A prospective study to determine the accuracy of triple test score in breast lump

Background: Breast cancer is the most common cancer in women worldwide. The commonest mode of presentation of diseases of the breast is lump. It is the most common site-specific cancer in women. Triple test score which includes clinical breast examination, mammogram, FNAC score. A simple non-invasive but reliable test can make a huge difference in management between benign and malignant lumps. Aims and objectives of the study were to differentiate between benign and malignant lesions based on TTS and correlated the accuracy of triple test score with histopathology report, and plan the management accordingly.Methods: A prospective study was carried out in which TTS was calculated by summation of individuals’ scores of all three components and compare with histopathology report.Results: In present study of 74 patients (age group of 30 to 65 years), based on TT score 52 benign, 12 malignant, and 10 suspicious (neither benign nor malignant). But the final histopathological result showed 59 as benign and 15 as malignant, which is in concordant with TTS, which shows the accuracy of up to 100%. Out of 10 (suspicious) which were dis-concordant, 7 are benign and 3 are malignant on histopathology.Conclusions: By use of the triple test score and its interpretation, definitive treatment can be initiated, which would reduce the need for unnecessary biopsy and its ability to predict benign lump, can avoid major surgery.

A cross-sectional study on awareness regarding breast cancer and its screening techniques in field practice area of GMERS Medical College, Dharpur, Patan, North Gujarat, India

Background: Breast cancer is one of the most dangerous and lately diagnosed cancers which precipitate high number of morbidity and mortality. Breast cancer is now the most common cancer in most cities in India. To prevent its occurrence, women should be aware of early signs of it. Early detection can be done by different screening techniques such as self-breast examination, clinical examination, and mammogram. Objectives: The objectives of this study were as follows: (a) To assess the awareness regarding breast cancer and their screening techniques among women and (b) to find out the associated factors of breast cancer and their awareness among women. Materials and Methods: The study was carried out among 100 women selected by purposive sampling residing in the field practice area of Gujarat Medical Education and Research Society Medical College, Dharpur, Patan, during January 2019–March 2019 after approval of the institutional ethics committee. Self-tested semi-structured questionnaire was used after performing a pilot study. Results: Very few female had personal and family history of breast cancer. Awareness regarding breast cancer was found higher in educated as compared to illiterate. Working women had more knowledge regarding the issue than housewife. Awareness regarding how often breast self-examination (BSE) should be performed and what to look for while doing BSE was awareness regarding BSE as a screening tool was found only in half of the study participants. Conclusions: The study participants who had personal and family history of breast cancer were well aware of the clinical signs of breast cancer and its screening techniques. Literate and working women were having more knowledge regarding breast cancer. Overall awareness regarding the disease and its screening techniques was low in the study population.

A novel pectoral muscle segmentation from scanned mammograms using EMO algorithm

Mammogram images are majorly used for detecting the breast cancer. The level of positivity of breast cancer is detected after excluding the pectoral muscle from mammogram images. Hence, it is very significant to identify and segment the pectoral muscle from the mammographic images. In this work, a new multilevel thresholding, on the basis of electro-magnetism optimization (EMO) technique, is proposed. The EMO works on the principle of attractive and repulsive forces among the charges to develop the members of a population. Here, both Kapur's and Otsu based cost functions are employed with EMO separately. These standard functions are executed over the EMO operator till the best solution is achieved. Thus, optimal threshold levels can be identified for the considered mammographic image. The proposed methodology is applied on all the three twenty-two mammogram images available in mammographic image analysis society dataset, and successful segmentation of the pectoral muscle is achieved for majority of the mammogram images. Hence, the proposed algorithm is found to be robust for variations in the pectoral muscle.

