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Communicating Results of All Radiologic Examinations Directly to Patients: Has the Time Come? AJR Am J Roentgenol 2007; 189:1275-82. [DOI: 10.2214/ajr.07.2740] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Schulz-Wendtland R, Sinn HP. [Radiological diagnosis of mammary carcinomas. I: pathology and x-ray mammography]. Radiologe 2004; 44:517-38; quiz 539-40. [PMID: 15250098 DOI: 10.1007/s00117-004-1060-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Breast cancer is the most common malignant tumor in women: almost 10 % will suffer from breast cancer during their life and almost half of these will die of it. The spectrum of radiologic methods for diagnosing breast cancer is wide, including X-ray mammography, ultrasound, magnetic resonance mammography, and minimally invasive biopsies. After long-lasting controversies, breast cancer screening using X-ray mammography has now been introduced in Germany, following the projects in the Netherlands and Sweden. However, assessing mammographic films under screening conditions requires skills distinctly different from those needed under clinical conditions. This first part of two covers the histopathological basics and X-ray mammography; the second will deal with ultrasound of the breast and magnetic resonance mammography.
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Affiliation(s)
- R Schulz-Wendtland
- Institut für Diagnostische Radiologie, Gynäkologische Radiologie, Universität Erlangen-Nürnberg, Erlangen.
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Berlin L. Communicating findings of radiologic examinations: whither goest the radiologist's duty? AJR Am J Roentgenol 2002; 178:809-15. [PMID: 11906852 DOI: 10.2214/ajr.178.4.1780809] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Leonard Berlin
- Department of Radiology, Rush North Shore Medical Center, 9600 Gross Point Rd., Skokie, IL 60076, USA
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Lindfors KK, O'Connor J, Parker RA. False-positive screening mammograms: effect of immediate versus later work-up on patient stress. Radiology 2001; 218:247-53. [PMID: 11152810 DOI: 10.1148/radiology.218.1.r01ja35247] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare the stress experienced by women who had false-positive screening mammograms and had undergone immediate on-site diagnostic imaging evaluation with that experienced by those who had been recalled for subsequent imaging. MATERIALS AND METHODS A retrospective survey was mailed to women with false-positive screening mammograms that had proved negative or benign at diagnostic imaging. The women were divided into (a) those who had undergone diagnostic imaging during the same appointment as their screening examination and (b) those who had returned at a later date for work-up. The survey included questions about stress that was related to the screening and diagnostic experiences, how subjects had been notified about screening results, and their breast health histories. RESULTS From the group that had undergone immediate work-up (n = 100), 50 eligible surveys were received; 71 were received from women who had undergone later work-ups (n = 176). The self-reported overall stress was significantly greater (P =.027) in the group recalled for subsequent diagnostic imaging. Among all respondents, stress from a false-positive screening result was greatest in women younger than 50 years of age with a positive first-degree family history of breast cancer. CONCLUSION Providing immediate on-site diagnostic evaluation can reduce the stress of a false-positive screening mammogram.
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Affiliation(s)
- K K Lindfors
- School of Medicine, Department of Radiology, University of California, Davis, 4860 Y St, Ste 3100, Sacramento, CA 95817, USA.
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Wilson TE, Wallace C, Roubidoux MA, Sonnad SS, Crowe DJ, Helvie MA. Patient satisfaction with screening mammography: online vs off-line interpretation. Acad Radiol 1998; 5:771-8. [PMID: 9809075 DOI: 10.1016/s1076-6332(98)80261-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to determine patient satisfaction with online and off-line methods of interpreting screening mammograms and to determine those characteristics that most influence patient preferences. MATERIALS AND METHODS A survey consisting of 17 questions assessing satisfaction and demographics was distributed to women whose screening mammograms were read in one of two ways at the same facility: (a) the "online" method, in which all additional requested studies are completed and results are immediately communicated, and (b) the "off-line" method, in which mammograms are read in batches the next day, results are communicated at a later time, and patients return for diagnostic studies. To ensure statistical power, at least 174 surveys were collected from each group. RESULTS Of 192 women whose mammograms were interpreted online, 188 (97%) responded, and of 247 women whose mammograms were interpreted off-line, 181 (73%) responded. Overall mean satisfaction with the mammographic experience and with the time it took to receive results differed significantly between the two groups (P < .002). Analysis of the subgroup of very satisfied respondents disclosed that 92% of patients in the online group and 59% of patients in the off-line group were very satisfied with their mammography experience. If allowed to choose the method of interpretation, 97% of patients in the online group and 91% of patients in the off-line group would choose online interpretation. CONCLUSION Patients preferred online mammographic interpretation of screening studies.
