Biomedical subjects

Berta M Geller

Publications and source records attributed to Berta M Geller.

At least 19 recordsLinked to original sources

PubMed2006

Risk factors for breast carcinoma in situ versus invasive breast cancer in a prospective study of pre- and post-menopausal women.

Risk factors for breast carcinoma in situ and invasive breast cancer were compared using data from 61,844 women (61% post-menopausal) with no prior breast cancer and at least one screening mammogram between April 1, 1996 and June 30, 2001. The women were followed until a subsequent mammogram before July 1, 2001, or a benign biopsy or breast cancer diagnosis before June 30, 2002. A total of 1,191 breast cancers (300 in situ and 891 invasive) were diagnosed during an average follow-up of 3.1 years. Multivariate Cox regression models were used to estimate the relative risks (RR) of in situ and invasive cancer associated with family history of breast cancer, age at first childbirth or nulliparity, post-menopausal hormone use, body mass index (BMI), and mammographic breast density. Separate analyses were done for pre- and post-menopausal women. BMI was unrelated to risk of in situ cancer regardless of menopausal status, but was associated with an increased risk of invasive cancer in post-menopausal women (RR = 1.9 for BMI > or = 30 vs. BMI < 22, 95% confidence interval 1.4-2.5). Later childbearing and nulliparity were more strongly associated with in situ than invasive cancer in pre-menopausal women. Post-menopausal hormone use was more strongly associated with invasive disease. RR associated with family history and breast density were similar for in situ cancer and invasive cancer. Results indicating that BMI is related to post-menopausal invasive cancers but unrelated to in situ cancers are consistent with the hypothesis that concomitants of obesity activate proliferation.

Adult↗

PubMed2006

Prospective breast cancer risk prediction model for women undergoing screening mammography.

BACKGROUND: Risk prediction models for breast cancer can be improved by the addition of recently identified risk factors, including breast density and use of hormone therapy. We used prospective risk information to predict a diagnosis of breast cancer in a cohort of 1 million women undergoing screening mammography. METHODS: There were 2,392,998 eligible screening mammograms from women without previously diagnosed breast cancer who had had a prior mammogram in the preceding 5 years. Within 1 year of the screening mammogram, 11,638 women were diagnosed with breast cancer. Separate logistic regression risk models were constructed for premenopausal and postmenopausal examinations by use of a stringent (P<.0001) criterion for the inclusion of risk factors. Risk models were constructed with 75% of the data and validated with the remaining 25%. Concordance of the predicted with the observed outcomes was assessed by a concordance (c) statistic after logistic regression model fit. All statistical tests were two-sided. RESULTS: Statistically significant risk factors for breast cancer diagnosis among premenopausal women included age, breast density, family history of breast cancer, and a prior breast procedure. For postmenopausal women, the statistically significant factors included age, breast density, race, ethnicity, family history of breast cancer, a prior breast procedure, body mass index, natural menopause, hormone therapy, and a prior false-positive mammogram. The model may identify high-risk women better than the Gail model, although predictive accuracy was only moderate. The c statistics were 0.631 (95% confidence interval [CI] = 0.618 to 0.644) for premenopausal women and 0.624 (95% CI = 0.619 to 0.630) for postmenopausal women. CONCLUSION: Breast density is a strong additional risk factor for breast cancer, although it is unknown whether reduction in breast density would reduce risk. Our risk model may be able to identify women at high risk for breast cancer for preventive interventions or more intensive surveillance.

Adult↗

PubMed2006

Pathologic findings from the Breast Cancer Surveillance Consortium: population-based outcomes in women undergoing biopsy after screening mammography.