The uptake of Mammogram screening in Malaysia and its associated factors: A systematic review

Introduction: This review aimed to summarise the trend ofmammogram screening uptake published in local studiesbetween years 2006 and 2015 among the Malaysian womenaged 40 years and above, and identify the associated factorsand barriers, as well as discuss limitations of the studiesand research gaps.Methods: A systematic review was conducted on breastcancer screening studies among Malaysian women,published between January 2006 and December 2015.Online databases were searched using keywords:“mammogram”, “mammography”, “uptake”, “breast cancerscreening” and “Malaysia”.Results: Thirteen original articles were reviewed. The rate ofmammography uptake ranged between 3.6% and 30.9%among the general population, and 80.3% among personnelof a tertiary hospital. Factors associated with mammogramscreening were clinical breast examination, age, income,knowledge on breast cancer and mammogram, perceivedsusceptibility to breast cancer, ethnicity and education level.Barriers to mammogram screening were lack of knowledge,embarrassment, fear of cancer diagnosis, perception thatbreast screening was unnecessary, lack of coping skills andpain during procedure. However, almost all of the studiescould not be generalised beyond the study sample becauseof the limited number of sites and respondents; and mostdata were self-reported with no objective measures of theresponses.Conclusion: Mammogram screening uptake among womenin selected communities were generally low. Further studiesinvolving the general population are essential. Futurestudies should also explore the availability, affordability andaccessibility of this service especially in the pursuit ofachieving universal health coverage in breast cancermanagement.

Triple-negative and non-triple-negative breast cancer prediction by mammographic radiomics features / 中华放射学杂志

Objective To develop and validate a radiomics predictive model based on mammogram for preoperative predicting triple-negative breast cancer (TNBC) or non-triple-negative breast cancer (NTNBC). Methods We retrospectively analyzed 459 Chinese women who were diagnosed with invasive breast cancer (confirmed by pathology) during August 2015 to November 2015. Our cohort included 34 TNBC and random selected 102 NTNBC cases. Regions of interest (ROIs) were manually selected from craniocaudal and mediolateral oblique mammograms by radiologists through manual lesion segmentation, and 43 radiomics features were evaluated. Craniocaudal (CC) single-view, mediolateral oblique (MLO) single-view and CC and MLO double-view classification model were constructed respectively. Classification performance was evaluated by the area under receiver operating characteristic curve (AUC), accuracy, sensitivity and specificity. Kruskal-Walls U test and t test were used to compare the radiomics features between TNBC and UTNBC. Results The model that used the combination of both the CC and MLO view images achieved the overall best performance than using either of the two views alone, yielding an AUC of 0.791, accuracy of 0.798, sensitivity of 0.776 and specificity of 0.806 for TNBC comparing with NTNBC. Three features were selected by the model (gray scale span and inverse different moment for CC, roundness for MLO) showed a statistical significance (P<0.05) and AUC>0.6 in the subtype classification. Conclusion This research constructed model based on mammograms classification model can effectively distinguish between TNBC and NTNBC. This model has potential value for breast cancer molecular subtype classification and clinical treatment.

Combination of noise removal and contrast enhancement methods for the preprocessing of mammogram images - towards the detection of breast cancer / Combinação de métodos de remoção de ruído e aperfeiçoamento de contraste para o pré-processamento de imagens de mamografias - rumo à detecção do câncer de mama

Breast cancer is a major killer disease for women and men. It can be treated and controlled only if it is detected at its earlier stage. Early detection can be achieved by the help of Computer Aided Detection (CAD) methods. From the detailed study on previous researches, it is found that, there is no system producing 100% accuracy because of one or more reasons. Absence of effective preprocessing is the discussed reason that obstructs the detection accuracy of CAD method. Noise removal and contrast enhancement are the two types of preprocessing. There is no system performs both the preprocessing on mammogram image. This work is an attempt to develop an enhanced preprocessing method for CAD of breast cancer by incorporating suitable noise reduction and contrast enhancement methods in the conventional CAD system. Among the available noise reduction techniques, Fast Discrete Curvelet Transform (FDCT) based UnequiSpaced Fast Fourier Transform (USFFT) has been utilized and the Modified Local Range Modification (MLRM) technique has been utilized for contrast enhancement. Contrast enhancement after noise reduction double enhances the mammogram image and the proposed methods MSE value for the mammogram image mdb072 has been 1.44% reduced when comparing to the LRM method. Reduction in MSE increases the PSNR to 0.16%. Many mammogram images have been tested and the result shows that, increase in contrast, decrease in mean square error and increase in peak signal to noise ratio when comparing to existing methods.

