The Burden of False-Positive Results in Analog and Digital Screening Mammography: Experience of the Nova Scotia Breast Screening Program

2014 ◽  
Vol 65 (4) ◽  
pp. 315-320 ◽  
Author(s):  
Jennifer I. Payne ◽  
Tetyana Martin ◽  
Judy S. Caines ◽  
Ryan Duggan
Keyword(s):  
False Positive ◽  
Screening Program ◽  
Task Force ◽  
Age Groups ◽  
Preventive Health Care ◽  
Screening Mammography ◽  
Age Group ◽  
Patients Âgés ◽  
Screening Performance ◽  
Screening Mammograms

Purpose The Canadian Task Force on Preventive Health Care released recommendations for breast cancer screening, in part, based on harms associated with screening. The purpose of this study was to describe the rate of false-positive (FP) screening mammograms and to describe the extent of the investigations after an FP. Methods A cohort was identified that consisted of all screening mammograms performed through the Screening Program (2000-2011) with patients ages 40-69 years at screening. Rates of FP screening mammograms were calculated as well as rates of further investigations required, including additional imaging, needle core biopsy, and surgery. Analyses were stratified by 10-year age group, screening status (first vs rescreen), and technology. Results A total of 608,088 screening mammograms were included. The FP rate varied by age group, and decreased with increasing age (digital, 40-49 years old, FP = 8.0%; 50-59 years old, FP = 6.3%; 60-69 years old, FP = 4.6%). The FP rate also varied by screening status (digital, first screen, FP = 12.0%; rescreen, FP = 5.6%), and this difference was consistent across age groups. The need for further investigation varied by age group, with invasive procedures being more heavily used as women age (digital, rescreen group, surgery: 40-49 years old, 1.1%; 50-59 years old 1.6%, 60-69 years old, 1.8%). Conclusions Both the FP screening mammogram rate and the degree to which further investigation was required varied by age group and screening status. Reporting on these rates should form part of the evaluation of screening performance.

scholarly journals Mammographic features and histopathological findings of interval breast cancers

2008 ◽  
Vol 49 (9) ◽  
pp. 975-981 ◽  
Author(s):  
S. Hofvind ◽  
B. Geller ◽  
P. Skaane
Keyword(s):  
Screening Program ◽  
Lymph Node Involvement ◽  
Screening Mammography ◽  
Tumor Characteristics ◽  
Breast Cancers ◽  
Interval Cancers ◽  
True Negative ◽  
Node Involvement ◽  
Screening Mammograms ◽  
Baseline Screening

Background: Interval cancers are considered a shortcoming in screening mammography due to less favorable prognostic tumor characteristics compared to screening-detected cancers and consequently a lower chance of survival from the disease. Purpose: To describe the mammographic features and prognostic histopathological tumor characteristics of interval breast cancers. Material and Methods: A total of 231 interval breast cancer cases diagnosed in prevalently screened women aged 50–69 years old were examined. Thirty-five percent of the cases were retrospectively classified as missed cancers, 23% as minimal sign, and 42% as true negative (including occult cancers) in a definitive classification performed by six experienced breast radiologists. The retrospective classification described the mammographic features of the baseline screening mammograms in missed and minimal-sign interval cancers, while histopathological reports were used to describe the tumor characteristics in all the subgroups of interval cancers. Results: Fifty percent of the missed and minimal-sign interval cancers combined presented poorly defined mass or asymmetric density, and 26% calcifications with or without associated density or mass at baseline screening. Twenty-seven percent of invasive tumors were <15 mm for missed and 47% for true interval cancers ( P<0.001). Lymph node involvement was more common in missed (49%) compared with the true cases (33%, P<0.05). Conclusion: Missed interval cancers have less prognostically favorable histopathological tumor characteristics compared with true interval cancers. Improving the radiologist's perception and interpretation by establishing systematic collection of features and implementation of organized reviews may decrease the number of interval cancers in a screening program.

Annual Mammography Screening: Is it Necessary?

2012 ◽  
Vol 78 (1) ◽  
pp. 104-106
Author(s):  
Veronica Hegar ◽  
Kristin Oliveira ◽  
Bharat Kakarala ◽  
Alicia Mangram ◽  
Ernest Dunn
Keyword(s):  
Breast Cancer ◽  
Breast Imaging ◽  
Task Force ◽  
Treatment Options ◽  
Retrospective Chart Review ◽  
Breast Cancer Diagnosis ◽  
Screening Mammography ◽  
Screening Mammograms ◽  
System 1 ◽  
Preventative Services