BACKGROUND: To the authors' knowledge, a comprehensive analysis of pathology outcomes after screening mammography, as it is practiced clinically in the U.S. general population, has not been performed. METHODS: Breast Cancer Surveillance Consortium data from 1996-2001 were used to identify pathology specimens that were obtained within 1 year of screening mammograms performed on 786,846 women ages 40-89 years. The pathology results were classified as invasive carcinoma, ductal carcinoma in situ (DCIS), or benign. The associations between overall pathology outcomes and invasive tumor size and lymph node status were analyzed by age and mammography assessment category. RESULTS: The rates of both recommending and performing a biopsy varied little with age. The 1,664,032 screening mammograms were followed by 26,748 known biopsies (1.6%) and 8815 diagnoses of breast carcinoma (0.53%). Overall, 81% of carcinomas were invasive, and 78% of those were pathologically lymph node-negative tumors, in contrast to the 66% prevalence observed in the Surveillance, Epidemiology, and End Results (SEER) data during the same period. Most invasive tumors measured between 0 mm and 10 mm (35%) or between 11 mm and 20 mm (36%) in greatest dimension, and 92% and 78% were lymph node-negative tumors, respectively: Biopsy results that were classified as malignant increased with age (P < 0.0001) and were most likely to follow Breast Imaging, Reporting, and Diagnosis System Category 5 and 4 assessments, respectively. Ductal hyperplasia (19.6%), fibroadenoma (18.5%), and other benign findings (56.1%) were the most common benign diagnoses. CONCLUSIONS: Pathologically negative lymph nodes were more prevalent in this mammographically screened population than in the overall SEER population. The prevalence of invasive carcinoma, DCIS, and benign findings presented herein establish a range of expected biopsy outcomes for women after screening mammography in the general U.S. population.

Adult↗

PubMed2006

Print information to inform decisions about mammography screening participation in 16 countries with population-based programs.

OBJECTIVE: To profile and compare the content and presentation of written communications related to informed decision-making about mammography. METHODS: Materials from 16 screening programs organized at the national or regional level were analyzed according to five major information domains suggested by the international literature. RESULTS: A majority of countries provided information on the program (interval, cost and quality). There was considerable variability in comprehensiveness of elements in the domains, e.g., test characteristics (false positive/negative) and pros and cons of screening. The majority noted the likelihood of recall for further tests, few commented on the risks of additional tests or finding unimportant tumors. The audit also found variation in presentation (words and pictures). CONCLUSIONS: Presentation of comprehensive, but balanced information on screening benefits and risks is complex and daunting. Issues such as framing effects, coupled with debate about screening efficacy are challenging to the design of effective information tools. The objective of increasing screening prevalence at the population level must be balanced with objectively presenting complete and clear information. Additional research is needed on how information (and mode of presentation) impact screening decisions. PRACTICE IMPLICATIONS: Public health officials need to articulate their objectives and review written communication according to important decision-making domains.

Australia↗

PubMed2006

Improving the concordance of mammography assessment and management recommendations.

PURPOSE: To retrospectively compare the concordance of initial and final assessment categories for mammograms with management recommendations made before and after the final rules of the Mammography Quality Standards Act (MQSA) were in effect for screening and diagnostic mammography. MATERIALS AND METHODS: The study included mammograms from 1996 to 2001 from the seven mammography registries of the Breast Cancer Surveillance Consortium (BCSC). The authors defined the pre-MQSA period as January 1, 1996-April 27, 1999, and the post-MQSA period as April 28, 1999-December 31, 2001 (2470151 screening and 194199 diagnostic mammograms). Assessment was cross-classified according to management recommendation. Changes in concordance between assessment and recommendation were evaluated by year and by period (before and after MQSA) for computer-linked data and for all data by using Pearson chi(2) test to evaluate differences. Mantel-Haenszel chi(2) test was used to measure change in concordance over time. Each registry and the BCSC Statistical Coordinating Center had a Federal Certificate of Confidentiality and approval from each institution's review board for protection of human subjects to collect and send data to coordinating center and conduct research with these data. Active consent was required at only one site in this HIPAA-compliant study. RESULTS: Concordance increased significantly in the post-MQSA period for Breast Imaging Reporting and Data System categories 3-5 assessments at both screening and diagnostic mammography. The most substantial improvements were in the use of the management recommendation for "additional imaging," which decreased from 41% in 1996 to 15% in 2001 for screening mammograms with an initial assessment of category 4 (P < .001). Recommendation for short-interval follow-up in women with screening mammograms with a category 3 final assessment increased from 51% in 1996 to 76% in 2001 (P < .001). Concordance for diagnostic mammograms assigned category 0 improved from 65% in the pre-MQSA period to 81% in the post-MQSA period (P < .001). CONCLUSION: This analysis demonstrates that over a relatively short period of time, major improvement in radiology reporting has occurred.

