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Siebers CCN, Appelman L, Appelman PTM, Go S, van Oirsouw MCJ, Broeders MJM, Mann RM. Women's Experiences with Digital Breast Tomosynthesis and Targeted Breast Ultrasound for Focal Breast Complaints: A Survey Study. J Womens Health (Larchmt) 2024; 33:499-501. [PMID: 38386779 DOI: 10.1089/jwh.2023.0502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Background: Owing to its high sensitivity, as concluded in the Breast UltraSound Trial (BUST), targeted ultrasound (US) now seems a promising accurate stand-alone modality for diagnostic evaluation of breast complaints. This approach implies omission of bilateral digital breast tomosynthesis (DBT) in women with clearly benign US findings. Within BUST, radiologists started with US followed by DBT. This side-study investigates women's experiences with DBT, their main motivation to undergo diagnostic imaging, and their view on US as a stand-alone modality. Methods: A subset of BUST participants completed a questionnaire on their DBT experiences, reason for undergoing diagnostic assessment, and view on US-only diagnostics. Responses were analyzed with descriptive statistics and logistic regression analyses. Results: In total, 778 of 838 women (response rate 92.8%) were included (M = 47, SD = 11.16). Of them, 16.8% reported no burden of DBT, 33.5% slight burden, 31.0% moderate, and 12.7% severe burden. Furthermore, 13% reported no pain, 35.3% slight pain, 33.2% moderate, and 11.3% severe pain. Moreover, 88.3% indicated that the most important reason for breast assessment was explanation of their complaint and to rule out breast cancer, whereas 3.2% wanted to "check" both breasts. And 82.4% reported satisfaction with US only in case of a nonmalignancy. Conclusions: Our study shows that most women in the diagnostic setting experience at least slight-to-moderate DBT-related burden and pain, and that explanation for their symptoms is their main interest. Also, the majority report satisfaction with US only in case of nonmalignant findings. However, exploration of women's perspectives outside this study is needed as our participants all underwent both examinations.
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Affiliation(s)
- Carmen C N Siebers
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Linda Appelman
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter T M Appelman
- Department of Radiology, St. Antonius Hospital, Utrecht, The Netherlands
| | - Shirley Go
- Department of Radiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Marja C J van Oirsouw
- Patient advocate on behalf of the Dutch Breast Cancer Society (Borstkankervereniging Nederland), Utrecht, The Netherlands
| | - Mireille J M Broeders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Expert Centre for Screening, Nijmegen, The Netherlands
| | - Ritse M Mann
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Yuge S, Miyake KK, Ishimori T, Kataoka M, Matsumoto Y, Torii M, Yakami M, Isoda H, Takakura K, Morita S, Takada M, Toi M, Nakamoto Y. Performance of dedicated breast PET in breast cancer screening: comparison with digital mammography plus digital breast tomosynthesis and ultrasound. Ann Nucl Med 2023; 37:479-493. [PMID: 37280410 DOI: 10.1007/s12149-023-01846-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/11/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To compare the diagnostic performance of dedicated breast positron emission tomography (dbPET) in breast cancer screening with digital mammography plus digital breast tomosynthesis (DM-DBT) and breast ultrasound (US). METHODS Women who participated in opportunistic whole-body PET/computed tomography cancer screening programs with breast examinations using dbPET, DM-DBT, and US between 2016-2020, whose results were determined pathologically or by follow-up for at least 1 year, were included. DbPET, DM-DBT, and US assessments were classified into four diagnostic categories: A (no abnormality), B (mild abnormality), C (need for follow-up), and D (recommend further examination). Category D was defined as screening positive. Each modality's recall rate, sensitivity, specificity, and positive predictive value (PPV) were calculated per examination to evaluate their diagnostic performance for breast cancer. RESULTS Out of 2156 screenings, 18 breast cancer cases were diagnosed during the follow-up period (10 invasive cancers and eight ductal carcinomas in situ [DCIS]). The recall rates for dbPET, DM-DBT, and US were 17.8%, 19.2%, and 9.4%, respectively. The recall rate of dbPET was highest in the first year and subsequently decreased to 11.4%. dbPET, DM-DBT, and US had sensitivities of 72.2%, 88.9%, and 83.3%; specificities of 82.6%, 81.4%, and 91.2%; and PPVs of 3.4%, 3.9%, and 7.4%, respectively. The sensitivities of dbPET, DM-DBT, and US for invasive cancers were 90%, 100%, and 90%, respectively. There were no significant differences between the modalities. One case of dbPET-false-negative invasive cancer was identified in retrospect. DbPET had 50% sensitivity for DCIS, while that of both DM-DBT and US was 75%. Furthermore, the specificity of dbPET in the first year was the lowest among all periods, and modalities increased over the years to 88.7%. The specificity of dbPET was significantly higher than that of DM-DBT (p < 0.01) in the last 3 years. CONCLUSIONS DbPET had a compatible sensitivity to DM-DBT and breast US for invasive breast cancer. The specificity of dbPET was improved and became higher than that of DM-DBT. DbPET may be a feasible screening modality.
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Affiliation(s)
- Shunsuke Yuge
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kanae K Miyake
- Department of Advanced Medical Imaging Research, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Takayoshi Ishimori
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masako Kataoka
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshiaki Matsumoto
- Preemptive Medicine and Lifestyle-Related Disease Research Center, Kyoto University Hospital, Kyoto, Japan
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masae Torii
- Department of Breast Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Masahiro Yakami
- Preemptive Medicine and Lifestyle-Related Disease Research Center, Kyoto University Hospital, Kyoto, Japan
| | - Hiroyoshi Isoda
- Preemptive Medicine and Lifestyle-Related Disease Research Center, Kyoto University Hospital, Kyoto, Japan
| | - Kyoko Takakura
- Preemptive Medicine and Lifestyle-Related Disease Research Center, Kyoto University Hospital, Kyoto, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahiro Takada
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masakazu Toi
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Abstract
Breast cancer is the second leading cause of cancer mortality in adult women in the United States. Screening mammography reduces breast cancer mortality between 22% and 48%; however, screening mammography remains underutilized. Screening mammography utilization data are available from insurance claims, electronic medical records, and patient self-report via surveys, and each data source has unique benefits and challenges. Numerous barriers exist that adversely affect the use of screening mammography in the United States. This article will review screening mammography utilization in the United States, explore factors that impact utilization, and briefly discuss strategies to improve utilization.
