Screening mammography program of British Columbia

Article Abstract:

Screening mammography (regularly scheduled breast X-rays for women without symptoms of cancer) is performed to detect early malignancy. The results of a pilot screening program conducted in British Columbia are reported. Over a period of nine months, 7,100 women were screened, and a diagnosis of cancer was made in 29 subjects (4.1/1,000). A family history of cancer and increased age were associated with higher risk. Thus, women with no family history had an incidence of 3.8/1,000, and women 70 or older had an incidence of 9.8/1,000, while those under 50 had an incidence of 1.4/1,000. Also of interest is the fact that women who had mammograms during the two years prior to the study had an incidence of only 0.8/1,000. Each screening cost $33.81 (Canadian dollars) for operating expenses, professional fees, and other expenses; this did not include the costs of equipment, amortization, and data collection. The cost of detection of each malignancy was $8,277.62. Follow-up costs for the patients with abnormal mammograms (722 patients) were also not included. The 29 positive biopsies represented a 19 percent positive biopsy rate, a figure that was considered low since biopsies were performed by different physicians in several different institutions. The success of this pilot program has led to a expansion of screening programs in British Columbia. The cost per positive diagnosis is considered justifiable, especially when compared with the social and economic costs of failing to detect breast cancer while it is still treatable. (Consumer Summary produced by Reliance Medical Information, Inc.)

Economic aspects, British Columbia

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Radiation and other pathological changes in breast tissue after conservation treatment for carcinoma

Article Abstract:

Changes in tissue histology are common occurrences after radiation therapy. They may be described as pronounced atypia (a deviation from normal) and can present a diagnostic problem, since radiation therapy is increasingly being used to treat cancer. This report focuses on breast cancer, and reviews and compares the histological changes in breast tissue following radiation therapy and surgery with those in nonirradiated breast tissue of patients who were treated only surgically. The tissues of 17 patients with recurring breast tumors constituted the study group. The effects of radiation on the various tissue layers are described in detail. Changes in the epithelium, resulting from radiation therapy, are such that false-positive diagnoses of malignancy can be made at various stages. (In this case, false-positive diagnoses refers to diagnoses of breast cancer in the absence of disease.) These changes include local fibrosis with skin puckering, skin thickening, distorted architecture, noticeable parenchymal density (in the functional part of the breast), calcification, and the presence of a mass (pseudotumor). To avoid misdiagnosing recurrent breast cancer, pathologists should be aware of these histological and physical changes in irradiated breast tissue. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Cancer, Radiotherapy, Pathology, Cancer recurrence

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Selective nonoperative management of patients referred with abnormal mammograms

Article Abstract:

Breast cancer can be detected by screening mammography; about 15 percent of screening mammograms are abnormal. Breast biopsy is frequently performed after abnormal mammograms, but it is not known if biopsy is necessary in all cases. A retrospective review was undertaken of 214 women referred after abnormal mammograms over an eight-year period. Based on specific mammographic criteria, the women were treated either by biopsy or were monitored with repeat mammography. There were 78 patients who met the criteria for breast biopsy, which was performed immediately. There were 114 patients who were observed mammographically. Following the second mammogram, seven more patients were recommended for biopsy; one of these patients was diagnosed with breast cancer. After the third mammogram, five more biopsies were performed, and a second woman was diagnosed with cancer. In the two cancer patients, the delay period between abnormal mammographic observation and biopsy was 3 and 12 months; an effect of this delay on patient outcome was not documented. There were 102 patients (53 percent) who did not have a biopsy performed; they are still monitored closely. This data suggests the efficacy of a selective approach for biopsy based upon mammographic criteria. (Consumer Summary produced by Reliance Medical Information, Inc.)

Breast, Breast biopsy

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