Breast Neoplasms↗

PubMed2006

Performance benchmarks for screening mammography.

PURPOSE: To retrospectively evaluate the range of performance outcomes of the radiologist in an audit of screening mammography by using a representative sample of U.S. radiologists to allow development of performance benchmarks for screening mammography. MATERIALS AND METHODS: Institutional review board approval was obtained, and study was HIPAA compliant. Informed consent was or was not obtained according to institutional review board guidelines. Data from 188 mammographic facilities and 807 radiologists obtained between 1996 and 2002 were analyzed from six registries from the Breast Cancer Surveillance Consortium (BCSC). Contributed data included demographic information, clinical findings, mammographic interpretation, and biopsy results. Measurements calculated were positive predictive values (PPVs) from screening mammography (PPV(1)), biopsy recommendation (PPV(2)), biopsy performed (PPV(3)), recall rate, cancer detection rate, mean cancer size, and cancer stage. Radiologist performance data are presented as 50th (median), 10th, 25th, 75th, and 90th percentiles and as graphic presentations by using smoothed curves. RESULTS: There were 2 580 151 screening mammographic studies from 1 117 390 women (age range, <30 to >/=80 years). The respective means and ranges of performance outcomes for the middle 50% of radiologists were as follows: recall rate, 9.8% and 6.4%-13.3%; PPV(1), 4.8% and 3.4%-6.2%; and PPV(2), 24.6% and 18.8%-32.0%. Mean cancer detection rate was 4.7 per 1000, and the median [corrected] mean size of invasive cancers was 13 mm. The range of performance outcomes for the middle 80% of radiologists also was presented. CONCLUSION: Community screening mammographic performance measurements of cancer outcomes for the majority of radiologists in the BCSC surpass performance recommendations. Recall rate for almost half of radiologists, however, is higher than the recommended rate.

Adult↗

PubMed2005

Predicting biopsy outcome after mammography: what is the likelihood the patient has invasive or in situ breast cancer?

BACKGROUND: As many as 1,000,000 breast biopsies are performed annually in the United States. Although substantial effort has been devoted to estimating breast cancer risk, there have been no studies to predict outcome in women undergoing breast biopsy. METHODS: A population-based study was undertaken to develop and test models for predicting the probability of invasive breast cancer and/or ductal carcinoma-in-situ in 7670 women undergoing breast biopsy after mammography. Logistical prediction models were developed by using data from 6129 randomly selected women and tested with data from the remaining women. RESULTS: The overall cancer prevalence among women undergoing biopsy was 22.4%. Prevalence in women with mammograms highly suggestive of malignancy (category 5) was 84.6%, with minimal variation in individual cancer probabilities due to age. A total of 24.6% of women with suspicious mammograms (category 4) had cancer, but individual probability estimates ranged from .01 to .86, depending on age, presence of a lump, previous biopsy, menopausal status, and use of postmenopausal hormone therapy. These variables also influenced biopsy outcome in women with other mammography assessments (categories 0-3), but the overall prevalence was lower (8.6%), and estimated probabilities ranged from .01 to .45. When cancer was present, the probability of invasive disease was influenced by mammogram assessment category, absence of mammogram calcifications, and presence of a lump. CONCLUSIONS: The probabilities of invasive cancer and ductal carcinoma-in-situ in women undergoing biopsy can be more accurately predicted by using clinical characteristics in addition to mammography findings. This information could potentially influence decisions regarding immediate biopsy or continued surveillance.

Adolescent↗

PubMed2005

Modeling the dissemination of mammography in the United States.

OBJECTIVE: This paper presents a methodology for piecing together disparate data sources to obtain a comprehensive model for the use of mammography screening in the US population for the years 1975-2000. METHODS: Two aspects of mammography usage, the age that a woman receives her first mammography and the interval between subsequent mammograms, are modeled separately. The initial dissemination of mammography is based on cross-sectional self report data from national surveys and the interval length between screening exams is fit using longitudinal mammography registry data. RESULTS: The two aspects of mammography usage are combined to simulate screening histories for individual women that are representative of the US population. Simulated mammography patterns for the years 1994-2000 were found to be similar to observed screening patterns from the state level mammography registry for Vermont. CONCLUSIONS: The model presented gives insight into screening practices over time and provides an alternative public health measure for screening usage in the US population. The comprehensive description of mammography use from its introduction represents an important first step to understanding the impact of mammography on breast cancer incidence and mortality.