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Affiliation(s)
- Kimberly Funaro
- H. Lee Moffitt Cancer Center and Research Institute, Department of Diagnostic Imaging, Tampa, FL, USA
| | - Bethany Niell
- H. Lee Moffitt Cancer Center and Research Institute, Department of Diagnostic Imaging, Tampa, FL, USA
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Lee ES, Kim Y, Shin HC, Hwang KT, Min J, Kim MK, Ahn S, Jung SY, Shin H, Chung M, Yoo TK, Jung S, Woo SU, Kim JY, Noh DY, Moon HG. Diagnostic accuracy of a three-protein signature in women with suspicious breast lesions: a multicenter prospective trial. Breast Cancer Res 2023; 25:20. [PMID: 36788595 PMCID: PMC9930228 DOI: 10.1186/s13058-023-01616-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Mammography screening has been proven to detect breast cancer at an early stage and reduce mortality; however, it has low accuracy in young women or women with dense breasts. Blood-based diagnostic tools may overcome the limitations of mammography. This study assessed the diagnostic performance of a three-protein signature in patients with suspicious breast lesions. FINDINGS This trial (MAST; KCT0004847) was a prospective multicenter observational trial. Three-protein signature values were obtained using serum and plasma from women with suspicious lesions for breast malignancy before tumor biopsy. Additionally, blood samples from women who underwent clear or benign mammography were collected for the assays. Among 642 participants, the sensitivity, specificity, and overall accuracy values of the three-protein signature were 74.4%, 66.9%, and 70.6%, respectively, and the concordance index was 0.698 (95% CI 0.656, 0.739). The diagnostic performance was not affected by the demographic features, clinicopathologic characteristics, and co-morbidities of the participants. CONCLUSIONS The present trial showed an accuracy of 70.6% for the three-protein signature. Considering the value of blood-based biomarkers for the early detection of breast malignancies, further evaluation of this proteomic assay is warranted in larger, population-level trials. This Multi-protein Assessment using Serum to deTermine breast lesion malignancy (MAST) was registered at the Clinical Research Information Service of Korea with the identification number of KCT0004847 ( https://cris.nih.go.kr ).
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Affiliation(s)
- Eun-Shin Lee
- grid.222754.40000 0001 0840 2678Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yumi Kim
- grid.410886.30000 0004 0647 3511Division of Breast Surgery, Cha Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| | - Hee-Chul Shin
- grid.412480.b0000 0004 0647 3378Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ki-Tae Hwang
- grid.412479.dDepartment of Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Junwon Min
- grid.411982.70000 0001 0705 4288Department of Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Min Kyoon Kim
- grid.254224.70000 0001 0789 9563Department of Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - SooKyung Ahn
- grid.256753.00000 0004 0470 5964Department of Surgery, Breast and Thyroid Center, Kangnam Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea
| | - So-Youn Jung
- grid.410914.90000 0004 0628 9810Center for Breast Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Hyukjai Shin
- grid.416355.00000 0004 0475 0976Breast and Thyroid Care Center, Myongji Hospital, Goyang, Republic of Korea
| | - MinSung Chung
- grid.49606.3d0000 0001 1364 9317Department of Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Tae-Kyung Yoo
- grid.411947.e0000 0004 0470 4224Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seungpil Jung
- grid.222754.40000 0001 0840 2678Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sang Uk Woo
- grid.222754.40000 0001 0840 2678Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ju-Yeon Kim
- grid.256681.e0000 0001 0661 1492Department of Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Dong-Young Noh
- grid.410886.30000 0004 0647 3511Division of Breast Surgery, Cha Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea ,grid.412484.f0000 0001 0302 820XDepartment of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeong-Gon Moon
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea. .,Genomic Medicine Institute, Medical Research Center, Seoul National University, Seoul, Republic of Korea. .,Cancer Research Institute, Seoul National University, Seoul, Republic of Korea.
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Siebers CCN, Appelman L, van Oirsouw MCJ, Appelman PTM, Go S, Mann RM. The Effect of Targeted Ultrasound as Primary Imaging Modality on Quality of Life in Women with Focal Breast Complaints: A Comparative Cohort Study. J Womens Health (Larchmt) 2023; 32:71-77. [PMID: 36318794 DOI: 10.1089/jwh.2022.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: The high diagnostic performance of modern breast ultrasound (US) opens the possibility to shift toward targeted US as initial imaging test in women with breast complaints. This comparative cohort study investigates the effects of starting with US followed by digital breast tomosynthesis (DBT), as practiced in the breast ultrasound study (BUST), on women's health-related quality of life (QoL). Methods: Fifty BUST participants and 50 "controls" who underwent DBT and US in regular order filled out the EQ-5D-3L three times during their visit: BUST participants before US (T1), after US (T2), and after DBT (T3) and non-BUST participants before DBT (T1), after DBT (T2), and after US (T3). Changes in QoL from baseline to T2 and T3 were assessed using generalized least squares, also taking into account the effects of biopsy, age, and complaint type. Results: Participants' mean age was 50.6 years (BUST: SD = 12.1, controls: SD = 11.5). At T2 the overall QoL was higher [t(102.9) = 2.4, p = 0.017] and anxiety levels were lower [t(98.7) = -2.4, p = 0.020] in BUST participants compared with controls. However, from T2 to T3 these effects equalize, resulting in similar performances in QoL and anxiety at T3, respectively [t(97.6) = -2.3, p = 0.023] and [t(97.2) = 3.1, p = 0.002]. Compared with BUST participants, controls show a clear decrease in pain after US [t(106.5) = -2.8, p = 0.006]. Women undergoing biopsy had lower QoL [t(167.1) = -2.4, p = 0.017] and pain [t(154.1) = -2.1, p = 0.038], and more anxiety [t(187.4) = 4.3, p = 0.000]. Conclusions: The results suggest that changing the radiological order by starting with US has a short-term positive effect on overall QoL, anxiety, and DBT pain experience in symptomatic women. Owing to its negative impact, biopsies should be performed cautiously. In conclusion, the moment of reassurance for women advances by reversing the radiological order according to the BUST, showing the high importance of human interaction in diagnostic care in addition to the clinical performance of imaging modalities.
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Affiliation(s)
- Carmen C N Siebers
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Linda Appelman
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marja C J van Oirsouw
- Patient Advocate on Behalf of the Dutch Breast Cancer Society (Borstkanker Vereniging Nederland), Utrecht, The Netherlands
| | - Peter T M Appelman
- Department of Radiology, St. Antonius Hospital, Utrecht, The Netherlands
| | - Shirley Go
- Department of Radiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Ritse M Mann
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Abstract
Anxiety is often cited as a risk of screening mammography, and organizations such as the U.S. Preventive Services Task Force list anxiety as a screening-associated "harm" that should be mitigated. However, the level of mammography-related anxiety risk is difficult to assign clearly for myriad reasons, including the variability of individuals' baseline susceptibility to anxiety, the self-reported nature of subjective anxiety states, and the multiple sources of breast cancer screening-related anxiety. In addition, anxiety measures differ between studies and psychological responses to screening mammography vary across racial and ethnic groups. Nonetheless, breast radiology practices should acknowledge the existence of mammography-associated anxiety and consider strategies to decrease it. These strategies include immediate screening interpretations, patient education efforts, and relaxation techniques.
