Does open-access mammography and ultrasound delay the diagnosis of breast cancer?

Application and Analysis of Biomedical Imaging Technology in Early Diagnosis of Breast Cancer

Breast cancer is the primary malignant tumor that endangers women's health. The incidence of breast cancer is increasing rapidly in recent years. Accurate disease evaluation before treatment is the key to the selection of treatment options. Biomedical imaging technology plays an irreplaceable role in the diagnosis and staging of tumors. Various imaging methods can provide excellent temporal and spatial resolution from multiple levels and perspectives and have become one of the most commonly used means of breast cancer early detection. With the development of radiomics, it has been found that early imaging diagnosis of breast cancer plays an important guiding role in clinical decision-making. The purpose of this study is to explore the characteristics of various breast cancer imaging technologies, promote the development of individualized accurate diagnosis and treatment of imaging, and improve the clinical application value of radiomics in the early diagnosis of breast cancer.

Direct access cancer testing in primary care: a systematic review of use and clinical outcomes

BACKGROUND

Direct access (DA) testing allows GPs to refer patients for investigation without consulting a specialist. The aim is to reduce waiting time for investigations and unnecessary appointments, enabling treatment to begin without delay.

AIM

To establish the proportion of patients diagnosed with cancer and other diseases through DA testing, time to diagnosis, and suitability of DA investigations.

DESIGN AND SETTING

Systematic review assessing the effectiveness of GP DA testing in adults.

METHOD

MEDLINE, Embase, and the Cochrane Library were searched. Where possible, study data were pooled and analysed quantitatively. Where this was not possible, the data are presented narratively.

RESULTS

The authors identified 60 papers that met pre-specified inclusion criteria. Most studies were carried out in the UK and were judged to be of poor quality. The authors found no significant difference in the pooled cancer conversion rate between GP DA referrals and patients who first consulted a specialist for any test, except gastroscopy. There were also no significant differences in the proportions of patients receiving any non-cancer diagnosis. Referrals for testing were deemed appropriate in 66.4% of those coming from GPs, and in 80.9% of those from consultants; this difference was not significant. The time from referral to testing was significantly shorter for patients referred for DA tests. Patient and GP satisfaction with DA testing was consistently high.

CONCLUSION

GP DA testing performs as well as, and on some measures better than, consultant triaged testing on measures of disease detection, appropriateness of referrals, interval from referral to testing, and patient and GP satisfaction.

Findings from a pilot environmental health intervention at early childhood centers in the District of Columbia

BACKGROUND

Children are uniquely susceptible to environmental health exposures that effect developmental delays and negatively impact long-term health outcomes. Despite extensive hours spent at early child care centers, child care providers (CCPs) lack the knowledge to identify and mitigate environmental hazards to the children.

METHODS

From 2007 to 2010, we recruited child care centers in the District of Columbia and offered interactive environmental health training to the CCPs. Each center underwent a 90-min environmental health risk assessment (ERA) at baseline and also after the trainings. Dependent t-tests were used to assess the mean change on the ERA score and also the knowledge test administered pre- and post-trainings. Analysis of variance was used to examine the association between knowledge change for the CCPs and the ERA scores of their centers.

RESULTS

Of the 60 facilities, 68% reduced their environmental risk. The 585 CCPs who attended the training session showed significant improvement on all items on the test. However, test scores for the CCPs from centers that reduced their risk were not significantly different from the other CCPs.

CONCLUSIONS

The trainings increased knowledge on environmental health hazards among CCPs. Areas of significant risk reduction were under the direct control of the CCPs and corresponded to key items on the knowledge test.

In-hospital delay in the diagnosis of breast cancer

BACKGROUND

There is evidence that delay in the diagnosis of breast cancer may prejudice survival. The aim of this study was to determine the incidence, time trends and causes of delay in a dedicated breast clinic.

METHODS

The interval between first breast clinic visit and a definitive diagnosis was recorded in all patients with invasive breast cancer between 1988 and 1997. In all patients with a delay of 3 months or more, the case notes were reviewed for evidence of a triple assessment (clinical examination, imaging and needle biopsy). The principal cause of delay was identified.

RESULTS

Of 1004 patients with invasive breast cancer, there was a delay in diagnosis of 3 months or more in 42 patients between 1988 and 1997, an incidence of 4.2 per cent. The median delay was 6 months and the median age at diagnosis was 53 (range 27-89) years. Triple assessment was undertaken in 30 patients; ten did not have a needle biopsy performed and three patients had no mammography. The principal cause of delay was: false-negative or inadequate fine-needle aspiration cytology (FNAC) in 19 patients, failure of follow-up in eight, clinical signs did not impress in five, FNAC not carried out in four, false-negative mammogram in three, failure of needle localization in two and one patient did not accept clinical advice. The annual incidence of delay in diagnosis did not change significantly over the 10-year interval.

CONCLUSION

Triple assessment is not sufficiently sensitive to detect every breast cancer and a small incidence of diagnostic delay is therefore inevitable with current techniques.