Recent recommendations from the U.S. Preventative Services Task Force suggest that screening mammography for women should be biennial starting at age 50 years and continue to age 74 years. With these recommendations in mind, we proposed a study to evaluate women at our institution in whom breast cancer is diagnosed within 1 year of a previously benign mammogram. A retrospective chart review was performed over a 4-year period. Only patients who had both diagnostic mammograms and previous mammograms performed at our institution and a pathologic diagnosis of breast cancer were included. Benign mammograms were defined as either Breast Imaging Reporting And Data System 1 or 2. Analysis of the time elapse between benign mammogram and subsequent mammogram indicative of the diagnosis of breast cancer was performed. A total of 205 patients were included. The average age was 64 years. From our results, 48 patients, 23 per cent of the total, had a documented benign mammogram at 12 months or less before a breast cancer diagnosis. One hundred forty-three (70%) patients had a benign mammogram at 18 months or less prior. This study raises concern that 2 years between screening mammograms may delay diagnosis and possible treatment options for many women.

scholarly journals Screening Mammography: There Is Value in Screening Women Aged 75 Years and Older

2019 ◽  
Vol 1 (3) ◽  
pp. 182-185 ◽  
Author(s):  
Stamatia Destounis ◽  
Andrea Arieno ◽  
Amanda Santacroce
Keyword(s):  
Cancer Detection ◽  
Surgical Intervention ◽  
Good Health ◽  
Screening Mammography ◽  
Age Group ◽  
Patient Demographics ◽  
Patient Screening ◽  
Screening Mammograms ◽  
Study Inclusion ◽  
Is Value

Abstract Objective Patient screening mammography records performed in women aged 75 years and older were reviewed to evaluate the value of screening in this population, by determining the incidence of cancer diagnosed and associated outcomes. Methods Data from patients aged 75 years and older who presented for screening mammography and underwent biopsy with resultant malignant pathology were retrospectively collected and analyzed to record patient demographics and outcomes. Results From 2007–2017, there were 763,256 screening mammography appointments in 130,232 patients, with 3716 patients diagnosed with 4412 screen-detected malignancies (5.8 per 1000 cancers). In women aged 75 years and older, 76,885 (76,885 per 130,232, 10.1%) screening mammograms were performed in 18,497patients, with 643 malignancies diagnosed in 614 women eligible for study inclusion (8.4 per 1000 cancers). Lesions frequently presented as a mass with or without calcifications (472 per 643, 73%). A majority (529 per 643, 82%) was invasive; 79% (507 per 643) stage 0 or 1, and 63% (407 per 643) grade 2 or 3. Lymph node–positive status was confirmed in 7% of patients (46 per 614). Surgical intervention was pursued by 98% of patients (599 per 614). Conclusion Screening mammograms in women aged 75 years and older comprise a small percentage of the total screening examinations; however, they represented a significant portion of all patients diagnosed with screen-detected cancers, showing a substantial cancer detection rate. Most tumors were low stage, intermediate to high grade, and invasive. The majority had treatment involving surgery, suggesting these women are in good health and want to pursue surgical intervention. Screening mammography should be performed in this age group.

scholarly journals Cytomorphometric Analysis of Cervical Papanicolaou Smear for Females with Gynecological Clinical Complaints

2021 ◽  
Vol 11 (1) ◽  
pp. 46-49
Author(s):  
Sahar Osman ◽  
Ehab Elmadenah ◽  
Osman Elmahi ◽  
Mubarak Alkarsani ◽  
Lienda Eltayeb ◽  
...  
Keyword(s):  
Pap Smear ◽  
Screening Program ◽  
Age Groups ◽  
Pap Test ◽  
Optical Microscope ◽  
Pap Smears ◽  
Age Group ◽  
Limited Information ◽  
Gynecological Diseases ◽  
A Prospective Study

Background: Limited information is provided on the quantitative cytomorphometric study of the cervical Pap test. The cervical Pap test is an important screening program for cervical cancer. A quantitative cytomorphometric examination of cervical Pap is used to accurately identify precancerous and cancerous lesions early and to reduce the occurrence and avoidance of invasive cancer. This study was aimed to assess the cytomorphological parameters (nuclear diameter [ND], cytoplasm diameter [CD], and nuclear-to-cytoplasmic ratio [N/C ratio]) of squamous epithelial cells from a cervical Pap smear. Methods and Results: A prospective study was performed on 142 consecutive cervical Pap smears from women with gynecological clinical complaints. The ND and CD were determined by the Optika optical microscope camera using a digitizer cursor in both axes. The final images were taken with an X40 magnification. The ND, CD, and the N/C ratio were then measured and expressed in micrometers. The women were classified into 5 age groups: 5(3.5%) in the age group of <19 years, 46(32%) in the 20-29 group, 67(47.2%) in the 30-39 group, 23(16.2%) in the 40-49 group, and 1(0.7%) woman was over age 50. There were no significant differences in the N/C ratio of superficial cells between age groups. The ND, CD, and the N/C ratio were significantly higher in women with clinical complaints than in women without clinical complaints Conclusion: Cytomorphometic analysis might assist in the identification of cellular alterations due to gynecological diseases and increase the sensitivity and accuracy of the Pap smear technique.

