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Technology in Cancer Research &... Aug 2004Interest in digital radiography was stimulated by the enthusiastic acceptance of computed tomography in the early 1970s. It quickly became apparent to the medical... (Review)
Review
Interest in digital radiography was stimulated by the enthusiastic acceptance of computed tomography in the early 1970s. It quickly became apparent to the medical community that images with improved information content, whose display characteristics could be manipulated by the viewer, provided many advantages. Subsequently, digital systems for subtraction angiography and later for conventional projection radiography and fluoroscopy were developed. The timing of the introduction of these systems was highly dependent on the readiness of certain key component technologies to meet the requirements of each of these applications. These components are the x-ray detectors, analog to digital converters, computers, data storage systems and high-resolution electronic displays and printers used in image acquisition, storage and display. Mammography represents one of the most demanding radiographic applications, simultaneously requiring excellent contrast sensitivity, high spatial resolution, and wide dynamic range at as low as radiation dose to the breast as is reasonably achievable while meeting the other requirements. For this reason, it is one of the last radiographic procedures to "go digital". Here, some of the considerations related to the detector technology for digital mammography will be discussed and systems currently available will be described.
Topics: Breast; Humans; Image Processing, Computer-Assisted; Mammography; Models, Statistical; Phosphorus; Radiographic Image Enhancement; Sensitivity and Specificity; Statistics as Topic; X-Ray Intensifying Screens
PubMed: 15270582
DOI: 10.1177/153303460400300401 -
International Journal of Occupational... Oct 2022Mammographic density (MD) refers to the percentage of dense tissue of an entire breast and was proposed to be used as a surrogate marker for breast cancer. High-dose...
OBJECTIVES
Mammographic density (MD) refers to the percentage of dense tissue of an entire breast and was proposed to be used as a surrogate marker for breast cancer. High-dose ionizing radiation (IR) has been recognized as a breast cancer risk factor. The aim of our study was to investigate association between lifetime low dose ionizing radiation (LDIR) and MD.
MATERIAL AND METHODS
A cross-sectional study included 467 women aged 40-60 years who underwent screening mammography in Łódź, Poland. The digital mammography examination of the breasts included both craniocaudal and mediolateral oblique views. The volumetric breast density (VBD) (%) and fibrograndular tissue volume (FG) (cm) were determined based on the analysis of mammographic image ("for processing") using Volpara Imaging Software. The exposure to IR was estimated for each individual, based on the data from interviews about diagnostic or therapeutic medical procedures performed in the area of the neck, chest, abdomen and spine, which involved X-rays and γ rays and the data about the doses derived from literature. Linear and logistic regression were fitted with VBD and FG as the outcomes and organ breast dose, effective dose and number of mammographies as the determinants, adjusted for major confounders.
RESULTS
The analyses showed no association between VBD or FG and the breast organ dose or the effective dose. The only significant finding observed concerned the association between the number of mammographies and the FG volume with β coefficient: 0.028 (95% CI: 0.012-0.043), and predicted mean FG volume >13.4 cm3 among the women with >3 mammographies when compared to those with none.
CONCLUSIONS
This study does not, in general, provide support for the positive association between LDIR and MD. The weak association of the FG volume with the number of mammographies warrants further verification in larger independent studies. Int J Occup Med Environ Health. 2022;35(5):635-49.
Topics: Breast Density; Breast Neoplasms; Cross-Sectional Studies; Early Detection of Cancer; Female; Humans; Mammography; Radiation, Ionizing
PubMed: 35913368
DOI: 10.13075/ijomeh.1896.01916 -
Clinical Interventions in Aging 2016Breast cancer is a major cause of cancer-related deaths among older women, aged 65 years or older. Screening mammography has been shown to be effective in reducing... (Review)
Review
Breast cancer is a major cause of cancer-related deaths among older women, aged 65 years or older. Screening mammography has been shown to be effective in reducing breast cancer mortality in women aged 50-74 years but not among those aged 75 years or older. Given the large heterogeneity in comorbidity status and life expectancy among older women, controversy remains over screening mammography in this population. Diminished life expectancy with aging may decrease the potential screening benefit and increase the risk of harms. In this review, we summarize the evidence on screening mammography utilization, performance, and outcomes and highlight evidence gaps. Optimizing the screening strategy will involve separating older women who will benefit from screening from those who will not benefit by using information on comorbidity status and life expectancy. This review has identified areas related to screening mammography in older women that warrant additional research, including the need to evaluate emerging screening technologies, such as tomosynthesis among older women and precision cancer screening. In the absence of randomized controlled trials, the benefits and harms of continued screening mammography in older women need to be estimated using both population-based cohort data and simulation models.