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Affiliation(s)
- T E Wilson
- Department of Radiology, University of Michigan Hospitals, Ann Arbor 48109-0326, USA
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Abstract
Worldwide, 31% of cancers in women are in the breast or uterine cervix. Prevention of cervical cancer is effective with the use of the cervical Pap smear test if applied in an organized and continuous fashion, including treatment of precancerous lesions. At best such programs have led to a 60% decrease in cervical cancer incidence and mortality in the Nordic countries. Early detection of breast cancer in a population based screening may lead to a 30% reduction of mortality from this disease in the screened population. Measures to guarantee high coverage and attendance, adequate field facilities, organized program for quality control and adequate facilities for diagnosis and treatment are prerequisites of successful programs. In absolute terms the contribution of screening to the total mortality reduction among middle-aged populations is small, much smaller than the potential gains from cancer prevention.
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Affiliation(s)
- L Elovainio
- Cancer Society of Finland, Helsinki, Finland
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Bonfill Cosp X, Marzo Castillejo M, Sentís Crivillé M, Rossell Mir R, Gallardo Cistaré X, Florensa Masip R, Rivero Ferrer E, Moreno Quiroga C. Evaluation of the regular practice of breast cancer screening in a health area. Int J Technol Assess Health Care 1996; 12:388-94. [PMID: 8707509 DOI: 10.1017/s0266462300009715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Breast cancer screening has proved to be efficacious only in clinical trials or structured programs. However, little is known of its effectiveness as a regular practice. This study is an assessment of breast cancer screening in regular practice in a Spanish area of 350,000 inhabitants through analysis of existing sources of information. It is evident that this screening is insufficient, inefficient, very variable, nonspecific, and probably ineffective, although there is insufficient information to prove it. The immediate implementation of a well-structured and accredited screening program is essential to overcome the current limitations.
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Kopans DB, Halpern E, Hulka CA. Statistical power in breast cancer screening trials and mortality reduction among women 40-49 years of age with particular emphasis on the National Breast Screening Study of Canada. Cancer 1994; 74:1196-203. [PMID: 8055437 DOI: 10.1002/1097-0142(19940815)74:4<1196::aid-cncr2820740403>3.0.co;2-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- D B Kopans
- Department of Radiology, Massachusetts General Hospital, Boston 02114
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Breen N, Kessler L. Changes in the use of screening mammography: evidence from the 1987 and 1990 National Health Interview Surveys. Am J Public Health 1994; 84:62-7. [PMID: 8279613 PMCID: PMC1614928 DOI: 10.2105/ajph.84.1.62] [Citation(s) in RCA: 220] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Mammography rates reported by women in the National Health Interview Surveys of 1990 and 1987 are examined. Why this screening modality is not more frequently used is explored. METHODS Data from the 1987 and 1990 National Health Interview Surveys, conducted by the National Center for Health Statistics, are cross-tabulated and compared. RESULTS In 1987, approximately 17% of women over 40 years of age reported having had a screening mammogram in the previous year. In 1990, the rate doubled. Race declined in importance; income and education remained strong, positive predictors of screening. CONCLUSIONS Despite this dramatic increase, two thirds of women are not having screening mammograms. Use was not higher primarily because women did not realize that screening mammography tests for breast cancer in asymptomatic women. Primary care physicians are the main source of health education for screening mammography. The data suggest that public health programs to promote screening mammography should especially target primary care physicians and women with low incomes and education. Likewise, health care providers should ensure that their patients are referred to facilities that deliver high-quality mammography at low cost to make the procedure more accessible.
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Affiliation(s)
- N Breen
- Applied Research Branch, National Cancer Institute, Bethesda, MD 20892
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Medicolegal Implications of Breast Imaging in Screening and Diagnosis of Breast Cancer. Surg Oncol Clin N Am 1994. [DOI: 10.1016/s1055-3207(18)30535-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
The past decade has seen an intense focus on the evaluation of American women for the detection and diagnosis of breast cancer. A concomitant increase in lawsuits filed for delay in diagnosis of breast cancer has occurred, creating consternation in the medical community. Efforts in responding to this public health challenge, comprised by fear of legal reprisal, may be supported by careful and deliberate planning that incorporates risk management principles and an understanding of different goals to be attained with consequent medical and legal responsibilities.