scholarly journals Cervical Cancer Registered in Two Developed Regions from Brazil: Upper Limit of Reachable Results from Opportunistic Screening

2018 ◽  
Vol 40 (06) ◽  
pp. 347-353 ◽  
Author(s):  
Julio Teixeira ◽  
Carlos Maestri ◽  
Helymar Machado ◽  
Luiz Zeferino ◽  
Newton Carvalho
Keyword(s):  
Cervical Cancer ◽  
Screening Program ◽  
Age Groups ◽  
Cancer Registries ◽  
Trend Test ◽  
Opportunistic Screening ◽  
Age Group ◽  
Number Pattern ◽  
Armitage Trend Test ◽  
Histologic Types

Objective The aim of this study was to assess the time trends and pattern of cervical cancer diagnosed in the period from 2001 to 2012 by means of an opportunistic screening program from two developed regions in Brazil. Methods An observational study analyzing 3,364 cancer records (n = 1,646 from Campinas and n = 1,718 from Curitiba region) available in hospital-based cancer registries was done. An additional 1,836 records of CIN3/AIS from the region of Campinas was analyzed. The statistical analysis assessed the pooled data and the data by region considering the year of diagnosis, age-group, cancer stage, and histologic type. The Cochran-Armitage trend test was applied and p-values < 0.05 were considered significant. Results The total annual cervical cancer registered from 2001 to 2012 showed a slight drop (273–244), with an age average of 49.5 y, 13 years over the average for CIN3/AIS (36.8 y). A total of 20.6% of the diagnoses (1.6% under 25 y) were done out of the official screening age-range. The biennial rate of diagnoses by age group for the region of Campinas showed an increase trend for the age groups under 25 y (p = 0.007) and 25 to 44 y (p = 0.003). Stage III was the most recorded for both regions, with an annual average of 43%, without any trend modification. There was an increasing trend for stage I diagnoses in the region of Campinas (p = 0.033). The proportion of glandular histologic types registered had an increased trend over time (p = 0.002), higher for the region of Campinas (21.1% versus 12.5% for the region of Curitiba). Conclusion The number, pattern and trends of cervical cancer cases registered had mild and slow modifications and reflect the limited effectivity of the opportunistic screening program, even in developed places.

Adult Preventive Health Care

2013 ◽  
Author(s):  
Jennifer S Haas
Keyword(s):  
United States ◽  
Primary Care ◽  
Screening Program ◽  
Task Force ◽  
Preventive Services ◽  
Lung Cancer Screening ◽  
Preventive Health Care ◽  
The United States ◽  
Quarter Century ◽  
Advantages And Disadvantages

Over the past quarter century, prevention has become a major activity in primary care. During a typical day, primary care clinicians spend much of their time managing asymptomatic conditions in which the main goal is to prevent death or complications (e.g., hypertension, hyperlipidemia, osteoporosis). This chapter focuses primarily on preventive screening recommendations from the United States Preventive Services Task Force (USPSTF). The rationale and evolution of preventive care guidelines are discussed. Advantages and disadvantages of cervical, colorectal, breast, prostate, ovarian and lung cancer screening are explained, along with recommendations regarding behavioral counseling, especially for smoking cessation and alcohol use. Graphs are included. Tables delineate major causes of death in the United States, criteria for evaluating a screening program, sample board examination questions about screening, government-sponsored preventive guidelines programs, the USPSTF grading system, strongly recommended noncancer preventive services in adults, the recommended adult immunization schedule, recommended and strongly recommended measures for cancer prevention, recommended preventive noncancer screening measures, and selected recommendations for counseling and patient education. This review contains 5 figures, 10 tables, and 77 references.

Canadian Radiologists Do Not Support Screening Mammography Guidelines of the Canadian Task Force on Preventive Health Care

2017 ◽  
Vol 68 (3) ◽  
pp. 257-266 ◽  
Author(s):  
Jean M. Seely ◽  
Jiyon Lee ◽  
Gary J. Whitman ◽  
Paula B. Gordon
Keyword(s):  
Health Care ◽  
Online Survey ◽  
Task Force ◽  
Preventive Health Care ◽  
Screening Mammography ◽  
Preventive Health ◽  
Entire Group ◽  
Average Risk ◽  
Risk Patients