Topics: Aged; Aging; Breast Neoplasms; Decision Making; Female; Humans; Life Expectancy; Mammography; Mass Screening
PubMed: 26893548
DOI: 10.2147/CIA.S65304 -
Scientific Reports May 2020We proposed to compare the accuracy and effectiveness of digital breast tomosynthesis (DBT), plus digital or synthetic mammography, with digital mammography alone in... (Meta-Analysis)
Meta-Analysis
We proposed to compare the accuracy and effectiveness of digital breast tomosynthesis (DBT), plus digital or synthetic mammography, with digital mammography alone in women attending population-based breast cancer screenings. We performed a systematic review and included controlled studies comparing DBT with digital mammography for breast cancer screening. Search strategies were applied to the MEDLINE, Embase, LILACS, and CENTRAL databases. With moderate quality of evidence, in 1,000 screens, DBT plus digital mammography increased the overall and invasive breast cancer rates by 3 and 2 (RR 1.36, 95% CI 1.18 to 1.58 and RR 1.51, 95% CI 1.27 to 1.79, respectively). DBT plus synthetic mammography increased both overall and invasive breast cancer rates by 2 (RR 1.38, 95% CI 1.24 to 1.54 and RR 1.37, 95% CI 1.22 to 1.55, respectively). DBT did not improve recall, false positive and false negative rates. However due to heterogeneity the quality of evidence was low. For women attending population-based breast cancer screenings, DBT increases rates of overall and invasive breast cancer. There is no evidence with high or moderate quality showing that DBT compared with digital mammography decreases recall rates, as well as false positive and false negative rates.
Topics: Breast Neoplasms; Early Detection of Cancer; Female; Humans; Mammography; Mass Screening; Publication Bias; Reproducibility of Results; Sensitivity and Specificity
PubMed: 32409756
DOI: 10.1038/s41598-020-64802-x -
Radiologia Mar 2022There have always been concerns about the secondary effects of diagnostic methods that use ionizing radiation. During mammography, the parameters to be concerned about...
Mean glandular dose in the mammary gland and dose of radiation in the thyroid gland and lens in women with and without breast implants during different modalities of mammography.
UNLABELLED
There have always been concerns about the secondary effects of diagnostic methods that use ionizing radiation. During mammography, the parameters to be concerned about are the mean glandular dose and the scatter dose. We evaluated the dose of radiation to the breast, thyroid gland, and lens in digital mammography in women with and without implants, in tomosynthesis in women with and without implants, and in contrast-enhanced mammography.
MATERIALS AND METHODS
The study included 212 women with and without disease who were attended at the Centro Clínico de Estereotaxia, CECLINES, in Caracas, Venezuela, between June 2017 and August 2017; the women were classified into five groups according to the mammographic modality used to evaluate them and whether or not they had implants. The statistical analysis included descriptive statistics for the study population. We used the Mann-Whitney U to compare the mean glandular dose and dose in the thyroid gland and lens between groups.
RESULTS
The mean glandular dose and the dose of radiation received in the thyroid and lens were within the acceptable range. In a few exceptions, the mean glandular dose per view was slightly higher than 3 mGy. The scatter dose to the thyroid gland and the lens during mammography has a very small contribution to the annual dose equivalent.
CONCLUSION
The mean glandular dose and the scatter dose to the thyroid gland and lens delivered during tomosynthesis and 2D mammography in women with implants were higher than those delivered during other mammographic techniques in women without implants.
Topics: Breast Implants; Female; Humans; Male; Mammary Glands, Human; Mammography; Radiation Dosage; Thyroid Gland
PubMed: 35428461
DOI: 10.1016/j.rxeng.2020.10.013 -
Australian and New Zealand Journal of... Oct 2009A systematic review assessed the relative safety and effectiveness of digital mammography compared with film-screen mammography. This study utilised the evidence from... (Review)
Review
OBJECTIVE
A systematic review assessed the relative safety and effectiveness of digital mammography compared with film-screen mammography. This study utilised the evidence from the review to examine the economic value of digital compared with film-screen mammography in Australia.
METHODS
A cost-comparison analysis between the two technologies was conducted for the overall population for the purposes of breast cancer screening and diagnosis. In addition, a cost-effectiveness analysis was conducted for the screening subgroups where digital mammography was considered to be more accurate than film-screen mammography.