Introdução: O câncer de mama é uma grande doença mortal para mulheres e homens. Ele só pode ser tratado e controlado se for detectado em sua fase inicial. A detecção precoce pode ser alcançada com a ajuda de métodos de detecção assistida por computador (CAD). A partir do estudo detalhado sobre pesquisas anteriores, verifica-se que, não há um sistema com 100% de precisão por causa de uma ou mais razões. A ausência de pré-processamento efetivo é o motivo discutido que obstrui a precisão de detecção do método CAD. A remoção de ruído e o aprimoramento do contraste são os dois tipos de pré-processamento. Não existe um sistema que realize ambos os pré-processamentos na imagem da mamografia. Objetivo: Este trabalho é uma tentativa de desenvolver um método de pré-processamento aprimorado para CAD de câncer de mama, incorporando métodos adequados de redução de ruído e aprimoramento de contraste no sistema de CAD convencional. Métodos: Entre as técnicas de redução de ruído disponíveis, a transformada de curva discreta rápida (FDCT) baseada na transformada rápida de Fourier desigualmente espaçada (USFFT) foi utilizada e a técnica de modificação de faixa local modificada (MLRM) foi utilizada para aprimoramento de contraste. Resultados: o aprimoramento do contraste após a redução do ruído melhora o dobro da imagem da mamografia e os métodos propostos para o valor de MSE para a imagem da mamografia mdb072 foram reduzidas em 1,44% quando comparados ao método LRM. A redução de MSE aumenta o PSNR para 0,16%. Conclusão: muitas imagens de mamografia foram testadas e o resultado mostra que, aumento no contraste, diminuição do erro quadrático médio e aumento da relação pico do sinal/ruído quando comparado aos métodos existentes.

Cribado para cáncer cervicouterino y de mama en la población femenina de la ciudad de cipolletti / Screening for cervix cancer and breast cancer in the female population of the city ofcipolletti

INTRODUCCIÓN: la detección precoz del cáncerde mama y cuello de útero en la mujer ha permitido aumentarla sobrevida y aun la curación en estas dos afecciones. Tanto lamamografía como la realización del Papanicolau (PAP) tienen unaadecuada sensibilidad y especificidad para la detección de tumoresincipientes. OBJETIVOS: conocer las prevalencias de utilizaciónde mamografía y PAP en la población femenina de la ciudad deCipolletti. MÉTODOS: Se realizó un estudio de prevalencia. Seincluyeron mujeres mayores de 18 años, no institucionalizadasy con más de 10 años de residencia. Los principales indicadoresfueron: realización de PAP y mamografía en los últimos dos años.RESULTADOS: Participaron del estudio 642 mujeres encuestadasefectivamente con edad promedio 50,24 +/-16,73 años y un rangoentre 18 y 91 años. El 76,7% (IC95%: 67,1-84,1%) de entre 50 y70 años había utilizado la mamografía, y el 74,9% (IC95%: 66,7-81,6%) de entre 25 y 65 se había realizado el Pap en los últimos 2años. Ambos indicadores resultaron mejores que en la Provinciade Río Negro. CONCLUSIONES: Si bien no todas las diferenciasdetectadas fueron estadísticamente significativas, se observa unatendencia a mayor prevalencia de realización de mamografía enCipolletti que en el resto de la provincia, la región y el país.