Age Distribution↗

PubMed2005

The use of additional imaging increased specificity and decreased sensitivity in screening mammography.

BACKGROUND AND OBJECTIVES: To examine the use of additional imaging after standard mammographic screening views to better understand the value of these additional testing in improving accuracy. MATERIALS AND METHODS: Statewide population data on screening mammography were used to report accuracy measures at screening and after additional imaging tests. Pathology data from biopsies performed within 1 year following the screening mammogram were used to determine cancer outcome (489 in situ and invasive cancers). Pathologic and population characteristics of women receiving different types of imaging were assessed by chi-square or t-tests. Similar tests compared women with the same imaging and differing outcomes. RESULTS: Of 77,799 women with screening mammograms 9.9% had additional imaging. Additional imaging reduced false positives from 7,765 (100/1,000 mammograms) to 1,112 (14/1,000 mammograms). The majority of false negatives (82%) occurred in women receiving only screening views, and additional imaging increased the number of false negatives from 82 (1/1,000 mammograms) to 115 (1.5/1,000 mammograms). CONCLUSION: Additional imaging can reduce unnecessary biopsy but at the cost of some additional false negatives. Additional imaging's potential for improving the sensitivity of screening is limited because most missed cancers occur in women who do not have additional imaging.

Adult↗

PubMed2005

Association between mammography timing and measures of screening performance in the United States.

PURPOSE: To evaluate whether there is an association between the number of months since previous mammography (MSPM) and performance measures (sensitivity, specificity, recall rate, cancer detection rate, and positive predictive value) in women who underwent U.S. community-based screening mammography. MATERIALS AND METHODS: Data from seven registries (Breast Cancer Surveillance Consortium) and mammographic data and cancer outcome in regard to 1 213 754 screening mammographic examinations performed in 680 641 women who were 40-89 years old for the years 1996-2000 were used in this study. These data are submitted annually in a standard format to a central statistical coordinating center that is subject to institutional review board approval, quality control, and confidentiality standards. Performance measures were calculated for first and subsequent screening mammography. For subsequent mammography, performance measures were calculated according to categories of MSPM (9-15, 16-20, 21-27, and >/=28 months). Receiver operating characteristic and multivariable logistic regression analyses were conducted to test the association between the number of MSPM and performance measures. RESULTS: With increasing MSPM in each category from 9-15 to 28 months or more and for first mammographic examinations, respectively, there was increased sensitivity (70.9%, 75.7%, 85.4%, 82.5%, and 88.6%), decreased specificity (93.3%, 92.7%, 91.6%, 91.0%, and 85.9%), increased recall rate (7.0%, 7.6%, 8.8%, 9.4%, and 14.7%), and increased cancer detection rates (3.2, 3.5, 4.5, 4.6, and 6.1 per 1000 mammographic examinations). When the category of 9-15 MSPM was compared with that of 21-27 MSPM, there was a slight increase in positive predictive value from 4.6% to 5.1%. Confidence intervals were narrow and did not overlap. Age affected these associations for all performance measures except sensitivity. CONCLUSION: Performance measures increased as MSPM increased, except for specificity, which decreased. Time between mammograms is an important factor to consider when audits are reviewed or screening performance measures are compared.

Adult↗

PubMed2005

Breast cancer yield for screening mammographic examinations with recommendation for short-interval follow-up.

