99mTc-Leukocyte Scintigraphy in Prosthetic Vascular Graft Infections

The aim of this study was to determine the diagnostic value of scintigraphy with 99mTc-HMPAO-labelled leukocytes for the detection of prosthetic vascular graft infection. 51 scans were recorded in 19 patients with suspected vascular graft infection and 8 control patients. Three-phase scanning was used at 0.5, 3 – 6 and 18–24 h. 13 vascular graft infections (10 early, 3 late) were found. 12 of these healed with antibiotics and only one patient with late infection had to be reoperated. None of them died during the follow-up period. The sensitivity was 100% and the specificity 96%. 99mTc-leukocyte scintigraphy seems a useful tool to detect vascular graft infection and to differentiate it from infections elsewhere. The results suggest that the incidence of vascular graft infection may be greater, and the mortality rate lower, than supposed before.

Clinical Comparison of 99Tcm-Hmpao Labelled Leucocytes and 99Tcm-Nanocolloid in the Detection of Inflammation

Forty-five patients with various inflammatory diseases were imaged with 99Tcm-HMPAO labelled leucocytes and 99Tcm-nanocolloid within 7 days. The overall sensitivity of 99Tcm-leucocytes was 97% and that of 99Tcm-nanocolloid 59% and both agents had a 100% specificity. The 99Tcm-leucocyte method showed reliable results in various inflammatory and infectious conditions, and seems suitable as a primary imaging method. On the contrary, 99Tcm-nanocolloid cannot be recommended for use in inflammatory bowel diseases, soft tissue abscesses or prosthetic vascular graft infections. However, 99Tcm-nanocolloid gave reliable information in inflammatory and infectious bone and joint diseases in which it had a 90% sensitivity and 100% specificity. In those lesions the 99Tcm-nanocolloid method may be useful, because it is simple, fast and cheap. Yet, further evaluation is needed.

US assessment of hip joint synovitis in rheumatic diseases: A comparison with MR imaging

Purpose: To assess the significance of ultrasonography (US) in detecting hip joint synovitis in patients with rheumatic diseases.

Material and Methods: Forty patients with rheumatic disease and suspected hip joint synovitis underwent MRI and US of the hip joint. In addition to the throughout MRI evaluation, the anterior collum-capsule distance (CCD) was determined by both MRI and US. Thirteen healthy volunteers were examined with MRI to establish the criteria for normal findings in MRI when classifying hip joints to those with synovitis and those without. MRI was used as a gold standard.

Results: Synovitis was found using MRI in 31 hips of 22 patients (9 patients had bilateral synovitis). The intraclass correlation was 0.61 between MRI and US in measuring CCD. In classifying hip joint synovitis with US, the sensitivity of the method was 87% and specificity 42%, when the CCD criterion for synovitis was determined to be ≥7 mm. If the cut-off point was raised to 9 mm, the sensitivity decreased to 61% while specificity increased to 94%. A difference in CCD of ≥1 mm between the hips as an additional criterion for synovitis increased the number of false-positive findings.

Conclusion: Measurement of CCD with US proved to be a rather inaccurate method to point out synovitis in rheumatic patients when using MRI as a reference. The main reason for this result was the thickened capsule, which US could not differentiate from a thickened synovium.

[Imaging of inflammatory back pain]

We recommend magnetic resonance imaging of the sacroiliac joints as the first line imaging method in suspected inflammatory back disorder. Plain X-ray can be taken from those over 35 years of age. A nonconclusive finding in plain X-ray should be verified by MR imaging. For the present, diagnostic criteria for spondylarthritis do not take into account spinal changes. Typical spinal findings can, however, be helpful in making treatment decisions. In case the spinal region MR imaging should be utilized if possible, because radiography is particularly insensitive for thoracic spine. After a confirmed diagnosis, the inflammatory nature of the condition can usually be assessed clinically.

The thoracic and lumbar spine in severe juvenile idiopathic arthritis: magnetic resonance imaging analysis in 50 children

OBJECTIVE

To determine the prevalence of vertebral fractures as a complication of juvenile idiopathic arthritis (JIA).