INTRODUCTION: early detection of breast cancer andcervix cancer in women has led to increased survival and evencure these diseases. Both mammography and Papanicolau (Pap)smear have adequate sensitivity and specificity for detection at earlystage these tumors. OBJECTIVES: To know the prevalence of use ofmammography and Pap smear in screening for breast cancer andcervix cancer in female population of the city of Cipolletti. METHODS:A cross sectional study was carried out. The population includedresidents of city of Cipolletti, older than 18 years, not institutionalizedand more than 10 years of residence. The main indicators wereperformed Pap smear and mammogram in the past two years.RESULTS: The study surveyed 642 women with an average age of50.24 +/- 16.73 years, with a range of age between 18 and 91 years.Mammogram was used in group included in current recommendationsin Argentina between 50 and 70 years in 76.7% (95% CI67.1% -84.1%) and Pap smear was used in 74.9% (CI95 % 66.7%-81.6%) of participants between 25 and 65 years, in the past 2years. Both indicators were better than they were in the Provinceof Río Negro. CONCLUSIONS: Although not all detected differencesare statistically significant, there is a higher use of mammographyin Cipolletti than in the province, the region and also the country.

Exame clínico das mamas e mamografia: desigualdades nas regiões Sul e Nordeste do Brasil / Clinical breast examination and mammography: inequalities in Southern and Northeast Brazilian regions

RESUMO: Objetivo: Avaliar a prevalência e os fatores associados à realização do exame clínico das mamas (ECM) e da mamografia (MMG) nas regiões Sul e Nordeste do Brasil, focando em algumas desigualdades sociais. Métodos: Estudo transversal, utilizando dados da Pesquisa Nacional por Amostra de Domicílios, de 2008. Foram avaliadas as prevalências de realização de ECM durante o último ano e de MMG nos últimos dois anos e analisadas conforme variáveis demográficas (idade, cor da pele e estado civil) e socioeconômicas (renda e escolaridade). As razões de prevalência brutas e ajustadas foram obtidas através de regressão de Poisson. As análises foram estratificadas por região. Resultados: Foram avaliadas 27.718 mulheres, entre 40 e 69 anos. Menos da metade das mulheres seguiu a recomendação de realização anual de ECM em ambas as regiões. A prevalência de realização de MMG nos últimos 2 anos foi de 58,6 e 45,5% para a região Sul e a Nordeste, respectivamente. Mais de um quarto das mulheres avaliadas de ambas as regiões nunca realizaram MMG (26,5% no Sul e 40,6% no Nordeste). Nunca ter realizado ambos os exames foi quase duas vezes mais prevalente na região Nordeste (29,7%) do que na região Sul (15,9%). O risco para a não realização de ambos os exames foi maior em mulheres com idades entre 60 e 69 anos, não brancas, com menor escolaridade e com menor renda familiar. Conclusão: Importantes desigualdades foram observadas entre as regiões Sul e Nordeste para o ECM e a MMG. Políticas públicas de saúde devem priorizar grupos mais vulneráveis para reduzi-las.

ABSTRACT: Objective: To evaluate the prevalence and associated factors of doing clinical breast examinations (CBE) and mammogram (MMG) in the Southern and Northeast Brazilian regions, focusing on some social inequalities. Methods: This is a cross-sectional study using data from the 2008 National Household Sampling Survey (PNAD). We evaluated the prevalence of CBE during the last year and of the MMG in the last two years, which were analyzed based on demographic (age, skin color, and marital status) and socioeconomic (income and schooling) variables. Gross and adjusted prevalence ratios were obtained using Poisson regression models. All analyses were stratified by region. Results: The sample comprised 27,718 women aged 40 to 69 years. Less than a half of the women followed the recommendation of annual CBE performance in both the regions. The MMG prevalence during the last two years was 58.6 and 45.5% for the Southern and Northeast regions, respectively. More than a quarter of the women had never had a MMG (26.5% in the Southern and 40.6% in the Northeast regions). Not having performed both examinations was almost two times higher in the Northeast region (29.7%) when compared with the Southern (15.9%). The risk for not having performed both examinations was greater among nonwhite women, aged 60 to 69 years, with lower schooling level and family income. Conclusion: Important inequalities were seen between the Southern and Northeast regions for CBE and MMG. Health public policies should prioritize the most vulnerable groups to reduce these inequalities.

