Breast cancer screening by mammography in Norway. Is it cost-effective?
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BACKGROUND: Mammography screening is a promising method for improving prognosis in breast cancer. PATIENTS AND METHODS: In this economic analysis, data from the Norwegian Mammography Project (NMP), the National Health Administration (NMA) and the Norwegian Medical Association (NMA) were employed in a model for cost-effectiveness analysis. According to the annual report of the NMP for 1996, 60,147 women aged 50-69 years had been invited to a two-yearly mammographic screening programme 46,329 (77%) had been screened and 337 (0.7%) breast cancers had been revealed. The use of breast conserving surgery (BCS) was in this study estimated raised by 17% due to screening, the breast cancer mortality decreased by 30% and the number of life years saved per prevented breast cancer death was calculated 15 years. RESULTS: The cost per woman screened was calculated 75.4 Pounds, the cost per cancer detected 10.365 Pounds and the cost per life year (LY) saved 8.561 Pounds. A raised frequency of BCS, diagnosis and adjuvant chemotherapy brought two years forward, follow-up costs and costs/savings due to prevented breast cancer deaths were all included in the analysis. A sensitivity analysis documented mammography screening cost-effective in Norway when four to nine years are gained per prevented breast cancer death. CONCLUSION: Mammography screening in Norway looks cost-effective. Time has come to encourage national screening programmes. (+info)
Factors associated with screening mammography and breast self-examination intentions.
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The factors associated with the use of two methods for the early detection of breast cancer were assessed using a theoretical framework derived from the theory of reasoned action and the Health Belief Model. Telephone interviews were conducted with 170 women aged between 50 and 70 years, randomly selected from the telephone directory of a provincial city in Victoria, Australia. The model explained 47% of the variance in intentions to have a mammogram and 22% of the variance in intentions to practise breast self-examination (BSE). The data supported the prediction that different variables would be associated with each method of early detection of breast cancer. Intentions to have a mammogram were associated with perceived susceptibility to breast cancer, knowing a woman who has had a mammogram, previous mammography history and Pap test history. Intentions to do BSE were associated with self efficacy, knowledge of breast cancer issues, concern about getting breast cancer and employment status. Both screening methods were associated with prior behaviour and concern about getting breast cancer. (+info)
Mammography: influence of departmental practice and women's characteristics on patient satisfaction: comparison of six departments in Norway.
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OBJECTIVE: To investigate how departmental practice and women's characteristics are related to low patient satisfaction with mammography. DESIGN: Survey of patients by means of self administered questionnaires before and after mammography. PATIENTS: 488 women (89% of those invited), aged 23-86 years, at six departments. MAIN OUTCOME MEASURES: Low level of satisfaction measured on psychometric scales of physical pain, psychological distress, staff punctuality and technical skills, information provided, and physical surroundings. RESULTS: Satisfaction varied by department on the scales for pain, punctuality, information, and surroundings. After adjustment for women's characteristics an attributable risk of negative outcome by department was identified on the scales for pain, distress, punctuality, information, and surroundings. Adjusted odds ratio (ORs) ranged from 0.3 (95% confidence interval (95% CI) 1.2 to 6.0) on the pain scale, to 6.0 (2.9 to 12.3) on the punctuality scale. After adjustment for confounding variables, higher risk of dissatisfaction was associated with age < 50, nervousness about mammography, expected pain, lack of knowledge about mammography, and distrust in mammography (adjusted OR (95% CI) ranged from 1.6 (1.0 to 2.7) to 3.7 (2.0 to 7.3)). CONCLUSION: Departmental practices differed for breast compression, information, punctuality, and facilities and were associated with a low level of satisfaction irrespective of patient characteristics. Women's lack of knowledge about mammography and distrust in the procedure were confirmed as risk factors for dissatisfaction. All these factors might be helped by training the staff, improving facilities, and informing the women. (+info)
Low income, race, and the use of mammography.
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OBJECTIVE: To describe national trends in mammography use by race and income and to test whether higher use of mammography among low-income African American women than low-income white women can be explained by health insurance coverage, usual place of health care, or place of residence. DATA SOURCES/STUDY SETTING: Data from five years of the National Health Interview Survey spanning the period 1987-1994. STUDY DESIGN: Trends in the percentage of women 50-64 years of age with a mammogram within the past two years were analyzed by race and income. Data for 1993-1994 were pooled, and with logistic regression analysis, variation in use of recent mammography for low-income women was investigated. Independent variables are age, race, family income, education, health insurance coverage, place of usual source of health care, metropolitan residence, and geographic region. DATA COLLECTION/EXTRACTION METHODS: The National Health Interview Survey is a cross-sectional national survey conducted by the National Center for Health Statistics. Data are collected through household interviews. [Editor's note: in keeping with HSR policy, the term black is used to conform to its use in the surveys studied. In other references to race, the term African American is used.] PRINCIPAL FINDINGS: Among women 50-64 years of age use of recent mammograms increased rapidly between 1987 and 1991 for all groups of women, and between 1991 and 1994 the increases slowed. However, increases between 1991 and 1994 have been more rapid among low-income black women than among low-income white women. In 1993-1994, low-income black women were about one-third more likely than low-income white women to report mammography within the past two years. This difference could not be explained by health insurance coverage, usual source of health care, metropolitan status, or region of residence. CONCLUSIONS: These results, which provide some evidence of success for screening programs targeted to the poor, raise the question of why low-income black women appear to be to more likely than low-income white women to have benefited from recent efforts to promote mammography. Continued evaluation of mammography programs focused on women who are underserved as well as the monitoring of trends and variations in service use by race and income are needed. (+info)
Comparison of mammographically guided breast biopsy techniques.