STUDY DESIGN

This cross-sectional study evaluated the prevalence and characteristics of spinal abnormalities in 50 children (aged 7.0-18.7 years) with treatment-resistant JIA by magnetic resonance imaging. Vertebral deformities, endplate irregularities, intervertebral disc involvement, spinal canal, neural foramina, and back muscles were analyzed and correlated with clinical characteristics and bone mineral density.

RESULTS

Magnetic resonance imaging revealed various abnormalities in 31 patients (62%). Vertebral compression was seen in 28%, disc degeneration in 46%, protrusions in 14%, prolapses in 4%, endplate changes in 26%, and anterior vertebral corner lesions in 16%. Two patients (4%) had mild spinal canal narrowing without medullar involvement; none had neural root compression. Six patients (12%) had mild back muscle atrophy. No correlation was observed between spinal fractures or other vertebral changes and disease activity or duration, pain or bone mineral density; patients with spinal fractures tended to have a higher recent glucocorticoid exposure (P=.086).

CONCLUSION

Children with severe JIA have a high prevalence of compression fractures and other vertebral, endplate, and disc abnormalities in the thoracic and lumbar spine.

[Strong metatarsal pain and localized bone lesions in a physically active male (clinico-pathological conference report)]

With the exception of a previous history of pulmonary sarcoidosis, a previously healthy 38-year old man developed a sudden unilateral metatarsal pain and gradually progressing osteoporotic, partly lytic metatarsal bone lesions. The patient received a bisphosphonate treatment. Clinical and radiological situation began to improve during the follow-up observation. The diagnosis was based on clinical picture.

A 30-year result of deforming arthritis in systemic lupus erythematosus

Symmetric non-erosive polyarthritis is the most common clinical feature in systemic lupus erythematosus (SLE). We report on a 42-year follow-up of a 71-year-old woman who first had polyarthritis in 1963 at the age of 29 and continuously since 1975. SLE was diagnosed in 2000 at the age of 66 as anti-dsDNA (56 kIU/l), and antinuclear antibodies (1:2,560) turned positive. In 2005 hand and feet radiographs revealed severe Jaccoud's arthritis with subluxations but without erosions.

Assessing the intra- and inter-reader reliability of dynamic ultrasound images in power Doppler ultrasonography

OBJECTIVE

To assess the intra-reader and inter-reader reliabilities of interpreting ultrasonography by several experts using video clips.

METHOD

99 video clips of healthy and rheumatic joints were recorded and delivered to 17 physician sonographers in two rounds. The intra-reader and inter-reader reliabilities of interpreting the ultrasound results were calculated using a dichotomous system (normal/abnormal) and a graded semiquantitative scoring system.

RESULTS

The video reading method worked well. 70% of the readers could classify at least 70% of the cases correctly as normal or abnormal. The distribution of readers answering correctly was wide. The most difficult joints to assess were the elbow, wrist, metacarpophalangeal (MCP) and knee joints. The intra-reader and inter-reader agreements on interpreting dynamic ultrasound images as normal or abnormal, as well as detecting and scoring a Doppler signal were moderate to good (kappa = 0.52-0.82).

CONCLUSIONS

Dynamic image assessment (video clips) can be used as an alternative method in ultrasonography reliability studies. The intra-reader and inter-reader reliabilities of ultrasonography in dynamic image reading are acceptable, but more definitions and training are needed to improve sonographic reproducibility.

Bone oedema predicts erosive progression on wrist MRI in early RA--a 2-yr observational MRI and NC scintigraphy study

OBJECTIVES

To investigate if disease assessment by contrast-enhanced dynamic and static magnetic resonance imaging (MRI) and quantitative nanocolloid (NC) scintigraphy gives useful additional information in early rheumatoid arthritis (RA).

METHODS

Twenty-seven patients with early RA (disease duration < or =12 months) were followed up for 1 yr and 24 of them for 2 yrs with contrast-enhanced MRI and NC scintigraphy of the wrist joint. Synovial inflammation was assessed by measuring time-dependent enhancement rates (E-rate) from dynamic MRI scans and technetium(99m)-labelled nanocolloid ((99m)Tc-NC) uptake from scintigraphy scans. Synovial membrane hypertrophy, bone oedema and erosions were semiquantitatively scored according to the Outcome Measures in Rheumatology Clinical Trials RA-MRI scoring system from static MR images. Response to the treatment was evaluated based on whether or not > or = 50% improvement was achieved in the tender and swollen joint scores and the Health Assessment Questionnaire score, with normal C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) levels. Progression of the erosion score on wrist MRI was evaluated as the outcome.