The follow-up of post-mastectomy patients: Should the ipsilateral side be assessed with both mammogram and ultrasound?

Aim: This study aimed to determine findings of axillary view mammogram (MMG) and ultrasound (USG) of the ipsilateral side in post-mastectomy patients and to document difficulty level in performing the axillary view and patients’ pain level during the procedure. Methods: Post-mastectomy patients who had MMG and USG on follow-up during an 18-months period were included. The MMG and USG findings of 183 patients were reviewed and histology results were recorded when available. Radiographers’ difficulty and patients’ pain level during the axillary view MMG were charted. Results: On MMG, 172 cases were normal, eight cases were benign (Category 2) and three cases indeterminate (Category 3). On USG, 175 cases were normal, three cases were benign (Category 2) and five cases indeterminate (Category 3). Malignant lesions detected in two out of 183 patients (1%) were metastatic carcinoma in bilateral axillary lymph nodes and leiomyosarcoma at the mastectomy site. These two cases were Category 3 on USG with negative MMG findings. In majority of cases (79%), the radiographer had no difficulty performing the axillary view compared with contralateral MMG. Majority of patients (80%) experienced similar pain during axillary view compared to contralateral MMG. Conclusion: Follow-up imaging of post-mastectomy patients should include (i) USG of the mastectomy site, both axillary regions, and the contralateral breast, and (ii) MMG of the contralateral side. Ipsilateral axillary view MMG is not necessary.

Is There a Correlation between the Presence of a Spiculated Mass on Mammogram and Luminal A Subtype Breast Cancer?

OBJECTIVE: To determine whether the appearance of a spiculated mass on a mammogram is associated with luminal A subtype breast cancer and the factors that may influence the presence or absence of the spiculated mass. MATERIALS AND METHODS: Three hundred seventeen (317) patients who underwent image-guided or surgical biopsy between December 2014 and April 2015 were included in the study. Radiologists conducted retrospective assessments of the presence of spiculated masses according to the criteria of Breast Imaging Reporting and Data System. We used combinations of estrogen receptor (ER), progesterone receptor (PR), human epithelial growth factor receptor 2 (HER2), and Ki67 as surrogate markers to identify molecular subtypes of breast cancer. Pearson chi-square test was employed to measure statistical significance of correlations. Furthermore, we built a bi-variate logistic regression model to quantify the relative contribution of the factors that may influence the presence or absence of the spiculated mass. RESULTS: Seventy-one percent (71%) of the spiculated masses were classified as luminal A. Masses classified as luminal A were 10.3 times more likely to be presented as spiculated mass on a mammogram than all other subtypes. Patients with low Ki67 index (< 14%) and HER2 negative were most likely to present with a spiculated mass on their mammograms (p <0.001) than others. The hormone receptor status (ER and PR), pathology grade, overall breast composition, were all associated with the presence of a spiculated mass, but with less weight in contribution than Ki67 and HER2. CONCLUSION: We observed an association between the luminal A subtype of invasive breast cancer and the presence of a spiculated mass on a mammogram. It is hypothesized that lower Ki67 index and HER2 negativity may be the most significant factors in the presence of a spiculated mass.

Imaging and Histopathology Correlation of Solid Papillary Carcinoma of the Breast : A Review of Four Cases

Solid papillary breast carcinoma is a rare type of breast carcinoma. We present four cases which highlight the radiological and histological findings of solid papillary carcinoma. Mammogram supplemented with ultrasound played an important role in detecting solid papillary carcinomas which usually presents as intraductal lesions or intracystic mass with Doppler signal. Excision biopsy is a better option than core biopsy as the latter modality may not be representative and the diagnosis of solid papillary breast carcinoma may be missed.