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Affiliation(s)
- Vilert A Loving
- Banner MD Anderson Cancer Center, Division of Diagnostic Imaging, Gilbert, AZ, USA
| | | | - Jessica W T Leung
- The University of Texas MD Anderson Cancer Center, Department of Breast Imaging, Houston, TX, USA
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7
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Huang CH, Lo YJ, Kuo KM, Lu IC, Wu H, Hsieh MT, Liu IT, Lin YC, Lai YC, Huang RY, Hung WC, Lin CW. Health literacy and cancer screening behaviors among community-dwelling female adults in Taiwan. Women Health 2021; 61:408-419. [PMID: 33902386 DOI: 10.1080/03630242.2021.1917477] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study was designed to explore the association among health literacy and cancer screening behaviors in Taiwanese females. A total of 353 community-dwelling females were recruited in this cross-sectional study from February to October 2015. Demographic, socioeconomic and personal behavior variables including physical activity, community activity, smoking, alcohol consumption, and betel nut chewing were recorded. Health literacy was evaluated using the Mandarin version of the European Health Literacy Survey Questionnaire. Data on screening behaviors for cervical, breast and colorectal cancers were confirmed by the Taiwanese National eHealth Database. Most respondents with inadequate or problematic general health literacy had no or irregular screening behaviors for cervical, breast and colorectal cancers. In multivariable regression analysis, women with inadequate health literacy were at a greater risk (Odds ratio = 5.71; 95% CI: 1.40-23.26) of having no previous Pap smear screening or >3 years screening interval regardless of education level. However, this association was not detected for breast or colorectal cancer. Women with inadequate health literacy were more likely to have irregular cervical cancer screening, however no associations among health literacy and breast or colorectal cancer were detected. The impact of health literacy on cancer screening behavior warrants further attention and research.
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Affiliation(s)
- Chi-Hsien Huang
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
| | - Yen-Ju Lo
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan
| | - Kuang-Ming Kuo
- Department of Business Management, National United University, Miaoli County, Taiwan
| | - I-Cheng Lu
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
| | - Hsing Wu
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan.,Department of Information Management, National Yunlin University of Science and Technology, Yunlin County, Taiwan
| | - Ming-Ta Hsieh
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan
| | - I-Ting Liu
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
| | - Yu-Ching Lin
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan
| | - Yu-Cheng Lai
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan
| | - Ru-Yi Huang
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan.,Center for International Medical Education, E-Da Hospital, Kaohsiung City, Taiwan
| | - Wei-Chieh Hung
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan.,Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Chi-Wei Lin
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
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van Lier MGJTB, de Groot JE, Muller S, den Heeten GJ, Schilling KJ. Pressure-based Compression Guidance of the Breast in Digital Breast Tomosynthesis Using Flexible Paddles Compared to Conventional Compression. J Breast Imaging 2020; 2:541-551. [PMID: 38424851 DOI: 10.1093/jbi/wbaa070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE We investigated the effect of introducing a pressure-based flexible paddle on compression parameters and user and patient experience of digital breast tomosynthesis (DBT) combined with patient-assisted compression or technologist compression. METHODS After institutional review board approval, women with a DBT appointment who gave informed consent received pressure-based flexible paddle breast compression. Eight lights on the paddle were illuminated (1.9 kPa per light) as pressure was applied, aiming for an 8-13.9 kPa target range. The compression level was applied by the technologist or the participant utilizing a remote control device. The participant's and technologist's experiences were assessed by a questionnaire. Compression parameters were compared to previous examinations. Comparative statistics were performed using t-tests. RESULTS Pressure-based compression (PBC) was judged to be similar or more comfortable compared with previous traditional exams (80%, 83/103), and 87% (90/103) of participants would recommend PBC to friends. Pressure variability decreased for craniocaudal (CC) views (-55%, P < 0.001) and mediolateral oblique (MLO) views (-34%, P < 0.0001). Subgroup analysis showed a similar glandular dose for CC views, while breast thickness was reduced (-3.74 mm, P < 0.0001). For MLO views, both glandular dose (-0.13 mGy, P < 0.0001) and breast thickness were reduced (-6.70 mm, P < 0.0001). Mean compression parameters were similar for technologist compression and patient-assisted examinations. CONCLUSION Use of the pressure-based flexible paddle in DBT, with or without patient-assisted compression, improved participant and technologist experience and reduced compression pressure variability, mean breast thickness, and glandular dose.
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Affiliation(s)
| | | | | | - Gerard J den Heeten
- Sigmascreening, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, The Netherlands
| | - Kathy J Schilling
- Christine E. Lynn Women's Health & Wellness Institute, Boca Raton Regional Hospital, Boca Raton, FL
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9
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Nelson DJ, England A, Cheptoo M, Mercer CE. A comparative study of pain experienced during successive mammography examinations in patients with a family history of breast cancer and those who have had breast cancer surgery. Radiography (Lond) 2020; 26:76-81. [PMID: 31902459 DOI: 10.1016/j.radi.2019.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/29/2019] [Accepted: 08/31/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION To measure mammography-related pain in two groups of women undergoing regular surveillance as a baseline for future care. METHODS Following ethical approval, two hundred and forty two women aged 32-84 years (mean 54), were invited by written invitation to participate in the study. Two hundred women accepted the invitation, 100 women had a family history (FH) of breast cancer, 100 had undergone conservative surgery (FU) for breast cancer and were currently asymptomatic. A validated pain scale was used to score the participants' perceived pain before compression based on memory, immediately after compression and one week later. A series of baseline parameters were also captured including compression force, breast size/density, menstrual history and any adverse events following mammography to allow the investigation of relationships. RESULTS There was a strong correlation (r = 0.79, p < 0.001) between previous pain scores and current pain scores, no significant correlations were found between breast size, breast density or total compression force and pain. Pain scores reduced between previous and current examinations and there was consistency in overall pain scores, despite variations in the compression forces applied. CONCLUSION Physical side effects from mammography can develop and extend beyond the examination period. Patients' prior experience of pain was the only significant predictor of current pain in this study. IMPLICATIONS FOR PRACTICE Data on past mammography experiences are essential to improve future pain outcomes. Post-mammography aftercare should be a routine feature of the examination.
