Breast Disease - Volume 10, issue 3-4

Authors: Lui, Edison T.

Article Type: Editorial

DOI: 10.3233/BD-1998-103-401

Citation: Breast Disease, vol. 10, no. 3-4, pp. 1-1, 1998

Authors: Pisano, Etta D.

Article Type: Introduction

DOI: 10.3233/BD-1998-103-402

Citation: Breast Disease, vol. 10, no. 3-4, pp. 3-4, 1998

Authors: Langer, Amy S.

Article Type: Research Article

DOI: 10.3233/BD-1998-103-403

Citation: Breast Disease, vol. 10, no. 3-4, pp. 7-11, 1998

Authors: Feig, Stephen A. | Kopans, Daniel B. | Sickles, Edward A. | Jackson, Valerie P. | Monsees, Barbara

Article Type: Research Article

Abstract: Proof of the benefit for mammographic screening of women ages 40–49 years is now available. Randomized controlled trials (RCTs) conducted in Gothenburg and Malmo, Sweden have shown statistically significant breast cancer mortality reductions of 36% and 45% respectively. A meta-analysis of all five Swedish trials has found a statistically significant mortality reduction of 29% for woman in this age group. Substantially greater reductions in mortality would likely have resulted if women in these trials had been screened annually. Because the benefits are substantial, and the risks from screening are relatively small and acceptable, screening mammography beginning at age 40 is …now recommended by the American Cancer Society, as well as the National Cancer Institute. Show more

DOI: 10.3233/BD-1998-103-404

Citation: Breast Disease, vol. 10, no. 3-4, pp. 13-21, 1998

Authors: Berry, Donald A.

Article Type: Research Article

Abstract: Nonrandomized screening studies and some analyses of randomized data are subject to enormous biases. Many such analyses have the goal of showing that screening mammography is beneficial. They masquerade as science but are extreme examples of lying with statistics. Randomized trials have provided mixed results concerning whether screening reduces breast cancer mortality. Estimates from these trials are subject to a great deal more variability than traditional meta-analyses belie. A blanket recommendation for the screening of women in their forties is inappropriate, and it is a disservice to these women. Regular screening mammography of women in this age group is not …an imperative health measure. If it is beneficial, its benefits are limited: taking the results of the randomized trials at face value, regular screening adds about five days in life expectancy per woman. In addition, screening has many significant risks.Those who are most concerned about their health will probably discount the risks and choose regular screening, and reasonably so. Others will eschew screening, also reasonably so. Show more

DOI: 10.3233/BD-1998-103-405

Citation: Breast Disease, vol. 10, no. 3-4, pp. 23-32, 1998

Authors: Richards, Chesley L. | Viadro, Claire I. | Earp, Jo Anne

Article Type: Research Article

Abstract: Although mammography screening is effective in reducing breast cancer mortality, major challenges still remain in increasing rates of initial mammography and in improving subsequent adherence to mammography screening. Behavioral science theories offer insights into the potential for individual, organizational, community, and population-level interventions to address these challenges. In this review, we draw on social ecological approaches to health promotion to suggest a conceptual framework for such interventions. After discussing theories of who is and is not screened regularly, and why, we consider selected barriers to mammography and corresponding interventions to overcome them. We conclude with an illustration of the North …Carolina Breast Cancer Screening Program (NC-BCSP), a series of interventions informed by the social ecological perspective. Show more

DOI: 10.3233/BD-1998-103-406

Citation: Breast Disease, vol. 10, no. 3-4, pp. 33-44, 1998

Authors: Somkin, Carol P. | Hiatt, Robert A.

Article Type: Research Article

Abstract: In this paper, we describe the attributes of a comprehensive approach to breast cancer screening possible in an integrated health care system. We define an integrated health care system as one in which comprehensive preventive and medical care is provided to a defined population, by a defined panel of providers, and in which this care can be tracked using automated electronic data systems. Guided by the Pathways Conceptual Framework, it is possible to identify and systematically address (through research and interventions) the multiple predisposing, enabling, and reinforcing factors at the individual and organizational level associated with each step along the …screening process. This framework is helpful as both a planning and an evaluation tool, in identifying places in the screening and follow-up process that could benefit from concerted quality improvement efforts and in guiding an evaluation of those efforts. We describe examples from research and organizational programmatic efforts, and use the framework to point to additional areas for further investigation and potential organizational intervention.These examples use a variety of research methods, impact the breast cancer screening pathway in different places, and therefore show how it is possible to approach the broad issue of reduction of breast cancer mortality from multiple perspectives. Integrated health care systems, unlike more traditional academic settings, are well suited to supporting this full spectrum of research while also providing the context for its application. Show more

DOI: 10.3233/BD-1998-103-407

Citation: Breast Disease, vol. 10, no. 3-4, pp. 45-53, 1998

Authors: Jackson, Valerie P. | Bassett, Lawrence W.

Article Type: Research Article

Abstract: Ultrasonography (US) is well established as the most useful adjunctive breast imaging modality. While the traditional role of ultrasonography has been to differentiate between cystic and solid breast masses, recent advances in ultrasound technology and interpretation have the potential to expand greatly the role of this modality in the evaluation of breast disease. This paper reviews the current status of sonography as used in clinical practice and examines recent progress in equipment, technique, and interpretation of breast ultrasonography.

DOI: 10.3233/BD-1998-103-408

Citation: Breast Disease, vol. 10, no. 3-4, pp. 55-66, 1998

Authors: DeAngelis, Gia A. | Fajardo, Laurie L. | Harvey, Jennifer A. | Hatwal, Namrata | Moran, Ruth E.

Article Type: Research Article

Abstract: Increasingly, biopsies for suspected breast abnormalities are conducted by percutaneous needle extraction of core samples rather than by standard surgical excision or fine-needle aspiration (FNA) of cellular material. Core-needle biopsies are highly accurate and have many advantages over surgical excisions, including reduction of the morbidity and cost of breast disease diagnosis. Limitations include differentiating atypical ductal hyperplasia from ductal carcinoma in situ. Equipment and technique for stereotactic and ultrasound-guided core breast biopsy are discussed. Appropriate indications for core-needle biopsy, excisional biopsy after needle localization, and FNA are provided. Appropriate management after core-needle biopsy includes the establishment of concordance of histologic …results with the level of suspicion of the mammographic findings to prevent false-negative core biopsies. A recommendation for return to regular mammographic screening, short-interval (6-month) mammographic follow-up, or repeat core or surgical appearance depends on this correlation. Show more

DOI: 10.3233/BD-1998-103-409

Citation: Breast Disease, vol. 10, no. 3-4, pp. 67-81, 1998

Authors: McLelland, Robert | Braeuning, M. Patricia | Burke, Eithne T.

Article Type: Research Article

Abstract: There are numerous political issues concerned with the roles of breast imaging in the detection, diagnosis, and management of breast cancer. These include issues regarding screening mammography, quality control, and results including cost-effectiveness of medical-legal considerations, but also their relation to overall health care of other societal needs.

DOI: 10.3233/BD-1998-103-410

Citation: Breast Disease, vol. 10, no. 3-4, pp. 83-93, 1998