PURPOSE: To compare cancer yield for screening examinations with recommendation for short-interval follow-up after diagnostic imaging work-up versus after screening mammography only. MATERIALS AND METHODS: From January 1996 to December 1999, Breast Imaging Reporting and Data System assessments and recommendations were collected prospectively for 1,171,792 screening examinations in 758,015 women aged 40-89 years at seven mammography registries in Breast Cancer Surveillance Consortium. Registries obtained waiver of signed consent or collected signed consent in accordance with institutional review boards at each location. Diagnosis of invasive cancer or ductal carcinoma in situ within 24 months of screening examination and tumor stage and size for invasive cancer were determined through linkage to pathology database or tumor registry. chi2 test was used to determine significant differences between groups. RESULTS: Overall, 5.2% of first and 1.7% of subsequent screens included recommendation for short-interval follow-up, which was similar to likelihood of recommendation for diagnostic evaluation (first screens, 4.6%; subsequent, 2.6%). Most recommendations for short-interval follow-up were based on screening mammography alone (86.2% of first screens, 77.5% of subsequent). Yield of cancer for screening examinations with probably benign finding (PBF) and recommendation for short-interval follow-up based on screening mammography alone tended to be lower than in those with PBF and recommendation for short-interval follow-up after additional work-up (first screens: 0.54% vs 0.96%, P=.10; subsequent: 1.50% vs 1.73%, P=.26). Proportion of stage II and higher disease tended to be higher for examinations with PBF and recommendation for short-interval follow-up based on screening mammography alone compared with those recommended for short-interval follow-up after additional work-up (first screens: 34.7% vs 24.4%, P=.43; subsequent: 27.5% vs 19.2%, P=.13). CONCLUSION: Many first screening examinations include recommendation for short-interval follow-up based on screening mammography alone. Cancer yield for these examinations is low and is lower than that with diagnostic work-up prior to short-interval follow-up recommendation. Absence of diagnostic work-up prior to short-interval follow-up recommendation may result in periodic surveillance of a high proportion of benign lesions.

Adult↗

PubMed2005

Performance benchmarks for diagnostic mammography.

PURPOSE: To evaluate a range of performance parameters pertinent to the comprehensive auditing of diagnostic mammography examinations, and to derive performance benchmarks therefrom, by pooling data collected from large numbers of patients and radiologists that are likely to be representative of mammography practice in the United States. MATERIALS AND METHODS: Institutional review board approval was met, informed consent was not required, and this study was Health Insurance Portability and Accountability Act compliant. Six mammography registries contributed data to the Breast Cancer Surveillance Consortium (BCSC), providing patient demographic and clinical information, mammogram interpretation data, and biopsy results from defined population-based catchment areas. The study involved 151 mammography facilities and 646 interpreting radiologists. The study population included women 18 years of age or older who underwent at least one diagnostic mammography examination between 1996 and 2001. Collected data were used to derive mean performance parameter values, including abnormal interpretation rate, positive predictive value (for abnormal interpretation, biopsy recommended, and biopsy performed), cancer diagnosis rate, invasive cancer size, and the percentages of minimal cancers, axillary node-negative invasive cancers, and stage 0 and I cancers. Additional benchmarks were derived for these performance parameters, including 10th, 25th, 50th (median), 75th, and 90th percentile values. RESULTS: The study involved 332,926 diagnostic mammography examinations. Mean performance parameter values were abnormal interpretation rate, 8.0%; positive predictive value for abnormal interpretation, 31.4%; positive predictive value for biopsy recommended, 31.5%; positive predictive value for biopsy performed, 39.5%; cancer diagnosis rate, 25.3 per 1000 examinations; invasive cancer size, 20.2 mm; percentage of minimal cancers, 42.0%; percentage of axillary node-negative invasive cancers, 73.6%; and percentage of stage 0 and I cancers, 62.4%. CONCLUSION: The presented BCSC outcomes data and performance benchmarks may be used by mammography facilities and individual radiologists to evaluate their own performance for diagnostic mammography as determined by means of periodic comprehensive audits.

Adult↗

PubMed2004

Biennial versus annual mammography and the risk of late-stage breast cancer.