RESULTS

The baseline MRI bone oedema score (rho= 0.67), MRI synovitis score (rho= 0.57), ESR (rho= 0.56), CRP (rho= 0.48), E-rate (rho= 0.47) and (99m)Tc-NC uptake (rho= 0.45) were related with the change in the MRI erosion score from baseline to 2 yrs (rho= Spearman's correlation). In the multivariate logistic regression model, the bone marrow oedema score was the only baseline variable that predicted erosive progression at 2 yrs' follow-up (OR 4.2, 95% CI 1.3-13.8). The median (interquartile range) change in the erosion score from baseline to 2 yrs was 0 (0, 0) and 4 (2, 5) in the patients with (n= 9) and without (n= 15) a persistent clinical response over the 2 yrs, respectively (P= 0.001). The non-responders who presented with erosive progression from 1 yr to 2 yrs had higher MRI synovitis scores, bone oedema scores, E-rate and (99m)Tc-NC uptake at 1-yr follow-up than the non-responders without progressive bone damage.

CONCLUSION

The degree of local synovial inflammation at baseline, evaluated by dynamic and static MRI and quantitative NC scintigraphy, is closely related to the progression of wrist joint erosions during the first 2 yrs of the disease. Furthermore, at follow-up, if no persistent clinical response is achieved, these imaging methods may help to predict future erosiveness and help in clinical therapeutic decision making.

Contrast-enhanced dynamic and static MRI correlates with quantitative 99Tcm-labelled nanocolloid scintigraphy. Study of early rheumatoid arthritis patients

OBJECTIVE

The aim of this study was to evaluate the roles of contrast-enhanced dynamic and static magnetic resonance imaging (MRI) and quantitative 99Tcm-labelled nanocolloid (NC) scintigraphy in detecting wrist joint inflammation in early rheumatoid arthritis (RA) patients.

METHODS

Twenty-eight early RA patients (median symptom duration 5 months, range 1-12 months) underwent MRI, NC scintigraphy, laboratory and clinical examinations. Static wrist MRI scans were retrospectively scored for synovitis, bone oedema and erosions by two independent readers using the recently published rheumatoid arthritis MRI scoring system (RAMRIS). Twenty NC scans were analysed quantitatively by measuring maximum 99Tcm-NC uptake in three small areas of each wrist. From the same locations on the wrists, dynamic MRI gadolinium-diethylenetriaminepenta-acetic acid (Gd-DTPA) enhancement rates (E-rate) were measured. The average 99Tcm-NC uptake of the whole wrist region was also measured and average E-rates were calculated. Correlations between MRI and NC scintigraphy measurements were calculated. Correlations between imaging methods of the wrist and the global measures of inflammation (laboratory and clinical examinations) were also assessed.

RESULTS

Strong correlations emerged between maximal 99Tcm-NC uptake and MRI E-rates, reflecting similar performance of the methods in detecting local synovial inflammation. 99Tcm-NC uptake and MRI E-rate correlated with semiquantitative scoring of synovitis and bone oedema from static MRI scans. The erythrocyte sedimentation rate (ESR) correlated with MRI scores, E-rate and 99Tcm-NC uptake. No correlation between the clinical parameters and the imaging methods was detected. Inter-observer reliability for scoring synovial hypertrophy, bone oedema and bone erosions from static MR images were high (single-measure fixed-effects intra-class correlations 0.87, 0.93 and 0.91 respectively). Intra-observer reliability for E-rate and 99Tcm-NC measurements of 10 randomly picked scans was found to be high, with an intra-class correlation of 0.92; 95% confidence interval (CI) 0.84-0.96 and 0.99; 95% CI 0.98-1.00, respectively.

CONCLUSIONS

Objective information about wrist joint inflammation can be obtained with contrast-enhanced dynamic MRI and quantitative 99Tcm-labelled NC scintigraphy. MRI also allows visualization and semiquantitative scoring of bone oedema and erosions of the wrist. Dynamic MRI and NC scintigraphy are safe and easy to perform, and they can be used in a long-term follow-up of rheumatoid patients.