A Review of Inflammatory Processes of the Breast with a Focus on Diagnosis in Core Biopsy Samples

Inflammatory and reactive lesions of the breast are relatively uncommon among benign breast lesions and can be the source of an abnormality on imaging. Such lesions can simulate a malignant process, based on both clinical and radiographic findings, and core biopsy is often performed to rule out malignancy. Furthermore, some inflammatory processes can mimic carcinoma or other malignancy microscopically, and vice versa. Diagnostic difficulty may arise due to the small and fragmented sample of a core biopsy. This review will focus on the pertinent clinical, radiographic, and histopathologic features of the more commonly encountered inflammatory lesions of the breast that can be characterized in a core biopsy sample. These include fat necrosis, mammary duct ectasia, granulomatous lobular mastitis, diabetic mastopathy, and abscess. The microscopic differential diagnoses for these lesions when seen in a core biopsy sample will be discussed.

Patrones de utilización de programas de prevención y diagnóstico temprano de cáncer en la mujer / Utilization patterns of prevention and early diagnosis for cancer in women

Objetivo. Estimar los patrones de utilización de los programas preventivos de cáncer en la mujer durante el periodo 2000-2012 en mujeres mexicanas que participaron en tres encuestas nacionales. Material y métodos. Se analizó información de la ENSA 2000 y de las ENSANUT 2006 y 2012 que son representativas de la población del país. Se obtuvieron prevalencias y se aplicaron pruebas de tendencia y regresión de Poisson para determinar las posibilidades de tener una mayor cobertura. Resultados. La cobertura de uso de Papanicolaou en los últimos 12 meses en 2012 fue de 45.5%, de prueba de VPH en los últimos cuatro años fue de 11.9% y de mastografía en los últimos dos años fue de 29.4 y de 17.2% en mujeres de 50 a 69 años y de 40 a 49 años, respectivamente. Conclusiones. Aunque se observa un incremento en la cobertura de los programas de detección se debe impulsar la calidad de los servicios y la cobertura universal.

Objective. To estimate the utilization patterns of cancer prevention programs in women during the period 2000-2012 in Mexican women who participated in three national surveys. Materials and methods. We analyzed data from the ENSA 2000, ENSANUT 2006 and ENSANUT 2012 that are representative of the Mexican population. Prevalences were obtained, trend tests and Poisson regression were used to determine the possibility of having more coverage. Results. The coverage of Papanicolaou use in the last 12 months in 2012 was 45.5%, HPV testing in the last four years was 11.9% and mammography use in the past two years was 29.4% and 17.2% in women aged 50-69 years and 40-49 years, respectively. Conclusions. Although there was an increase in the coverage of screening programs, there should be a boost in the service quality and universal coverage.

Do Elderly Women In Malaysia Go For Mammogram Screening?

Despite the debates of the benefits of continuing mammography screening among elderly women, studies in Malaysia have shown that the prevalence of breast examination declines after age 45 years and for mammogram per se, the prevalence of examination increases until age of 64. This study aims to determine the prevalence of mammogram screening among elderly women in Hulu Langat, Selangor and its relationship with factors such as demographic factors, family history of breast cancer, perceived health status, perceived general psychological factor and lifestyle factors. Data used were from a cross sectional study of health status among community in Hulu Langat area by the Department of Community Health, Universiti Kebangsaan Malaysia carried out from the year 1998 till 2002. However this paper focused on the database involving elderly women age 60 and above. The sample population was 652. The mean (standard deviation) age was 67.17 (5.995). Only 8.3% of the elderly women claimed to ever had mammogram screening done. Hence, the prevalence of mammogram screening is still low among elderly women in Hulu Langat. Having family history of breast cancer (p < 0.001) and perceived positive psychological status (p=0.003) had shown significant associations with mammogram screening among them. It is therefore important for researcher to further look into the reasons behind this and qualitative exploration is highly recommended.