BACKGROUND: Mammography screening may reduce breast cancer mortality by detecting cancers at an earlier stage. However, certain questions remain, including the ideal interval between mammograms. METHODS: We conducted an observational study using information collected by seven mammography registries across the United States to investigate whether women diagnosed with breast cancer after having screening mammograms separated by a 2-year interval (n = 2440) are more likely to be diagnosed with late-stage disease (positive lymph nodes or metastases) than women diagnosed with breast cancer after having screening mammograms separated by a 1-year interval (n = 5400). Analyses were stratified by age and breast density to clarify whether groups that have the poorest mammography sensitivity (i.e., women under age 50 years and those with mammographically dense breasts) would benefit most from annual screening. The subjects were women diagnosed with breast cancer between 1996 and 2001 who were 40-89 years old at their index mammographic examination (i.e., the most recent screen at or before breast cancer diagnosis). Data were analyzed by logistic regression, adjusting for race, ethnicity, family history of breast cancer, and mammography registry. RESULTS: Among women age 40-49 years at the index mammogram, those with a 2-year screening interval were more likely to have late-stage disease at diagnosis than those with a 1-year screening interval (28% versus 21%; odds ratio [OR] = 1.35, 95% confidence interval [CI] = 1.01 to 1.81). There was no increase in late-stage disease for women 50 years or older with a 2-year versus a 1-year screening interval (women age 50-59 years at index mammogram: OR = 0.97, 95% CI = 0.75 to 1.25; women age 60-69 years at index mammogram: OR = 0.99, 95% CI = 0.72 to 1.35; women age 70 years or older at index mammogram: OR = 0.88, 95% CI = 0.64 to 1.19). There was no indication that women with dense breasts would benefit more from a 1-year versus 2-year screening interval than women with fatty breasts. CONCLUSION: These findings may be useful for policy decisions about appropriate screening intervals and for use in statistical models that estimate the costs and benefits of mammography by age and screening interval.

Adult↗

PubMed2004

Effect of breast augmentation on the accuracy of mammography and cancer characteristics.

CONTEXT: Breast augmentation is not associated with an increased risk of breast cancer; however, implants may interfere with the detection of breast cancer thereby delaying cancer diagnosis in women with augmentation. OBJECTIVE: To determine whether mammography accuracy and tumor characteristics are different for women with and without augmentation. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort of 137 women with augmentation and 685 women without augmentation diagnosed with breast cancer between January 1, 1995, and October 15, 2002, matched (1:5) by age, race/ethnicity, previous mammography screening, and mammography registry, and 10 533 women with augmentation and 974 915 women without augmentation and without breast cancer among 7 mammography registries in Denver, Colo; Lebanon, NH; Albuquerque, NM; Chapel Hill, NC; San Francisco, Calif; Seattle, Wash; and Burlington, Vt. MAIN OUTCOME MEASURES: Comparison between women with and without augmentation of mammography performance measures and cancer characteristics, including invasive carcinoma or ductal carcinoma in situ, tumor stage, nodal status, size, grade, and estrogen-receptor status. RESULTS: Among asymptomatic women, the sensitivity of screening mammography based on the final assessment was lower in women with breast augmentation vs women without (45.0% [95% confidence interval [CI], 29.3%-61.5%] vs 66.8% [95% CI, 60.4%-72.8%]; P =.008), and specificity was slightly higher in women with augmentation (97.7% [95% CI, 97.4%-98.0%] vs 96.7% [95% CI, 96.6%-96.7%]; P<.001). Among symptomatic women, both sensitivity and specificity were lower for women with augmentation compared with women without but these differences were not significant. Tumors were of similar stage, size, estrogen-receptor status, and nodal status but tended to be lower grade (P =.052) for women with breast augmentation vs without. CONCLUSIONS: Breast augmentation decreases the sensitivity of screening mammography among asymptomatic women but does not increase the false-positive rate. Despite the lower accuracy of mammography in women with augmentation, the prognostic characteristics of tumors are not influenced by augmentation.

Adult↗

PubMed2004

Patient perceptions of breast biopsy procedures for screen-detected lesions.

OBJECTIVE: This study was undertaken to compare patient perceptions of 2 common image-guided breast biopsy procedures on 3 main outcomes: decision making about which procedure to undergo, its convenience, and its side effects. METHODS: Women who had either an excisional or ultrasound-guided core needle breast biopsy in 1997 for a screen-detected lesion had telephone interviews 1 to 3 months after the biopsy. Bivariate associations were tested by using chi(2) and t test statistics. Mulitvariate analyses were used to control for effects of demographic characteristics. RESULTS: Most women (66%) could not remember being offered a choice of procedures, and of those who did have a choice, a higher proportion had an excisional biopsy. Only 2% reported being told the cost of the biopsy procedure. Women who had an excisional biopsy compared with those who had undergone a core needle biopsy reported statistically more hours and days off from work and reported more side effects 1 to 3 days after the biopsy (P<.05). Associations between side effects and type of biopsy procedure were unchanged when adjustment was made for demographic characteristics. CONCLUSION: Women who had the ultrasound-guided needle biopsy reported significantly fewer side effects and needed less time off from work. When a suspicious lesion is noticed on a screening mammogram, it is important that women and their physicians discuss the benefits and risks of the various biopsy procedures before deciding how to proceed, allowing for informed choice.