Magnetic resonance imaging of the rotator cuff in destroyed rheumatoid shoulder: comparison with findings during shoulder replacement

PURPOSE

To evaluate the predictive value of preoperative magnetic resonance imaging (MRI) with respect to rotator cuff ruptures.

MATERIAL AND METHODS

Thirty-one patients with rheumatic disease underwent preoperative MRI before shoulder arthroplasty. The scans were reviewed independently by two experienced radiologists. Three surgeons performed all the replacements (hemiarthroplasties), and the condition of the rotator cuff was assessed. Complete and massive tears of the rotator cuff were recorded and compared at surgery and on MRI.

RESULTS

With MRI, 21 shoulders (68%) were classified as having complete or massive tears of the rotator cuff and at surgery 14 shoulders (45%). Cohen's kappa coefficient was 0.44 (95% CI: 0.16 to 0.72) and accuracy 0.71 (95% CI: 0.52 to 0.86).

CONCLUSION

In severely destroyed rheumatoid shoulder, the findings of soft tissues were incoherent both with MRI and at surgery. The integrity of tendons could not readily be elucidated with MRI because of an inflammatory process and scarred tissues; in surgery, too, changes were frequently difficult to categorize. Preoperative MRI of severely destroyed rheumatoid shoulder before arthroplasty turned out to be of only minor importance.

Can we rely on magnetic resonance imaging when evaluating unstable atlantoaxial subluxation?

OBJECTIVES

To examine whether functional radiography and functional magnetic resonance imaging (MRI) are equally efficient in detecting the extent of unstable anterior atlantoaxial subluxation (aAAS) in rheumatic patients.

METHODS

23 patients with unstable aAAS (diagnosed by functional radiography) were examined by functional MRI because of a neck symptom. Twenty two patients had rheumatoid arthritis and one had juvenile idiopathic arthritis. aAAS was diagnosed if the anterior atlantoaxial diameter (AAD) was >3 mm and was considered unstable if the AAD differed by >2 mm between flexion and extension radiographs. The AAD was measured from radiographs (flexion and extension) and MRI images (flexion and neutral).

RESULTS

The extent of aAAS during flexion measured by radiography was greater than that found by MRI in all 23 patients (mean difference 3 mm (95% confidence interval 2 to 4)). In four (17%) patients flexion MRI could not demonstrate aAAS detected by radiography. The difference between the AAD measurements during flexion by these two methods was substantial (that is, >or=4 mm) in nine (39%) cases. Severe aAAS (>or=9 mm) was seen in 15 (65%) patients by functional radiography and in four (17%) by functional MRI.

CONCLUSIONS

The magnitude of aAAS was often substantially smaller when measured by functional MRI rather than by functional radiography. Thus one cannot rely on the result of functional MRI alone; functional radiographs are needed to show the size of unstable aAAS. The maximal extent of the subluxation must be taken into account when the possible compression of neural structures is evaluated by MRI.

US assessment of hip joint synovitis in rheumatic diseases. A comparison with MR imaging

PURPOSE

To assess the significance of ultrasonography (US) in detecting hip joint synovitis in patients with rheumatic diseases.

MATERIAL AND METHODS

Forty patients with rheumatic disease and suspected hip joint synovitis underwent MRI and US of the hip joint. In addition to the throughout MRI evaluation, the anterior collum-capsule distance (CCD) was determined by both MRI and US. Thirteen healthy volunteers were examined with MRI to establish the criteria for normal findings in MRI when classifying hip joints to those with synovitis and those without. MRI was used as a gold standard.

RESULTS

Synovitis was found using MRI in 31 hips of 22 patients (9 patients had bilateral synovitis). The intraclass correlation was 0.61 between MRI and US in measuring CCD. In classifying hip joint synovitis with US, the sensitivity of the method was 87% and specificity 42%, when the CCD criterion for synovitis was determined to be > or = 7 mm. If the cut-off point was raised to 9 mm, the sensitivity decreased to 61% while specificity increased to 94%. A difference in CCD of > or = 1 mm between the hips as an additional criterion for synovitis increased the number of false-positive findings.