Purpose The study sought to determine screening mammography recommendations that radiologists in Canada promote to average-risk patients and family or friends, and do or would do for themselves. Methods An online survey was delivered from February 19, 2014, to July 11, 2014. Data included radiologists' recommendations for mammography and their personal screening habits based on gender. The 3 radiologists' cohorts were women ≥40 years of age, women <40 years of age, and men. The distribution of responses for each question was summarized, and proportions for the entire group and individual cohorts were computed. Results Of 402 surveys collected, 97% (299 of 309) radiologists recommended screening every 1-2 years, 62% (192 of 309) starting ≥40 years of age and 2% (5 of 309) recommended screening every 2-3 years for women 50-74 years of age. Recommendations were similar for family and friends: 96% (294 of 305) recommended screening every 1-2 years, 66% (202 of 305) recommended screening every 1-2 years for women ≥40 years of age, and 2% (5 of 305) recommended screening every 2-3 years. For women radiologists ≥40 years of age, 76% (48 of 63) underwent screening every 1-2 years and started at 40 years of age, 76% (16 of 21) female radiologists <40 years of age would undergo screening ≥40 years of age, 100% every 1-2 years, and 90% (151 of 167) male radiologists would undergo screening every 1-2 years, with 71% (120 of 169) beginning at 40 years of age. Conclusion The majority of Canadian radiologists recommend screening mammography every 1-2 years for average-risk women ≥40 years of age, whether they are patients or family and friends.

Attendance of the fourth (2008–2009) screening round of the Hungarian organized, nationwide breast cancer screening program

2013 ◽  
Vol 154 (50) ◽  
pp. 1975-1983 ◽  
Author(s):  
Imre Boncz ◽  
Lajos Döbrőssy ◽  
Zoltán Péntek ◽  
Attila Kovács ◽  
András Budai ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Screening Programme ◽  
Screening Program ◽  
Target Population ◽  
Screening Mammography ◽  
Insurance Fund ◽  
Age Group ◽  
Attendance Rate ◽  
Cancer Screening Program ◽  
Diagnostic Mammography

Introduction: Organised, nationwide screening for breast cancer with mammography in the age group between 45 and 65 years with 2 years screening interval started in Hungary in January 2002. Aim: The aim of this study is to analyze the attendance rate of nationwide breast screening programme for the 2008–2009 years. Method: The data derive from the database of the National Health Insurance Fund Administration. The ratio of women in the age group 45–65 years was calculated having either a screening mammography or a diagnostic mammography in the 4th screening round of the programme. Results: In the years 2000–2001, 7.6% of the women had an opportunistic screening mammography while in 2008–2009 31.2% of the target population had screening mammography within the organized programme. During the same periods 20.2% (2000–2001) and 20.4% (2008–2009) of women had a diagnostic mammography. Thus the total (screening and diagnostic) coverage of mammography increased from 26.6% (2000–2001) to 50.1% (2008–2009). The attendance rate failed to change between 2002 and 2009. Conclusions: In order to decrease the mortality due to breast cancer, the attendance rate of mammography screening programme should be increased. Orv. Hetil., 154(50), 1975–1983.

scholarly journals Questioning the benefits of current screening protocols for common cancers

2016 ◽  
Vol 85 (2) ◽  
pp. 44-46
Author(s):  
Stefan Rodic ◽  
Ariel Gershon
Keyword(s):  
Breast Cancer ◽  
Sensitivity And Specificity ◽  
Task Force ◽  
Specific Antigen ◽  
Age Groups ◽  
Clinical Signs ◽  
Preventive Health Care ◽  
Net Benefit ◽  
Specificity And Sensitivity ◽  
Asymptomatic Patients

Screening is the application of a diagnostic test to a population of patients without suspicious clinical signs or symptoms of a disease. Applying screening protocols to detect cancer is especially attractive as cancer is a growing burden and earlier detection of malignancies can lead to better outcomes. While the initial excitement over screening for cancers has caused protocols to be put into practice, data analysis has cast doubt on the net benefit. Prostate-specific antigen (PSA) blood testing has been used as a screening test for prostate cancer. The harms of a positive PSA screen include invasive investigations and treatments with side effects such as infection and incontinence. The poor sensitivity and specificity of PSA screening caused the Canadian Task Force on Preventive Health Care to recommend against PSA as a screening tool. Similarly, mammography and ultrasound for detecting breast cancer lesions in asymptomatic women suffer from relatively low sensitivity and specificity. The harms of screening include emotional stress and invasive surgical procedures. Meta-analyses reveal that the risks outweigh the benefits for some age groups, but there may be a role in screening asymptomatic patients with a family history of breast cancer with more sensitive but more expensive modalities, such as magnetic resonance imaging (MRI). Finally, colonoscopy, which is the gold standard to diagnose colorectal cancers, has failed to show net benefit in screening. While screening protocols thus far have provided underwhelming results, the key in screening in the future may lie in using tests with high specificity and sensitivity, as in next generation screening modalities that rely on molecular markers and analytics.

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