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Affiliation(s)
- D J Nelson
- Breast Imaging Unit, Tameside and Glossop Integrated Care NHS Foundation Trust, United Kingdom.
| | - A England
- Directorate of Radiography, University of Salford, United Kingdom
| | - M Cheptoo
- Directorate of Radiography, University of Salford, United Kingdom
| | - C E Mercer
- Directorate of Radiography, University of Salford, United Kingdom
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10
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Souza KCB, Evangelista AF, Leal LF, Souza CP, Vieira RA, Causin RL, Neuber AC, Pessoa DP, Passos GAS, Reis RMV, Marques MMC. Identification of Cell-Free Circulating MicroRNAs for the Detection of Early Breast Cancer and Molecular Subtyping. J Oncol 2019; 2019:8393769. [PMID: 31485228 DOI: 10.1155/2019/8393769] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/15/2019] [Accepted: 06/19/2019] [Indexed: 01/21/2023]
Abstract
Early detection is crucial for achieving a reduction in breast cancer mortality. Analysis of circulating cell-free microRNAs present in the serum of cancer patients has emerged as a promising new noninvasive biomarker for early detection of tumors and for predicting their molecular classifications. The rationale for this study was to identify subtype-specific molecular profiles of cell-free microRNAs for early detection of breast cancer in serum. Fifty-four early-stage breast cancers with 27 age-matched controls were selected for circulating microRNAs evaluation in the serum. The 54 cases were molecularly classified (luminal A, luminal B, luminal B Her2 positive, Her-2, triple negative). NanoString platform was used for digital detection and quantitation of 800 tagged microRNA probes and comparing the overall differences in serum microRNA expression from breast cancer cases with controls. We identified the 42 most significant (P ≤ 0.05, 1.5-fold) differentially expressed circulating microRNAs in each molecular subtype for further study. Of these microRNAs, 19 were significantly differentially expressed in patients presenting with luminal A, eight in the luminal B, ten in luminal B HER 2 positive, and four in the HER2 enriched subtype. AUC is high with suitable sensitivity and specificity. For the triple negative subtype miR-25-3p had the best accuracy. Predictive analysis of the mRNA targets suggests they encode proteins involved in molecular pathways such as cell adhesion, migration, and proliferation. This study identified subtype-specific molecular profiles of cell-free microRNAs suitable for early detection of breast cancer selected by comparison to the microRNA profile in serum for female controls without apparent risk of breast cancer. This molecular profile should be validated using larger cohort studies to confirm the potential of these miRNA for future use as early detection biomarkers that could avoid unnecessary biopsy in patients with a suspicion of breast cancer.
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11
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Abstract
In the United States, older women (aged ≥65 years) continue to receive routine screening mammography surveillance, despite limited evidence supporting the benefits to this subpopulation. This article reviews screening mammography guidelines and the potential harms of such screening for older women in the United States. Published guidelines and recommendations on screening mammography for older women from professional medical societies and organizations in the United States were reviewed from the mid-20th century to present. Observational data were then synthesized to present the documented harms from screening mammography among older women. In 1976, the American Cancer Society recommended to screen all women aged ≥40 years with no upper age limit. With time, other major U.S. medical societies adopted their own screening guidelines without a consensus on age of screening cessation. A population-wide screening effort has largely continued without an upper age limit and with it, a growing body of literature on the harms of screening older women. Reported harms from screening mammography procedures have included physical pain, psychological distress, excessive use of health services from overdiagnoses/false positives, and undue financial expenses. These costs are particularly pronounced among special populations with limited life expectancies such as those of very advanced age ≥80 years, long-term nursing home residents, and the cognitively impaired. When potential harms, remaining life years, and the viability of available treatments are considered, the burdens of screening mammography often outweigh the benefits for older women. For some cases, an individualized approach to recommendations would be appropriate. National guidelines should be updated to provide clear guidance for screening women of advanced age, especially those in special populations with limited life expectancies.
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Affiliation(s)
- Deborah S Mack
- 1 Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.,2 Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Kate L Lapane
- 2 Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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Cruz-Jiménez L, Torres-Mejía G, Mohar-Betancourt A, Campero L, Ángeles-Llerenas A, Ortega-Olvera C, Martínez-Matsushita L, Reynoso-Noverón N, Duggan C, Anderson BO. Factors associated with ever use of mammography in a limited resource setting. A mixed methods study. Int J Qual Health Care 2018; 30:520-529. [PMID: 29648641 DOI: 10.1093/intqhc/mzy053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 03/01/2018] [Indexed: 12/31/2022] Open
Abstract
Objective To evaluate facilitators and barriers influencing mammography screening participation among women. Design Mixed methods study. Setting Three hospital catchment areas in Hidalgo, Mexico. Participants Four hundred and fifty-five women aged 40-69 years. Intervention Three hundred and eighty women completed a survey about knowledge, beliefs and perceptions about breast cancer screening, and 75 women participated in semi-structured, in-person interviews. Survey data were analyzed using logistic regression; semi-structured interviews were transcribed and analyzed using elements of the grounded theory method. Main Outcome Measure Women were categorized as never having had mammography or having had at least one mammogram in the past. Results From survey data, having had a Pap in the past year was associated with ever having had breast screening (odds ratio = 2.15; 95% confidence interval 1.30-3.54). Compared with never-screened women, ever-screened women had better knowledge of Mexican recommendations for the frequency of mammography screening (49.5% vs 31.7% P < 0.001). A higher percentage of never-screened women perceived that a mammography was a painful procedure (44.5% vs 33.8%; P < 0.001) and feared receiving bad news (38.4% vs 22.2%; P < 0.001) compared with ever-screened women. Women who participated in semi-structured, in-person interviews expressed a lack of knowledge about Mexican standard mammographic screening recommendations for age for starting mammography and its recommended frequency. Women insured under the 'Opportunities' health insurance program said that they are referred to receive Pap tests and mammography. Conclusions Local strategies to reduce mammogram-related pain and fear of bad news should work in tandem with national programs to increase access to screening.