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OBJECTIVE: To determine which mammographically guided breast biopsy technique is the most efficient in making a diagnosis in women with suspicious mammograms. SUMMARY BACKGROUND DATA: Mammographically guided biopsy techniques include stereotactic 14-gauge core-needle biopsy (SC bx), stereotactic 11-gauge suction-assisted core biopsy (Mammotome [Mbx]), stereotactic coring excisional biopsy (Advanced Breast Biopsy Instrument [ABBI]), and wire-localized biopsy (WL bx). Controversy exists over which technique is best. METHODS: All patients undergoing any one of these biopsy methods over a 15-month period were reviewed, totaling 245 SC bx, 107 Mbx, 104 ABBI, and 520 WL bx. Information obtained included technical success, pathology, discordant pathology, and need for open biopsy. RESULTS: Technical success was achieved in 94.3% of SC bx, 96.4% of Mbx, 92.5% of ABBI, and 98.7% of WL bx. The sensitivity and specificity were 87.5% and 98.6% for SC bx, 87.5% and 100% for Mbx, and 100% and 100% for ABBI. Discordant results or need for a repeat biopsy occurred in 25.7% of SC bx, 23.2% of Mbx, and 7.5% of ABBI biopsies. In 63.6% of ABBI and 50.9% of WL bx, positive margins required reexcision; of the cases with positive margins, 71.4% of ABBI and 70.4% of WL bx had residual tumor in the definitive treatment specimen. CONCLUSION: Although sensitivities and specificities of SC bx and Mbx are good, 20% to 25% of patients will require an open biopsy because a definitive diagnosis could not be reached. This does not occur with the ABBI excisional biopsy specimen. The positive margin rates and residual tumor rates are comparable between the ABBI and WL bx. The ABBI avoids operating room and reexcision costs; therefore, in appropriately selected patients, this appears to be the most efficient method of biopsy. (+info)
Breast cancer screening in underserved women in the Bronx.
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This article reports the results of mammography screening among socioeconomically disadvantaged women in Bronx, NY using a federally funded low-cost or no-cost cancer screening service. The New York State Department of Health provided funds for the uninsured through the Bronx Breast Health Partnership. All women < or = 40 years underwent screening mammography using both a mobile van unit and hospital-based mammographic x-ray unit, both American College of Radiology (ACR) accredited. Return visits were coordinated by a follow-up clinic at Montefiore Medical Center using a patient navigator who acted as an advocate for patients with abnormal screening findings. The overall detection rate of 12.9 per 1000 women screened was significantly higher than the New York State detection rate of 6 per 1000 and 5.1 per 1000 nationally. Availability of a patient navigator was an essential factor in the effectiveness of the work-up of problem cases. Low-cost or no-cost breast cancer screening programs can improve the availability, accessibility, acceptability, and utilization of mammography among underserved and uninsured women who are least likely to be screened otherwise. (+info)
A pilot study of mammographic density patterns among Japanese women.
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Mammographic density patterns, which refer to the distribution of fat, connective, and epithelial tissue in the healthy female breast, have been shown to be related to breast cancer risk. We used a quantitative method to assess mammographic densities in 41 mammograms from women in Japan without a diagnosis of breast cancer. Information about reproductive behavior and family history for breast cancer was available from a questionnaire. The statistical analysis applied Spearman correlation coefficients and multiple linear regression. The breast size as measured on the cranio-caudal view of the mammogram was approximately 12% larger, the size of the dense areas was 20% smaller, and the mean percent mammographic densities were 30% greater among premenopausal than among postmenopausal women. We found a strong relation between age at menarche and mammographic densities in premenopausal women and significant associations for age, family history of breast cancer, and age at menopause with mammographic densities in postmenopausal women. These preliminary data will be used to plan a future study that will compare mammographic density patterns and the relative importance of dietary, reproductive, and anthropometric factors between women in Japan and in the United States. (+info)
Detection of cancerous masses for screening mammography using discrete wavelet transform-based multiresolution Markov random field.
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When cancerous masses are embedded in and camouflaged by varying densities of parenchymal tissue structures, they are difficult to visually detect on mammograms. We present a novel algorithm based on the discrete wavelet transform (DWT) and multiresolution markov random field (MMRF) that will single out the suspicious masses to assist the attending radiologist in making decisions. (+info)