Biopsy↗

PubMed2004

Moving in between mammography: screening decisions of American Indian women in Vermont.

Breast cancer is a leading cause of cancer death among American Indian women, with mammography screening rates below the national average for this population. A grounded theory study, conducted with Vermont American Indian women, explicated factors that influence mammography decision making. The authors examined mammography decision making across the breast cancer screening continuum: women with a history of consistent annual mammograms, women who were under users or nonusers of mammography, and women who were breast cancer survivors. The generated theory, Moving in Between Mammography, describes the decision-making process and factors that influenced women's participation in routine mammography screening. Specific influencing factors addressed include Connecting to Nativeness, Taking Care of Self, Financing Health Care, and (Mis)Trusting the Health Care System. Implications and directions for future research are addressed.

Breast Neoplasms↗

PubMed2004

A prospective study of breast cancer risk using routine mammographic breast density measurements.

Mammographic breast density is a major risk factor for breast cancer but estimates of the relative risk associated with differing density patterns have varied widely. It is also unclear how menopausal status influences this association and to what extent the effects of density are due to its correlation with other risk factors. Most recent investigations of breast density have been case-control studies, which provide indirect estimates of relative risk. We have prospectively followed 61,844 women for an average of 3.1 years to directly estimate risk among women in the four mammographic breast density categories defined by the American College of Radiology's Breast Imaging Reporting and Data System (BI-RADS). The study was population-based and used density assessments routinely made by community radiologists. Cox regression was used to obtain age-adjusted relative risk estimates and to control for other risk factors. Risk increased with density and the risk associated with extremely dense breasts, relative to entirely fatty breasts, was 4.6 (95% confidence interval, 1.7-12.6) for premenopausal women and 3.9 (95% confidence interval, 2.6-5.8) for postmenopausal women. Estimates for pre- and postmenopausal women did not differ significantly. Although breast density was significantly related to body mass index, age at first childbirth, and postmenopausal hormone use (P < 0.001), adjustment for these variables only slightly altered the relative risk estimates. Our results correspond well to those from case-control studies using more quantitative measures of mammographic breast density and suggest that routine Breast Imaging Reporting and Data System density measurements may be useful in models for assessing breast cancer risk in individual women.

Adult↗

PubMed2003

Prognostic characteristics of breast cancer among postmenopausal hormone users in a screened population.

PURPOSE: We determined the risk of breast cancer and tumor characteristics among current postmenopausal hormone therapy users compared with nonusers, by duration of use. METHODS: From January 1996 to December 2000, data were collected prospectively on 374,465 postmenopausal women aged 50 to 79 years who underwent screening mammography. We calculated the relative risk (RR) of breast cancer (invasive or ductal carcinoma-in-situ) and type of breast cancer within 12 months of postmenopausal therapy use among current hormone users with a uterus (proxy for estrogen and progestin use) and without a uterus (proxy for estrogen use), compared with nonusers. RESULTS: Compared with nonusers, women using estrogen and progestin for >/= 5 years were at increased risk of breast tumors of stage 0 or I (RR, 1.51; 95% CI, 1.37 to 1.66), stage II or higher (RR, 1.46; 95% CI, 1.30 to 1.63), size </= 20 mm (RR, 1.59; 95% CI, 1.43 to 1.76), size greater than 20 mm (RR, 1.24; 95% CI, 1.09 to 1.42), grade 1 or 2 (RR, 1.60; 95% CI, 1.44 to 1.77), grade 3 or 4 (RR, 1.54; 95% CI, 1.37 to 1.73), and estrogen receptor-positive (RR, 1.72; 95% CI, 1.55 to 1.90). Estrogen-only users were slightly more likely to have estrogen receptor-positive breast cancer compared with nonusers (RR, 1.14; 95% CI, 1.06 to 1.23). CONCLUSION: Use of estrogen and progestin postmenopausal hormone therapy for five years or more increased the likelihood of developing breast cancer, including both tumors with favorable prognostic features and tumors with unfavorable prognostic features.

Aged↗