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Affiliation(s)
- L Cruz-Jiménez
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - G Torres-Mejía
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - A Mohar-Betancourt
- Unidad de Epidemiología, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - L Campero
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - A Ángeles-Llerenas
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - C Ortega-Olvera
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - L Martínez-Matsushita
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - N Reynoso-Noverón
- Unidad de Epidemiología, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - C Duggan
- The Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Public Health Sciences, Fred Hutchinson Cancer Research Center, WA, USA
| | - B O Anderson
- The Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Public Health Sciences, Fred Hutchinson Cancer Research Center, WA, USA
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Mack DS, Epstein MM, Dubé C, Clark RE, Lapane KL. Screening mammography among nursing home residents in the United States: Current guidelines and practice. J Geriatr Oncol 2018; 9:626-634. [PMID: 29875079 DOI: 10.1016/j.jgo.2018.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/16/2018] [Accepted: 05/04/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE United States (US) guidelines regarding when to stop routine breast cancer screening remain unclear. No national studies to-date have evaluated the use of screening mammography among US long-stay nursing home residents. This cross-sectional study was designed to identify prevalence, predictors, and geographic variation of screening mammography among that population in the context of current US guidelines. MATERIALS AND METHODS Screening mammography prevalence, identified with Physician/Supplier Part B claims and stratified by guideline age classification (65-74, ≥75 years), was estimated for all women aged ≥65 years residing in US Medicare- and Medicaid- certified nursing homes (≥1 year) with an annual Minimum Data Set (MDS) 3.0 assessment, continuous Medicare Part B enrollment, and no clinical indication for screening mammography as of 2011 (n = 389,821). The associations between resident- and regional- level factors, and screening mammography, were estimated by crude and adjusted prevalence ratios from robust Poisson regressions clustered by facility. RESULTS Women on average were 85.4 (standard deviation ±8.1) years old, 77.9% were disabled, and 76.3% cognitively impaired. Screening mammography prevalence was 7.1% among those aged 65-74 years (95% Confidence Interval (CI): 6.8%-7.3%) and 1.7% among those ≥75 years (95% CI, 1.7%-1.8%), with geographic variation observed. Predictors of screening in both age groups included race, cognitive impairment, frailty, hospice, and some comorbidities. CONCLUSIONS These results shed light on the current screening mammography practices in US nursing homes. Thoughtful consideration about individual screening recommendations and the implementation of more clear guidelines for this special population are warranted to prevent overscreening.
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Affiliation(s)
- Deborah S Mack
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.
| | - Mara M Epstein
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States; Department of Medicine, Division of Geriatrics, University of Massachusetts Medical School, Worcester, MA, United States
| | - Catherine Dubé
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Robin E Clark
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States; Department of Family Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
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Baenziger NL. Painful Reality: Inappropriate Provider Management of Pain as a Determinant of Health Care Avoidance. Creat Nurs 2016; 22:151-160. [PMID: 29195523 DOI: 10.1891/1078-4535.22.3.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although pain is often characterized as a subjective, highly individualized phenomenon, in fact, numerous elements which are simply biological in nature underlie interpersonal differences in pain experience that influence the effectiveness of provider pain management. Elements acting at the level of tissues and cells include signal-transmitting molecules in pain pathways; elements acting at the level of the whole person comprise entire brain networks and anatomic elements fostering pain vulnerability. However, knowledge of these elements and translation of such knowledge into practical means for relieving patient pain is dismayingly sparse across the total spectrum of health care professionals. A serious consequence of this knowledge and action gap is that isolated, or worse yet, repeated, pain experiences may lead to profound mistrust of the health care system and its providers and to health care avoidance (e.g., mammography). This article outlines a biologic knowledge base and proposed remedies to improve pain management across the entire domain of health care. Key components of this approach include enhanced education for providers and informational outreach to health care consumers, clarifying pain mechanisms to both constituencies. Moreover, increased accountability within the health care system is needed, both in knowing and applying well-established biomedical knowledge and in best using technical and interpersonal skills necessary for effective pain management.
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Chhor CM, Mercado CL. Integrating Customer Intimacy Into Radiology to Improve the Patient Perspective: The Case of Breast Cancer Screening. AJR Am J Roentgenol 2016; 206:265-9. [PMID: 26797352 DOI: 10.2214/AJR.15.15459] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The customer intimacy business model has emerged as a key operational approach for health care organizations as they move toward patient-centered care. The question arises how the customer intimacy approach can be implemented in the clinical setting and whether it can help practitioners address problems and improve quality of care. CONCLUSION Breast cancer screening and its emphasis on the patient perspective provides an interesting case study for understanding how the customer intimacy approach can be integrated into radiologic practice to improve the patient experience.
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Branderhorst W, de Groot JE, Neeter LMFH, van Lier MGJTB, Neeleman C, den Heeten GJ, Grimbergen CA. Force balancing in mammographic compression. Med Phys 2016; 43:518. [DOI: 10.1118/1.4939129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Fernández-Feito A, Lana A, Cabello-Gutiérrez L, Franco-Correia S, Baldonedo-Cernuda R, Mosteiro-Díaz P. Face-to-face Information and Emotional Support from Trained Nurses Reduce Pain During Screening Mammography: Results from a Randomized Controlled Trial. Pain Manag Nurs 2015; 16:862-70. [DOI: 10.1016/j.pmn.2015.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 07/21/2015] [Accepted: 07/23/2015] [Indexed: 12/25/2022]
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Matamala N, Vargas MT, González-Cámpora R, Miñambres R, Arias JI, Menéndez P, Andrés-León E, Gómez-López G, Yanowsky K, Calvete-Candenas J, Inglada-Pérez L, Martínez-Delgado B, Benítez J. Tumor microRNA expression profiling identifies circulating microRNAs for early breast cancer detection. Clin Chem 2015; 61:1098-106. [PMID: 26056355 DOI: 10.1373/clinchem.2015.238691] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 05/07/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND The identification of novel biomarkers for early breast cancer detection would be a great advance. Because of their role in tumorigenesis and stability in body fluids, microRNAs (miRNAs) are emerging as a promising diagnostic tool. Our aim was to identify miRNAs deregulated in breast tumors and evaluate the potential of circulating miRNAs in breast cancer detection. METHODS We conducted miRNA expression profiling of 1919 human miRNAs in paraffin-embedded tissue from 122 breast tumors and 11 healthy breast tissue samples. Differential expression analysis was performed, and a microarray classifier was generated. The most relevant miRNAs were analyzed in plasma from 26 healthy individuals and 83 patients with breast cancer (36 before and 47 after treatment) and validated in 116 healthy individuals and 114 patients before treatment. RESULTS We identified a large number of miRNAs deregulated in breast cancer and generated a 25-miRNA microarray classifier that discriminated breast tumors with high diagnostic sensitivity and specificity. Ten miRNAs were selected for further investigation, of which 4 (miR-505-5p, miR-125b-5p, miR-21-5p, and miR-96-5p) were significantly overexpressed in pretreated patients with breast cancer compared with healthy individuals in 2 different series of plasma. MiR-505-5p and miR-96-5p were the most valuable biomarkers (area under the curve 0.72). Moreover, the expression levels of miR-3656, miR-505-5p, and miR-21-5p were decreased in a group of treated patients. CONCLUSIONS Circulating miRNAs reflect the presence of breast tumors. The identification of deregulated miRNAs in plasma of patients with breast cancer supports the use of circulating miRNAs as a method for early breast cancer detection.