RESULTS
Digital mammography in a screening setting is $11 more per examination than film-screen mammography, and $36 or $33 more per examination in a diagnostic setting when either digital radiography or computed radiography is used. In both the screening and diagnostic settings, the throughput of the mammography system had the most significant impact on decreasing the incremental cost/examination/year of digital mammography.
CONCLUSION
Digital mammography is more expensive than film-screen mammography. Whether digital mammography represents good value for money depends on the eventual life-years and quality-adjusted life-years gained from the early cancer diagnosis.
IMPLICATIONS
The evidence generated from this study has informed the allocation of public resources for the screening and diagnosis of breast cancer in Australia.
Topics: Australia; Breast Neoplasms; Cost-Benefit Analysis; Humans; Mammography; Mass Screening; Resource Allocation
PubMed: 19811478
DOI: 10.1111/j.1753-6405.2009.00424.x -
Danish Medical Journal Apr 2013The rationale for breast cancer screening with mammography is deceptively simple: catch it early and reduce mortality from the disease and the need for mastectomies. But... (Review)
Review
The rationale for breast cancer screening with mammography is deceptively simple: catch it early and reduce mortality from the disease and the need for mastectomies. But breast cancer is a complex problem, and complex problems rarely have simple solutions. Breast screening brings forward the time of diagnosis only slightly compared to the lifetime of a tumour, and screen-detected tumours have a size where metastases are possible. A key question is if screening can prevent metastases, and if the screen-detected tumours are small enough to allow breast conserving surgery rather than mastectomy. A mortality reduction can never justify a medical intervention in its own right, but must be weighed against the harms. Overdiagnosis is the most important harm of breast screening, but has gained wider recognition only in recent years. Screening leads to the detection and treatment of breast cancers that would otherwise never have been detected because they grow very slowly or not at all and would not have been detected in the woman's lifetime in the absence of screening. Screening therefore turns women into cancer patients unnecessarily, with life-long physical and psychological harms. The debate about the justification of breast screening is therefore not a simple question of whether screening reduces breast cancer mortality. This dissertation quantifies the primary benefits and harms of screening mammography. Denmark has an unscreened "control group" because only two geographical regions offered screening over a long time-period, which is unique in an international context. This was used to study breast cancer mortality, overdiagnosis, and the use of mastectomies. Also, a systematic review of overdiagnosis in five other countries allowed us to show that about half of the screen-detected breast cancers are overdiagnosed. An effect on breast cancer mortality is doubtful in today's setting, and overdiagnosis causes an increase in the use of mastectomies. These findings are discussed in the context of tumour biology and stage at diagnosis. The information provided to women in invitations and on the Internet exaggerates benefits, participation is directly recommended, and the harms are downplayed or left out, despite agreement that the objective is informed choice. This raises an ethical discussion concerning autonomy versus paternalism, and the difficulty in weighing benefits against harms. Finally, financial, political, and professional conflicts of interest are discussed, as well as health economics.
Topics: Breast Neoplasms; Conflict of Interest; Decision Making; Early Detection of Cancer; Female; Humans; Mammography; Mastectomy; Neoplasm Metastasis; Patient Acceptance of Health Care; Risk Assessment
PubMed: 23651722
DOI: No ID Found -
American Family Physician Feb 2013Breast cancer is the most common non-skin cancer and the second leading cause of cancer death in North American women. Mammography is the only screening test shown to... (Review)
Review
Breast cancer is the most common non-skin cancer and the second leading cause of cancer death in North American women. Mammography is the only screening test shown to reduce breast cancer-related mortality. There is general agreement that screening should be offered at least biennially to women 50 to 74 years of age. For women 40 to 49 years of age, the risks and benefits of screening should be discussed, and the decision to perform screening should take into consideration the individual patient risk, values, and comfort level of the patient and physician. Information is lacking about the effectiveness of screening in women 75 years and older. The decision to screen women in this age group should be individualized, keeping the patient's life expectancy, functional status, and goals of care in mind. For women with an estimated lifetime breast cancer risk of more than 20 percent or who have a BRCA mutation, screening should begin at 25 years of age or at the age that is five to 10 years younger than the earliest age that breast cancer was diagnosed in the family. Screening with magnetic resonance imaging may be considered in high-risk women, but its impact on breast cancer mortality is uncertain. Clinical breast examination plus mammography seems to be no more effective than mammography alone at reducing breast cancer mortality. Teaching breast self-examination does not improve mortality and is not recommended; however, women should be aware of any changes in their breasts and report them promptly.