Frecuencia de mamografía y examen clínico de mama en mujeres del régimen subsidiado - Manizales (Caldas) / Mammogram frequency and clinical breast exam in women under the subsidized health regime- Manizales (Caldas) / Frequencia de mamografía e exame clínico de mama em muheres do régime subsidiado - Manizales (Caldas)

Objetivo: Determinar la cobertura del examen clínico y mamografía de tamización para cáncer de mama en un grupo de mujeres del régimen subsidiado en el municipio de Manizales. Materiales y Métodos: Estudio observacional de tipo transversal. Se efectuó una encuesta telefónica a 352 mujeres con edades comprendidas entre 50 y 69 años, residentes en el área urbana y rural del municipio de Manizales durante el cuarto trimestre de 2010. La cobertura de tamización se valoró como la proporción de mujeres con antecedente de mamografía y examen clínico de la mama, fueron excluidas las mujeres con antecedente personal de cáncer de mama. Se estimó frecuencia de vida, frecuencia en los últimos dos años y en el último año. Se analizaron factores asociados a la práctica de tamización mediante el cálculo de OR ajustados. Resultados: La frecuencia de vida de uso de examen clínico fue de 56% y de mamografía 42,3%, de los cuales el 3 y el 7% fueron diagnósticos respectivamente (mujeres sintomáticas), el resto lo hizo con fines de cribado. Por tamización 53,1% tenían examen clínico en el último año y 24,7% mamografías en los últimos dos años. No se halló relación de las diferentes variables con la no realización de la mamografía. Conclusiones: Existe una baja cobertura de la mamografía y el examen clínico de mama por tamización en las mujeres del régimen subsidiado, a pesar de las recomendaciones generadas por el Ministerio de la Protección Social y el Instituto Nacional de Cancerología.

Objective: To determine the scope of breast clinical exam and screening for cancer mammogram in a group of women under the subsidized health regime in the municipality of Manizales. Materials and Methods: Observational, transversal type study. Telephone interviews were carried out with 352 women in ages between 50 and 69 years old, resident in the urban and rural areas of the municipality of Manizales during the fourth trimester in 2010. The scope of screening was assessed as the proportion of women with mammogram and clinical breast exam history and women with personal record of breast cancer were excluded. Life frequency, frequency in the last two years and in the previous year was estimated. Factors associated with the screening practice were analyzed using the adjusted OR calculation. Results: Frequency of useful life of the clinical exam was 56% and mammogram was 42.3% from which 3 and 7% were diagnoses respectively (asymptomatic women); the rest were done for screening purposes. Through screening, 53.1% had had clinical exam during the previous year and 24.7% had had mammograms during the last two years. Relationship of the different variables with the carrying out of mammograms was not found. Conclusions: There is low coverage of mammogram and clinical breast exam through screening in women under the subsidized health regime in spite of the recommendations generated by Social Protection Ministry and the National Study of Cancer Institute.

Objetivo: Determinar a cobertura do exame clínico e mamografia de tamisação para câncer de mama num grupo de mulheres do regime subsidiado no município de Manizales. Materiais e Métodos: Estudo observacional de tipo transversal. Efeito se uma enquete telefônica a 352 mulheres com idades compreendidas entre 50 e 69 anos, residentes na aérea urbana e rural do município de Manizales durante o quarto trimestre de 2010. A cobertura de tamisação se valorou como a proporção de mulheres com antecedente de mamografia e exame clínico da mama, foram excluídas as mulheres com antecedente pessoal de câncer de mama. Estimou se frequência nos últimos dois anos e no ultimo ano. Analisaram se fatores associados a pratica de tamisação mediante o calculo de OR ajustados. Resultados: A frequência de vida de uso de exame clinica foi de 56% e de mamografia 42,3%, dos quais o 3 e o 7% foram diagnósticos respectivamente (mulheres sintomáticas), o resto o fez com fins de crivado. Por tamisação 53,1% tinham exame clinico no ultimo ano e 24,7% mamografias nos últimos dois anos. Não se encontrou relação das diferentes variáveis com a não realização da mamografia. Conclusões: Existe uma baixa cobertura da mamografia e o exame clínico de mama por tamisação nas mulheres do regime subsidiado, a pesar das recomendações geradas pelo Ministério da Proteção Social e o Instituto Nacional de Cancerologia.