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Affiliation(s)
| | | | | | | | | | | | - Eduardo Andrés-León
- Bioinformatics Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Gonzalo Gómez-López
- Bioinformatics Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | | | | | - Lucía Inglada-Pérez
- Human Cancer Genetics Programme and Spanish Network in Rare Diseases (CIBERER), Madrid, Spain
| | - Beatriz Martínez-Delgado
- Molecular Genetics Unit, Research Institute of Rare Diseases (IIER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Javier Benítez
- Human Cancer Genetics Programme and Spanish Network in Rare Diseases (CIBERER), Madrid, Spain;
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Uchiyama M, Lee Y, Kazama K, Minagawa Y, Tsurumaki M. Quantification of the Pain and Physical Burden Experienced during Positioning for Craniocaudal Imaging in Mammography, Evaluated by Measurement of Muscle Activity. Health (London) 2015. [DOI: 10.4236/health.2015.71004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Robinson L, Hogg P, Newton-Hughes A. The power and the pain: Mammographic compression research from the service-users' perspective. Radiography (Lond) 2013. [DOI: 10.1016/j.radi.2013.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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22
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Mathers SA, McKenzie GA, Robertson EM. ‘It was daunting’: Experience of women with a diagnosis of breast cancer attending for breast imaging. Radiography (Lond) 2013. [DOI: 10.1016/j.radi.2012.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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23
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Engelman KK, Cizik AM, Ellerbeck EF, Rempusheski VF. Perceptions of the screening mammography experience by Hispanic and non-Hispanic White women. Womens Health Issues 2012; 22:e395-401. [PMID: 22658890 DOI: 10.1016/j.whi.2012.04.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 04/23/2012] [Accepted: 04/24/2012] [Indexed: 11/22/2022]
Abstract
PURPOSE To uncover perceptive differences in mammography experiences (from scheduling the mammography appointment to receipt and reporting of mammography results) between women from two different racial/ethnic groups. METHODS Focus groups (n = 9) were conducted with Hispanic, and non-Hispanic White women (n = 88) who were aged 40 years or older and had a mammogram within the preceding 36 months. We used a qualitative ethnographic approach with content analysis to identify key categories present in the transcripts and domain analysis to discover domains of meaning. A matrix was designed to determine which domains differed by racial/ethnic group. The primary mammography-related topics of focus group discussion included 1) the scheduling process, 2) the day of the mammogram, 3) receipt of results, and 4) recommendations to improve the mammography process. MAIN FINDINGS Six domains uniquely described issues women of the differing racial/ethnic groups experience and perceive as important. Hispanic women highlighted embarrassment surrounding the examination and fear of negative news about their mammography results. Non-Hispanic White women focused on instructions given before or during the examination as a critical process feature. CONCLUSIONS Perceptions of the mammography experience vary by race/ethnicity. Mammography experiences might be improved through enhanced sensitivity of healthcare personnel to cultural differences in perceptions of mammogram testing. Future research to investigate the extent to which the domains of meanings uncovered in this study influence a women's decision to return for routine mammograms would be of great value.
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Ahmed NU, Winter K, Albatineh AN, Haber G. Clustering very low-income, insured women's mammography screening barriers into potentially functional subgroups. Womens Health Issues 2012; 22:e259-66. [PMID: 22459695 DOI: 10.1016/j.whi.2012.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 12/12/2011] [Accepted: 02/08/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mammography screening is essential for early detection of breast cancer and increased survival rates. Women, particularly those of low socioeconomic status, face barriers that impede their screening adherence. Although many studies have sought to identify these barriers, more research is needed on to address these obstacles in practice. The objective of this study is to divide mammography screening barriers into functional clusters using empirical evidence, which may guide the development of effective mammography screening promotion messages. METHODS A sample of 173 low-income White and Black women randomly selected from a managed care organization rated each of 21 potential mammography barriers on a scale ranging from "strongly agree" to "strongly disagree." A maximum clustering similarity method was used to identify relevant clusters of screening barriers. RESULTS Five clusters were derived, with a high similarity index (0.881). Each cluster was named to reflect the shared theme of the barriers within it: Perceived Lack of Value in Health Care, Lack of Information, Mistrust/Skepticism, Medical Delay Behavior, and Anxiety/No Control. A dominant barrier within each cluster was identified, and bivariate correlation coefficients were reported. CONCLUSION Cluster analysis yielded five distinct subgroups of mammography screening barriers.
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Affiliation(s)
- Nasar U Ahmed
- Department of Epidemiology and Biostatistics, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, USA.
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Uchiyama M, Lee Y, Sadakata M, Sayama M, Tsai DY. Measurement of Muscle Activities for Evaluating Physical Burden and Pain during Mammography Positioning. TOHOKU J EXP MED 2012; 228:53-8. [DOI: 10.1620/tjem.228.53] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Yongbum Lee
- Graduate School of Health Sciences, Niigata University
| | | | | | - Du-Yih Tsai
- Graduate School of Health Sciences, Niigata University
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Uchiyama M, Lee Y, Kazama K, Minagawa Y, Tsai DY, Sadakata M, Sayama M. [A preliminary study on measurement of muscle activity during mammography positioning]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2011; 67:679-82. [PMID: 21720078 DOI: 10.6009/jjrt.67.679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study focused on measuring examinees' muscle activities during mammography positioning using surface electromyography. Muscle activities were measured in three women (40-50s) in two-view mammography (MLO: mediolateral oblique, CC: craniocaudal). The muscles measured were the sternocleidomastoid, biceps, trapezius, and gastrocnemius, selected based on the visual analogue scale reported by Sharp et al. We used a multi-purpose portable bio-amplifier (Polymate AP1000) to assess the muscle activities. The results showed that the trapezius in right MLO and sternocleidomastoid in right CC were active in all three subjects. This suggests that the muscles directly related to mammography positioning are highly active. In addition, the gastrocnemius was active throughout the mammography. The biceps and gastrocnemius were also active in at least one of the three women. We believe that quantitative assessment of muscle activities during mammography positioning will contribute to the improvement of pain-reduction programs in mammography.