Topics: Adult; Age Factors; Aged; Breast Neoplasms; Breast Self-Examination; Early Detection of Cancer; Female; Humans; Magnetic Resonance Imaging; Mammography; Middle Aged; Practice Guidelines as Topic; Ultrasonography, Mammary
PubMed: 23418799
DOI: No ID Found -
Asian Pacific Journal of Cancer... Jan 2022While the past decades have seen a rise in the number of cases diagnosed with cancer, breast cancer in particular has become the most frequently diagnosed cancer in...
Analysing the Insights and Assessing the Impact of a Digital Mammography and Tomosynthesis Based 2-year Long Prospective Breast Screening Programme Organised in Western India.
BACKGROUND
While the past decades have seen a rise in the number of cases diagnosed with cancer, breast cancer in particular has become the most frequently diagnosed cancer in women over the past decade. The figures for associated mortality are on a decline in most Western and developed nations, but in contrast they continue to remain high in transitional nations like India.
MATERIALS AND METHODS
After receiving approval by IEC and IRB, we set-up a prospective 2-year long screening programme combined with outreach camps to ensure representation of the larger population and include urban, rural and tribal population. Strict screening criteria were enforced and trained female paramedical staff were assigned to the camp for patient counselling and breast cancer awareness. Investigation was performed at the tertiary care institute utilising both full-field digital breast mammography and tomosynthesis. Biopsy was advised for highly suspicious lesions.
RESULTS
The study encompassed n=1017 Indian women and revealed that 39% (n=397) of them belonged to 41-50 years age group. BIRADS categorisation of the lesions revealed that while majority (57%; n=580) women had no detectable abnormality, nearly 22% (n=224) had lesions suspected to be benign while 10% (n=99) of them had lesions with a suspicion of high index of malignancy. 43% (n=437) of the populace had dense breasts (type-C). Most of the BIRADS-5 lesions (36/38) were confirmed as malignant on histopathology.
CONCLUSION
We propose a model for screening mammography and also presents the results of this programme which we implemented to screen populace from a large and densely populated geographic region. The model was successful in being self-sustainable and received a good turnout on the back of community outreach breast awareness camps and by incentivizing the women by performing mammograms completely free of cost and also providing them reports.
Topics: Adult; Breast Neoplasms; Early Detection of Cancer; Female; Humans; India; Mammography; Middle Aged; Program Evaluation; Prospective Studies
PubMed: 35092402
DOI: 10.31557/APJCP.2022.23.1.327 -
BMC Public Health Aug 2023In Germany, all women aged 50-69 have been invited to biennial mammography screening since 2009. We aimed to assess longitudinal adherence over ten years in women aged...
BACKGROUND
In Germany, all women aged 50-69 have been invited to biennial mammography screening since 2009. We aimed to assess longitudinal adherence over ten years in women aged 50 in 2009 and characterize the different adherence groups.
METHODS
Using the German Pharmacoepidemiological Research Database (GePaRD, ~ 20% of the German population), we included women aged 50 in 2009 (baseline) with continuous health insurance coverage and without breast cancer or in-situ-carcinoma. We followed them until age 59 and categorized them according to mammography screening participation into the following groups: never, 1-2, 3-4, 5-6 times. We characterized these groups, inter alia, regarding the use of other preventive measures, non-screening mammography (i.e., mammography outside the organized screening program) and menopausal hormone therapy.
RESULTS
Overall, 82,666 women were included. Of these, 27.6% never participated in the screening program, 15.1% participated 1-2 times, 31.7% participated 3-4 times and 25.6% participated regularly (5-6 times). Among regular participants, 91% utilized other preventive measures (e.g., cervical cancer screening, general health checkup) before baseline as compared to 66% among non-participants. Menopausal hormone therapy was least common among non-participants (11% vs. 18% among regular participants). Among non-participants, the proportions using ≥ 1, ≥ 2, and ≥ 3 non-screening mammographies between age 50-59 were 25%, 18%, and 15%, respectively.
CONCLUSIONS
Using a large cohort based on claims data, this study provides novel insights into longitudinal adherence to the mammography screening program and the use of mammography outside of the program in Germany. Between age 50-59, 57% of eligible women participated at least three times in the German mammography screening program and 28% (~ 3 in 10 women) never participated. Among non-participants, 15% had at least three non-screening mammographies during this period, indicating potential gray screening. Participants more often utilized other preventive measures as compared to non-participants.
Topics: Humans; Female; Early Detection of Cancer; Uterine Cervical Neoplasms; Mammography; Breast Neoplasms; Databases, Factual
PubMed: 37653487
DOI: 10.1186/s12889-023-16589-5