CONCLUSION

Measurement of CCD with US proved to be a rather inaccurate method to point out synovitis in rheumatic patients when using MRI as a reference. The main reason for this result was the thickened capsule, which US could not differentiate from a thickened synovium.

Insufficiency fractures in patients with chronic inflammatory joint diseases

OBJECTIVE

To describe the typical sites of stress fractures in the lower extremities and pelvis in rheumatoid patients (rheumatoid arthritis, juvenile chronic arthritis, psoriatic arthritis, ankylosing spondylitis).

METHODS

Thirty-three patients with 52 stress fractures [mean age 44 years (range 11-73)] were studied at the authors' institution when they were being treated for their rheumatic diseases. Fourteen patients had RA, 9 JCA, 5 PsoA, and 5 SPA. Stress fractures were detected from patient documents and from series radiographs in suspected cases. In some cases magnetic resonance imaging was also performed.

RESULTS

One patient presented with 5 fractures, 2 patients with 4 and 3 fractures, and 7 patients with 2 fractures each. Other patients (n = 19) had only one fracture each. The metatarsal (MT) bones were the most common site of involvement. Twenty-five of the 52 fractures were located on MT I-V. The second and third most common sites were thefibula (n = 13) and tibia (n = 6). All fractures of the lower tibia or fibula were associated with valgus malalignment of the ankle.

CONCLUSION

If a patient with rheumatic disease experiences sudden and unexplained pain localised in the forefoot, above the ankle, below the knee, or in the pelvis, a stress fracture should be suspected. Patients with severe osteoporosis, high-load corticosteroid or methotrexate therapy, or marked joint deformity are at high risk of developing stress fracture.

"Bamboo spine" starts to bend--something is wrong

A typical complication of ankylosing spondylitis with an atypical patient history is reported and the topic is discussed. The diagnosis of a spinal fracture may be difficult in a "bamboo spine".

Changes in voice characteristics after uvulopalatopharyngoplasty

Previous reports have warned that tonsillectomy or uvulopalatopharyngoplasty (UPPP) may alter patients' speech by increasing the amount of nasal resonance as well as by changing voice timbre due to enlargement of the vocal tract. However, very few objective investigations, excluding nasality problems, have been carried out. We studied eight patients who underwent surgery for UPPP and recorded pre- and postoperative speech. The speech samples were then rated by seven experienced listeners, and acoustic spectra of two long vowels,/a/ and /e/, were analyzed using a computer program (MacSpeech Lab II). The listeners were unable to make a distinction between pre- and postoperative voice samples in the recordings studied. Acoustic analysis showed that the fundamental frequency as well as the first and second formants remained essentially unchanged. Present findings show that UPPP should not have a significant effect on voice characteristics as long as excessive nasality is not produced.

Age at first birth, parity and risk of breast cancer: a meta-analysis of 8 studies from the Nordic countries

Several large epidemiological studies in the Nordic countries have failed to confirm an association between age at first birth and breast cancer independent of parity. To assess whether lack of power or heterogeneity between the countries could explain this, a meta-analysis was performed of 8 population-based studies (3 cohort and 5 case-control) of breast cancer and reproductive variables in the Nordic countries, including a total of 5,568 cases. It confirmed that low parity and late age at first birth are significant and independent determinants of breast-cancer risk. Nulliparity was associated with a 30% increase in risk compared with parous women, and for every 2 births, the risk was reduced by about 16%. There was a significant trend of increasing risk with increasing age at first birth, women giving first birth after the age of 35 years having a 40% increased risk compared to those with a first birth before the age of 20 years. Tests for heterogeneity between studies were not significant for any of the examined variables. In the absence of bias, this suggests that several individual Nordic studies may have had too little power to detect the weak effect of age at first birth observed in the meta-analysis.

Clinical comparison of 99Tcm-HMPAO labelled leucocytes and 99Tcm-nanocolloid in the detection of inflammation

Forty-five patients with various inflammatory diseases were imaged with 99Tcm-HMPAO labelled leucocytes and 99Tcm-nanocolloid within 7 days. The overall sensitivity of 99Tcm-leucocytes was 97% and that of 99Tcm-nanocolloid 59% and both agents had a 100% specificity. The 99Tcm-leucocyte method showed reliable results in various inflammatory and infectious conditions, and seems suitable as a primary imaging method. On the contrary, 99Tcm-nanocolloid cannot be recommended for use in inflammatory bowel diseases, soft tissue abscesses or prosthetic vascular graft infections. However, 99Tcm-nanocolloid gave reliable information in inflammatory and infectious bone and joint diseases in which it had a 90% sensitivity and 100% specificity. In those lesions the 99Tcm-nanocolloid method may be useful, because it is simple, fast and cheap. Yet, further evaluation is needed.