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A SCREENING MAMMOGRAPHY PROGRAM. Radiol Clin North Am 1992. [DOI: 10.1016/s0033-8389(22)02495-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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MEDICOLEGAL ASPECTS OF BREAST IMAGING. Radiol Clin North Am 1992. [DOI: 10.1016/s0033-8389(22)02501-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Mammography is generally accepted as a useful problem-solving clinical tool in characterizing known breast lesions, so that appropriate and timely treatment can be given. However, it remains grossly underutilized at what it does best: screening. The major strengths of mammography are a) its ability to detect breast cancer at a smaller, potentially more curable stage than any other examination, and b) its proved efficacy in reducing breast cancer mortality in asymptomatic women aged 40-74. If, as has recently been estimated, screening with mammography and physical examination can be expected to lower breast cancer deaths by 40%-50% among those actually examined (13), then the lives of almost 20,000 U.S. women might be saved each year if screening were to become very widely used. The challenges of the next decade are clear, to mount much more effective campaigns to educate physicians and lay women about the life-saving benefits of breast cancer screening, to devise increasingly effective and lower cost screening strategies, to further improve the current high quality of mammographic imaging despite its increasing proliferation, and to train large numbers of breast imaging specialists to guarantee that the growing case load of screening and problem-solving mammograms is interpreted with a very high level of skill.
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Affiliation(s)
- E A Sickles
- Breast Imaging Section, University of California School of Medicine, San Francisco 94143
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Nielsen BB. Breast cancer screening. Semin Oncol Nurs 1991; 7:161-5. [PMID: 1656505 DOI: 10.1016/0749-2081(91)90028-n] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Screening for breast cancer is receiving increased emphasis with the development of modern technology. Health care providers must inform the public that screening for breast cancer may increase survival. Legislation must be enacted to ensure that a screening examination is affordable and can be readily obtained upon referral. The message to both health care professionals and the public must be positive. Early detection is the best protection in breast cancer.
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Abstract
The goals of screening mammography are reproducibly optimum images, accurately interpreted, at the lowest possible cost. This can reduce the mortality from breast cancer. Despite this, screening mammography has not been widely used because of the controversy over the age at onset and interval of screening, charge for the examination, misinformed primary care physicians, uninformed women, and other factors. The American College of Radiology's educational efforts and mammography accreditation program are overcoming some of these obstacles.
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Affiliation(s)
- R McLelland
- Department of Radiology, University of North Carolina, School of Medicine, Chapel Hill 27599-7510
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McLelland R. Low-cost mass screening as a means of reducing overall mortality from breast cancer. Recent Results Cancer Res 1990; 119:53-9. [PMID: 2236862 DOI: 10.1007/978-3-642-84065-4_7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Mammography is a screening method that has been proven effective and could significantly reduce the overall mortality from breast cancer if it were more widely applied. The challenge to radiology is to provide sufficient competent personnel and adequate facilities such that reproducibly optimal screening mammography, accurately interpreted at the lowest possible cost, is made widely available.
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Affiliation(s)
- R McLelland
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill 27514
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Sickles EA. One versus two views per breast for screening mammography. Recent Results Cancer Res 1990; 119:81-7. [PMID: 2236866 DOI: 10.1007/978-3-642-84065-4_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- E A Sickles
- Department of Radiology, University of California School of Medicine, San Francisco 94143
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Affiliation(s)
- R McLelland
- University of North Carolina, School of Medicine, Department of Radiology, Chapel Hill 27599-7510
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Abstract
Of an estimated pool of 1,700 potential participants, only 382 (22%) eligible women participated in a low-cost breast cancer screening program offered to university and medical center employees. Because most women were still available and data were needed to understand why the opportunity to participate was refused by so many, a survey was done to determine factors related to mammography behavior. Three distinct groups of women were identified according to health beliefs, mammography behaviors, and modifying factors. Women who participated in the mammogram program were predominantly well-educated working women who were aware of mammography and its relationship to the breast cancer trajectory; they were affected by cost and convenience issues. One group of women did not participate in the program offered because they had had a recent mammogram; these women were at high risk for breast cancer and perceived mammography to be beneficial. The women who did not participate for other reasons were in nonprofessional jobs, had lower levels of education, and tended not to participate in the health care system as readily as women in the other groups; they perceived themselves less susceptible to breast cancer, valued mammography less, and knew less about breast cancer.
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Affiliation(s)
- D N Rutledge
- School of Nursing, Vanderbilt University Medical Center, Nashville, Tennessee 37240
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Moskowitz M. Costs of Screening for Breast Cancer. Radiol Clin North Am 1987. [DOI: 10.1016/s0033-8389(22)02281-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Low-cost Mass Screening With Mammography As A Means of Reducing Overall Mortality From Breast Cancer. Radiol Clin North Am 1987. [DOI: 10.1016/s0033-8389(22)02279-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Mammography Screening: Successes and Problems in Implementing Widespread Use in the United States. Radiol Clin North Am 1987. [DOI: 10.1016/s0033-8389(22)02282-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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