evaluation of a breast examination facilitation device

Breast self-examination (BSE) is recommended in order to help women detect possible breast cancer early in its development Correct BSE performance has been shown tobe positively associated with breast lump detection ability Few women, however, report practising BSE, citing reasons such as dislike of touching one's own breasts, fear of finding a lump, lack of confidence in their-ability to perform BSE The purpose of this study was to test a breast examination facilitation device (BEFD) for women, which would provide a teaching/screening tool, as well as a shield between breast and fingers for women who are reluctant to touch their breasts A sample of 36 registered nurses in the United States was asked to perform BSE on three separate occasions using a BEFD made of latex, paper or cloth on which a wedge pattern for BSE had beenimprinted Subjects found the BEFD to be a useful tool for teaching/learning BSE, and expressed a clear preference for the latex material One size of BEFD is not adequate for all women A smaller size for women who wear A and B cup-size bras, and a larger size for women who wear C cup size and above, would be more acceptable     

Breast arterial calcifications as a cardiovascular risk marker in women

Cardiovascular disease and breast cancer are the two main causes of mortality in women. Mammography as a screening test for breast cancer is recommended for all women from the age of 40 to 50 years. Mammographically detected breast arterial calcifications are currently considered an incidental finding without clinical importance, since they are not associated with an increased risk of breast cancer. However, recent studies have shown that breast arterial calcifications on mammograms have been associated with cardiovascular risk factors and atherosclerotic cardiovascular disease. These results suggest that breast arterial calcifications, detected during routine mammography, are a noteworthy finding that could be valuable in identifying asymptomatic women at increased cardiovascular risk.     

Breast arterial calcifications as a cardiovascular risk marker in women

Cardiovascular disease and breast cancer are the two main causes of mortality in women. Mammography as a screening test for breast cancer is recommended for all women from the age of 40 to 50 years. Mammographically detected breast arterial calcifications are currently considered an incidental finding without clinical importance, since they are not associated with an increased risk of breast cancer. However, recent studies have shown that breast arterial calcifications on mammograms have been associated with cardiovascular risk factors and atherosclerotic cardiovascular disease. These results suggest that breast arterial calcifications, detected during routine mammography, are a noteworthy finding that could be valuable in identifying asymptomatic women at increased cardiovascular risk.     

Cancer screening promotion among medically underserved Asian American women: integration of research and practice

Mammography and Pap smear tests are known to be effective early detection measures for breast and cervical cancers, respectively, but Asian Americans are reluctant to make visits for routine preventive care. Quantitative and qualitative research conducted by the Healthy Asian Americans Project (HAAP) between 1996 and 1999 indicated that Asian residents in southeastern Michigan, like the general Asian population in the US, underutilized early cancer screening programs due to cultural, psychosocial, linguistic, and economic barriers. This article reports how the HAAP's research findings guided the Michigan Breast and Cervical Cancer Control Program (BCCCP) promotion (conducted from 2000 to 2001 among medically underserved Asian women residing in southeastern Michigan), and how evaluation of the HAAP's BCCCP promotion will direct future research and health promotion programs. The article presents strategies used to improve access to cancer screening programs for diverse Asian sub-groups as well as outcomes of the 2-year HAAP's BCCCP promotion among the target population. Discussion regarding lessons and experiences gained from integration of research and practice has implications on design and implementation of the cancer screening promotion for the rapidly increasing Asian American population as well as other medically underserved minority populations in the US.