Technetium-99m HM-PAO-labeled leukocytes in detection of inflammatory lesions: comparison with gallium-67 citrate

Forty-three patients with suspected benign, inflammatory, or infectious diseases were imaged with [99mTc]HM-PAO-labeled leukocytes and [67Ga]citrate. Technetium-99m leukocytes showed 22 true-positive, no false-positive, 19 true-negative, and two false-negative findings and [67Ga]citrate 23, 7, 12 and 1, respectively. The sensitivity, specificity, and accuracy values with 99mTc leukocytes were 92%, 100%, and 95%, and with [67Ga]citrate 96%, 63%, and 81%. Technetium-99m leukocyte scintigraphy has a promising future in comparison with [67Ga]citrate because of the ready availability of [99mTc]HM-PAO, the good image quality, more rapid results (within few hours), and the lower radiation exposure to the patient with 99mTc leukocytes. The usefulness of 99mTc leukocytes in chronic osteomyelitis needs further evaluation.

99mTc-leukocyte scintigraphy in prosthetic vascular graft infections

The aim of this study was to determine the diagnostic value of scintigraphy with 99mTc-HMPAO-labelled leukocytes for the detection of prosthetic vascular graft infection. 51 scans were recorded in 19 patients with suspected vascular graft infection and 8 control patients. Three-phase scanning was used at 0.5, 3-6 and 18-24 h. 13 vascular graft infections (10 early, 3 late) were found. 12 of these healed with antibiotics and only one patient with late infection had to be reoperated. None of them died during the follow-up period. The sensitivity was 100% and the specificity 96%. 99mTc-leukocyte scintigraphy seems a useful tool to detect vascular graft infection and to differentiate it from infections elsewhere. The results suggest that the incidence of vascular graft infection may be greater, and the mortality rate lower, than supposed before.

[18F]fluorodeoxyglucose scintigraphy in diagnosis and follow up of treatment in advanced breast cancer

Seventeen patients with advanced breast cancer were imaged with a specially collimated gamma camera to study tumor uptake of 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) before and during therapy. Fourteen patients (82%) showed increased FDG accumulation in metastatic tumors, 6/8 (75%) of axillary, supra or infraclavicular metastatic lymph nodes were detectable. In one of these cases, FDG imaging was the first method to identify axillary metastasis causing nerve compression. Also, pulmonary and liver metastases could be imaged with FDG; both in two patients. The intra individual variability in uptake was considerable in bone metastases, and some lesions remained FDG negative: 99mTc-DPD was superior in detecting bone disease. Bone metastases of the osteolytic or mixed type were better visualized than sclerotic ones. Ten patients were reimaged later to assess the effect of therapy on FDG uptake. Increased uptake was associated with clinical progression, while unchanged or diminished uptake did not predict the course of disease as reliably. This study indicates that FDG can be used to image breast cancer metastases. FDG may be valuable in monitoring treatment response, but positron emission tomography (PET) would probably be more appropriate than planar imaging for this purpose.

Double-contrast examination of the stomach: 100mm fluorography vs. full-size radiography

Full-size radiographs and 100mm fluorographic spot views taken with an image intensifier were compared during double-contrast examination of the stomach. Differences in image quality between the two modalities were small; there was also a small decrease in absorbed dose, since fluoroscopy comprised more than half of the total dose. The authors recommend that 100mm spot views be used routinely in double-contrast examination of the stomach.

Independent risk factors of benign and malignant breast lesions

The purpose of this study is to evaluate the risk factors of benign breast disease and to compare them with the known risk factors of breast cancer in order to make inferences on the relationship between benign breast disease and breast cancer. All benign breast lesions diagnosed from the population of the city of Tampere, Finland in 1974-1977 were reclassified by two pathologists into two groups of dysplasias and two groups of tumors. In the risk analysis of 422 age-matched pairs no group of benign lesions had risk factors consistently similar to those of breast cancer. It is therefore likely that either benign breast disease is not associate with breast cancer or it is an independent risk factor, not associated with the other high risk indicators of breast cancer.