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Affiliation(s)
- Mieko Uchiyama
- School of Health Sciences, Faculty of Medicine, Niigata University
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Feldstein AC, Perrin N, Rosales AG, Schneider J, Rix MM, Glasgow RE. Patient Barriers to Mammography Identified During a Reminder Program. J Womens Health (Larchmt) 2011; 20:421-428. [PMID: 21275649 DOI: 10.1089/jwh.2010.2195] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Background: Patient mammogram reminders are effective at increasing screening, but patient barriers remain. We evaluated patient characteristics and reported barriers for their association with mammogram completion after a reminder program. Methods: This retrospective cohort study used data from electronic records and a subgroup survey. Participants were female Kaiser Permanente Northwest health maintenance organization (HMO) members aged 50-69 who were 20 months past their last mammogram (index date) and had received a reminder intervention (n = 4708). A mailed survey was completed by 340 of 667 (50.2%) women who received it. The intervention was a "mammogram due soon" postcard 20 months after the last mammogram, followed by up to two automated phone calls and one live call for nonresponders. The outcome was mammogram completion at 10 months after index date. Results: Characteristics associated with lower mammogram completion rates were aged <60 (odds ratio [OR] 0.69, p < 0.0001), health plan membership <5 years (OR 0.81, p = 0.019), family income <$40,000/year (OR 0.77, p = 0.018), and obesity (OR 0.67, p < 0.0001). Obese women were more likely than nonobese women to report "too much pain" from mammograms (31.3% vs.18.8%, p < 0.01). Younger women were more likely to endorse that they were "too busy" (19.1% vs. 6.4%, p < 0.001) and had more worries about mammogram accuracy (2.5 vs. 2.3 on a 5-point scale, p < 0.05). Pain mediated the relationship between obesity and mammogram completion rates (indirect effect = -0.111, p = 0.008). Conclusions: Important barriers to mammogram completion remain even after an effective mammogram reminder system among insured patients. Tailored interventions are necessary to overcome these barriers.
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Affiliation(s)
- Adrianne C Feldstein
- Kaiser Permanente Northwest, Portland, Oregon.,Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Nancy Perrin
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - A Gabriela Rosales
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Jennifer Schneider
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Mary M Rix
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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Saunders RS, Samei E, Lo JY, Baker JA. Can Compression Be Reduced for Breast Tomosynthesis? Monte Carlo Study on Mass and Microcalcification Conspicuity in Tomosynthesis. Radiology 2009; 251:673-82. [PMID: 19474373 DOI: 10.1148/radiol.2521081278] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Robert S Saunders
- Department of Radiology, Duke Advanced Imaging Laboratories, Duke University Medical Center, 2424 Erwin Rd, Suite 302, Durham, NC 27710, USA.
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Abstract
This study analyzed how the inherent quality of diagnostic information in digital mammography could be affected by breast compression. A digital mammography system was modeled using a Monte Carlo algorithm based on the Penelope program, which has been successfully used to model several medical imaging systems. First, the Monte Carlo program was validated against previous measurements and simulations. Once validated, the Monte Carlo software modeled a digital mammography system by tracking photons through a voxelized software breast phantom, containing anatomical structures and breast masses, and following photons until they were absorbed by a selenium-based flat-panel detector. Simulations were performed for two compression conditions (standard compression and 12.5% reduced compression) and three photon flux conditions (constant flux, constant detector signal, and constant glandular dose). The results showed that reduced compression led to higher scatter fractions, as expected. For the constant photon flux condition, decreased compression also reduced glandular dose. For constant glandular dose, the SdNR for a 4 cm breast was 0.60 +/- 0.11 and 0.62 +/- 0.11 under standard and reduced compressions, respectively. For the 6 cm case with constant glandular dose, the SdNR was 0.50 +/- 0.11 and 0.49 +/- 0.10 under standard and reduced compressions, respectively. The results suggest that if a particular imaging system can handle an approximately 10% increase in total tube output and 10% decrease in detector signal, breast compression can be reduced by about 12% in terms of breast thickness with little impact on image quality or dose.
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Affiliation(s)
- Robert S Saunders
- Duke Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center, Durham, North Carolina 27705, USA.
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Lin K, Eradat J, Mehta NH, Bent C, Lee SP, Apple SK, Bassett LW. Is a short-interval postradiation mammogram necessary after conservative surgery and radiation in breast cancer? Int J Radiat Oncol Biol Phys 2008; 72:1041-7. [PMID: 18407428 DOI: 10.1016/j.ijrobp.2008.02.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2007] [Revised: 02/09/2008] [Accepted: 02/12/2008] [Indexed: 11/22/2022]
Abstract
PURPOSE To examine, in a retrospective study, whether the initial posttreatment mammogram offers any benefit to patients. METHODS AND MATERIALS Patients were selected who had radiation after breast-conservation therapy from 1995 through 2005 and had follow-up mammography at the University of California-Los Angeles (UCLA) within 1 year of completing radiotherapy. Results of the initial follow-up mammogram were analyzed to determine the yield of this initial mammogram. RESULTS Between 1995 and 2005, 408 patients treated with breast-conserving therapy and radiation had follow-up mammograms at UCLA within 1 year of completion of radiation. Median age at radiation completion was 56.9 years. Median interval between radiation and the initial mammogram was 3.1 months. Ten patients were found to have suspicious findings on the initial postradiation mammogram, prompting biopsy, but only 2 were found to have recurrent cancer. None of those lesions were palpable. In both cases the recurrences were ductal carcinoma in situ. Thus, the yield of the initial postoperative mammogram as compared with physical examination findings is estimated at 0.49 recurrences detected per 100 mammograms performed (95% confidence interval 0.059-1.759). CONCLUSIONS The yield of the initial postradiation mammography at UCLA seems to be low, and only noninvasive carcinomas were found. Our data support the rationale to avoid the initial short-interval postradiation mammography and evaluate patients at 12 months.
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Kang HS, Thomas E, Kwon BE, Hyun MS, Jun EM. Stages of change: Korean women's attitudes and barriers toward mammography screening. Health Care Women Int 2008; 29:151-64. [PMID: 18350421 DOI: 10.1080/07399330701738176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The positive and negative aspects of breast cancer screening were measured to gain insight into the barriers that prevent Korean women from participating in mammography screening. Breast cancer screening behaviors, attitudes, and barriers were identified from a convenience sample of 328 Korean women recruited in Seoul, Gyeonggi, and Jeju, South Korea. Pros, cons, and decisional balance constructs of the transtheoretical model of behavior change were used to identify stages of change in attitude related to mammography screening. There were significant differences in pros (F = 5.175, p = .001) and cons (F = 3.357, p = .012) across the five stages of change for mammography. Participants indicated that the major barriers to mammography screening were, in order of frequency, the belief that an absence of symptoms meant there was no need for a breast examination, the high cost of breast cancer screening, lack of time, lack of information, embarrassment, fear about x-rays and test results, reliance on breast self-examination (BSE), and discomfort or pain. The benefits of breast cancer screening should be emphasized among Korean women.
