Biomedical subjects
M Moskowitz
Publications and source records attributed to M Moskowitz.
Breast cancer detection and treatment revisited.
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Clinical examination of the breasts by nonphysicians: a viable screening option?
After four years of annual screening 10,566 women, physical examination (PE) by nurse clinicians is as effective in detecting suspect cases as is the examination of surgeons and the general medical community of Cincinnati. Carefully performed physical examination has found 45% of the extant cancers detected. Twenty-eight percent of the cancers detected by PE were minimal lesions. One-third of all the minimal cancers currently detectable were discovered by PE.
Growth and G1 arrest of sarcoma virus trnasformed cells in serum free media.
Rous-sarcoma transformed BHK cells can be continuously cultured in a medium containing Eagle's Minimal Essential Medium, iron and biotin. The rate of cell multiplication increased when serine, or serine plus other non-essential amino-acids were added to the medium. With biotin deleted from the medium there is a reduction in DNA synthesis and most cells are blocked in G1.
Cost analysis of aggressive breast cancer screening.
It is estimated that mammographic and physical examination (PE) screening would cost $3,866 per person year gained; screening with PE alone would cost $4,550. Sixty thousand person years are gained with combined screening, and 24,000 with PE alone per million women screened. The cost per cancer found is $9,046; for each highly curable cancer $26,961, and for each death averted $61,100. An estimated 16 years are added to each life saved. The cost per patient screening examination, using all techniques, is $20.04.
Screening is not diagnosis.
Mammography and physical examination, usually employed as diagnostic tools, may be used to screen for early detection of breast cancer. A study of these modalities used to aggressively screen patients in Cincinnati and Milwaukee is presented and compared to more traditional methods of breast cancer detection and diagnosis as done in Louisville. For a similar-sized group over the same period, the rate of cancers detected in Louisville did not exceed that in Cincinnati-Milwaukee. Aggressive screening will not increase the overall number of detected cancers but will decrease the number of advanced cancers. Mammography as a screening device is not in itself a diagnostic tool, since its potential benefit is maximized only through the use of nondiagnostic, indirect radiographic criteria.
Breast cancer missed by mammography.
Because a "negative" mammogram that is followed by a biopsy diagnostic of cancer is a matter of deep concern, a retrospective review was conducted of 48 such missed diagnoses at four Breast Cancer Detection Centers. The study group comprised 40,000 women participating in breast cancer screening examinations. From 3,271 biopsies during screening, 499 cancers had been found. Biopsies in the interval between screening examinations totaled 630 and yielded 48 malignancies. These 48 interval cancers were studied in an attempt to discover why they were not found on the preceding mammographic examination. Three major categories of error were disclosed and each is discussed: (1) poor radiographic technique; (2) absence of radiographic criteria of cancer; (3a) obvious oversight by the radiologist; and (3b) lack of recognition of subtle radiographic signs. This last reason is discussed in detail in the belief that better recognition of these indirect radiographic signs will lead to more accurate diagnoses, particularly in early cancers.
Mammography in medical practice. A rational approach.
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Arrest of cell growth in the G1 phase of the cell cycle by serine deprivation.
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Regulation of the rate of protein synthesis in BHK21 cells by exogenous serine.
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Differences in the rates of protein degradation in untrasformed and transformed cell lines.
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Benefit/risk analysis of aggressive mammographic screening.
Based on the results of aggressive screening of 20,000 women and an annual average midbreast absorbed dose of 1 rad per year, the authors describe a model for estimating the benefit/risk ratio for mammography in screening populations of asymptomatic, randomly selected women. Benefits in terms of breast-cancer deaths averted over not screening are estimated. The "worst-case" estimate of the benefit/risk ratio for five annual mammographic examinations on randomly selected asymptomatic women age 35-49 at the start of screening is 3.4 +/- 1.1 to 1. The corresponding "most probable" estimate is 8.0 +/- 3.1 to 1.
Special lecture: the breast cancer screening controversy: a perspective.
Analysis of the data of the Health Insurance Plan of New York Breast Cancer Screening Study indicates that in patients whose cancers were found by screening, the case fatality rate at all ages is almost half the case fatality rate of controls. The data also strongly suggest that maximal benefit in young women resides in the detection of in situ cancers. Due to relatively low yield of these early lesions, projected 20 year survival in that study may be little different for all women screened compared to controls. We have shown that the yield of these early lesions can be increased by aggressive screening and liberal use of biopsy. Furthermore, where J.C. Bailar has indicated a net gain (or loss) of -4 to +8 lives per 20,000 women using the HIP data, using his method and our data we find a savings of 25-27 lives/20,000 women by 3 year screening to date. These are lives that have been saved by mammography alone.
Survey of administration of infiltration anesthesia.
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Recognition and management of breast cancer.
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Mammographic screening for breast cancer by lateral view only: is it practical?
If a single lateral examination would suffice for mammography, sose and risk would be cut in half in screening procedures. This prospective study of 150 lateral xerographic images would indicate that, while 80% true positive rate can be achieved using a single lateral view, the projected savings in radiation exposure does not offset the losses due to cancers not detected by this single exposure screening method.