Effect of a screening programme on breast carcinoma incidence, mortality and survival

Screening for breast carcinoma revealed 27 cases of malignancy, 7 of them preclinical. The method consisted of palpation and health education. Mammary radiography and fine needle biopsy were used in uncertain cases only. Shortly after the screening the incidence and mortality were lower (1.07 and 0.29 per 10(3), respectively) than during the screening (1.40 and 0.45 per 10(3)). Survival also improved and the percentage of localized cases was higher for patients diagnosed during or after screening than for patients diagnosed before. However, the changes did not show any substantial differences from the long-term trends. It was concluded that the screening programme had no real effect on the malignancy risk. The absence of effect was accounted for by the relatively inefficient screening method.

Inverse association between risk factors for benign and malignant breast lesions

The purpose of the present study was to compare the risk of breast cancer and the risk of benign breast disease using known risk factors for breast cancer. The series was taken during breast cancer screening of women aged 41-60 in an industrial city in Finland. 158 breast lesions were diagnosed, 27 of which were malignant. Women with breast disease and 534 controls were interviewed to obtain epidemiological data. The prevalence of benign lesions decreased after menopause but the prevalence of carcinomas was essentially the same over the age span 41-60. Several risk factors for breast cancer, such as selected reproductive and hormonal characteristics, were not associated with the risk of benign breast disease. Thus it was concluded that benign and malignant breast lesions are not associated in general, and the decrease in the prevalence of benign breast lesions after menopause is more likely to be due to regression than to transition to carcinoma.

Breast cancer incidence: geographical correlations in Finland

Correlation analysis was performed on breast cancer incidence and risk factors in geographical areas of Finland. Breast cancer risk is associated with fertility and taxable income but not with the size of the woman. Trends in risk factors indicate that the rapid increase in the incidence of breast cancer is likely to continue. It is concluded that factors which are reflected by the standard of living and fertility might act independently and not through the nutritional status, for which the size of the woman is an operational indicator.

Failure of selective screening for breast cancer by combining risk factors

The possibilities of selective screening to reduce the costs of screening programmes for breast cancer were considered. Discriminant function analysis was used in an effort to describe a high-risk group of breast cancer, which will be subjected to screening. The high-risk group consisted of females with a combination of reproductive and hormone use characteristics. One-fifth of the breast cancer cases remained in the low-risk group, when the high-risk group was small enough (two-thirds of the population) to yield a meaningful reduction in costs. Selective screening for breast cancer seems to have only limited applicability and is not effective enough for application in public health work.

Risk factors of breast cancer in Finland

The risk of breast cancer in Finland is low (40.1/100,000) compared with the other Nordic countries. A case-control study was carried out on 122 cases of breast cancer and 534 controls between the ages of 41 and 60. It was found that age at first marriage and birth of the first child as well as the number of abortions and parity adjusted for age at first birth were associated with the breast cancer risk, whereas lactation was not. The results did not confirm the hypothesis (de Waard) that overweight and/or the size of the woman influence the risk of breast cancer.

Screening for breast cancer in women aged 41--60

All women aged 41--60 (20 644) living in the city of Tampere were invited to attend screening for breast cancer during the period April 1974--March 1975. The breasts and the axillary lymph nodes were examined and palpated by specially trained nurses. The women were instructed in self-examination and given a leaflet for study at home. If anything abnormal was revealed at this stage the subject was referred to a physician for further examination. The women who attended totalled 17 261 (84%), 627 (3.6%) of whom were referred for further examination and 615 attended. Surgical biopsy was recommended for 117 (19%) of these 615. Breast cancer was histologically verified in 27 subjects. Ten further cases of breast cancer were detected outside this screening during the same one year screening period, which made the overall detection rate 1.79 per thousand in this age group. As the expected incidence was 1.20 per thousand, the primary detection excess was 0.59 per thousand or 12 cases. A further advantage of screening of this kind is the instruction given to the subjects, which is expected to result in more cases of cancer being revealed at an earlier stage.