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Affiliation(s)
- Hee Sun Kang
- Department of Nursing, College of Medicine, Chung-Ang University, Seoul, Korea
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Nimmo LJ, Alston LA, McFadyen AK. The influence of HRT on technical recall in the UK Breast Screening Programme: are pain, compression force, and compressed breast thickness contributing factors? Clin Radiol 2007; 62:439-46. [PMID: 17398269 DOI: 10.1016/j.crad.2006.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2005] [Revised: 11/02/2006] [Accepted: 12/15/2006] [Indexed: 10/23/2022]
Abstract
AIM To investigate recall for technical reasons within the UK Breast Screening Programme, and to determine whether differences exist in those women using hormone replacement therapy (HRT), considering potential associations with reported pain, compression force used and compressed breast thickness (CBT) obtained. MATERIALS AND METHOD A prospective cohort study of 2765 women attending for incident round breast screening appointments who were either HRT users, with a minimum of 1 year duration (n=1077), or had never used HRT (n=1688). Data were collected using technical recall records, a radiographer data-collection sheet, and a self-administered participant questionnaire. RESULTS Sixty-eight (2.5%) participants were recalled for technical reasons of whom 28 (2.6%) were HRT and 40 (2.4%) non-HRT users. This difference was not statistically significant (p=0.80). Significant differences were found for CBT between those HRT users who were and were not recalled for technical reasons (p<0.01) and for the similar categories of non-HRT users (p=0.03). No significant differences were found for force between those HRT users who were recalled or not (p=0.73) and for the similar categories of non-HRT users (p=0.07). Similarly no significant differences were found for pain between those HRT users who were recalled or not (p=0.75) and for the similar categories of non-HRT users (p=0.73). CONCLUSION CBT was the only variable to have both a statistically and a clinically significant relationship with technical recall.
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Dibble SL, Israel J, Nussey B, Sayre JW, Brenner RJ, Sickles EA. Mammography with breast cushions. Womens Health Issues 2005; 15:55-63. [PMID: 15767195 DOI: 10.1016/j.whi.2004.12.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2004] [Revised: 11/11/2004] [Accepted: 12/21/2004] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We conducted a randomized clinical trial to determine the impact on pain and image quality when breast cushions were used to pad the surfaces of the mammography equipment during film-screen mammography. METHODS We recruited a consecutive volunteer sample of 394 participants. Breast cushions were used for only one breast, with laterality and sequence of use assigned randomly. Data collected from participants included demographic data, rating of pain from previous mammography, and rating of pain from present mammography using both a numeric rating scale and a visual analogue scale. Research assistants also collected breast compression and radiation exposure data. Radiologists were blinded to the laterality of cushion assignment while reading the mammograms and assessing image quality. RESULTS Participants were primarily white women (75.3%), mean age 55.4 years. Most (94.4%) reported having previous mammography. Eight percent (n = 32) of those surveyed had thought about skipping or delaying mammography because of the pain involved. The pain associated with mammography was significantly (p < .001) less during oblique and craniocaudal views when breast cushions were used during the procedure. Retakes were required for 2% of the 1576 views with the most common reason being positioning (53%). CONCLUSION The use of breast cushions significantly reduced the pain during film-screen mammography. Image quality with the cushions was reduced in a very small subset of women probably due to the difficulty in positioning the breast without visual clues. More research needs to be done prior to the routine use of these cushions in clinical practice.
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Affiliation(s)
- Suzanne L Dibble
- Institute for Health and Aging, University of California, San Francisco, California, USA.
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Sharp PC, Michielutte R, Spangler JG, Cunningham L, Freimanis R. Primary care providers' concerns and recommendations regarding mammography screening for older women. J Cancer Educ 2005; 20:34-8. [PMID: 15876180 DOI: 10.1207/s15430154jce2001_11] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Morbidity and mortality from breast cancer increase with age; however, mammography screening does not reflect this increased risk for older women. Lack of provider recommendation is a major barrier to screening. METHODS This is a descriptive study of mammography screening recommendations of community primary care providers in North Carolina (N = 96) participating in a National Cancer Institute funded research project. Providers self-reported screening recommendations for typical patients of different ages and issues and concerns that might influence the decision. Chart reviews compared actual practices with policies stated. RESULTS Of the providers, 51% recommended biannual, 45% annual for women ages 50 through 74; 4% recommended biannual, 80% annual, 5% did not recommend screening, and 10% had no general policy for women over 75. Cost, inconsistent guidelines, comorbidity, functional status, value of mammography, and patient resistance influenced screening recommendations. Chart review showed even lower rates of recommendation than self-reported figures. CONCLUSIONS Although the use of screening mammography has increased over the past decade, older women are one of the last subgroups to derive benefit from this screening test. Our survey revealed lower rates for mammography referral in older women. The primary care provider appears to be essential to increasing participation for these older women in breast cancer screening.
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Affiliation(s)
- Penny C Sharp
- Wake Forest University School of Medicine, Department of Family & Community Medicine, Winston-Salem, NC 27157-1084, USA.
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Abstract
This study examined the pain/discomfort ratings during mammography and their relationship to pain-coping strategies. Prior to their mammogram in order to assess how they cope with day-to-day pain experience 220 women completed an Iranian translation of the Coping Strategies Questionnaire (IR-CSQ). Immediately after mammography, all subjects completed a modified version of the IR-CSQ to assess their coping style with pain during mammography. Ratings of pain/discomfort during the mammogram were also collected, using a 100-mm Visual Analog Scale and a 6-point Pain/Discomfort Rating Scale (PRDS). Up to 92% of the women reported that the mammogram examination was painful. However, considerable variability in pain ratings was found, with some women reporting severe pain and others reporting little or no pain. While the ratings of coping effectiveness in facing day-to-day pain experience were not significantly related to mammography pain ratings, there was a significant association between the ratings of coping efficacy in facing mammography pain specifically and measures of mammography pain. Multiple hierarchical regression analyses revealed that while higher use of catastrophising and coping self-statements in facing mammography pain were predictors of more severe pain during mammography, higher use of ignoring pain sensations was predictive of less severe pain during mammography. The potential significance of these findings for identifying patients at risk of poor adjustment to chronic pain is discussed.
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Affiliation(s)
- Ali Asghari
- School of Psychology, University of Shahed, P.O. Box 14155-7137, Tehran, Iran
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