Densidade mamográfica em mulheres menopausadas assintomáticas: correlação com dados clínicos e exames ultrassonográficos / Mammographic density in asymptomatic menopausal women: correlation with clinical and sonographic findings

OBJETIVO: Avaliar a densidade mamográfica de mulheres menopausadas, assintomáticas, correlacionando com dados clínicos e ultrassonográficos. MATERIAIS E MÉTODOS: Foram analisados, retrospectivamente, as mamografias e os dados clínicos e ultrassonográficos de 238 pacientes assintomáticas, no período entre fevereiro de 2002 e junho de 2006. As variáveis analisadas foram: padrões de densidade mamográfica, achados ultrassonográficos, idade, paridade, índice de massa corporal e uso de terapia de reposição hormonal. RESULTADOS: Idade, paridade e índice de massa corporal apresentaram relação inversa com os padrões de densidade mamográfica, enquanto o uso de terapia de reposição hormonal apresentou relação direta. Foram realizados exames ultrassonográficos complementares em 103 (43,2%) pacientes, sendo constatadas alterações em 34 (33%) delas. Os nódulos ultrassonográficos foram mais frequentes nas mulheres com padrões mamários 3 e 4 e sem expressão mamográfica. CONCLUSÃO: Concluímos que os padrões mamográficos de densidade foram influenciados pela idade, índice de massa corporal, paridade e tempo de uso de terapia de reposição hormonal. Apesar de não termos encontrado alterações malignas nos casos estudados, evidenciamos alterações ultrassonográficas benignas nas mulheres com padrões mamários de alta densidade e que apresentaram mamografias sem alterações, demonstrando a importância da ultrassonografia complementar para a detecção de lesões mamárias nessas pacientes.

OBJECTIVE: To evaluate mammographic breast density in asymptomatic menopausal women in correlation with clinical and sonographic findings. MATERIALS AND METHODS: Mammograms and clinical and sonographic findings of 238 asymptomatic patients were retrospectively reviewed in the period from February/2022 to June/2006. The following variables were analyzed: mammographic density patterns, sonographic findings, patients' age, parity, body mass index and use of hormone replacement therapy. RESULTS: Age, parity and body mass index showed a negative correlation with breast density pattern, while use of hormone replacement therapy showed a positive correlation. Supplementary breast ultrasonography was performed in 103 (43.2%) patients. Alterations which could not be visualized at mammography were found in 34 (33%) of them, most frequently in women with breast density patterns 3 and 4. CONCLUSION: The authors concluded that breast density patterns were influenced by age, parity, body mass index and time of hormone replacement therapy. Despite not having found any malignant abnormality in the studied cases, the authors have observed a predominance of benign sonographic abnormalities in women with high breast density patterns and without mammographic abnormalities, proving the relevance of supplementary ultrasonography to identify breast lesions in such patients.

Opinion of nurses regarding breast cancer screening programs.

Aim: Found to be effective in its treatment. The increased incidence of breast cancer supports the implementation of breast cancer screening programs. The present study evaluates the opinion among nurses regarding breast cancer screening programs in United Arab Emirates (UAE). Materials and Methods: The study population included 154 nurses practicing at different hospitals in United Arab Emirates (UAE), all nurses who participated in the breast cancer awareness programme organized by Gulf Medical University, Ajman, UAE. A self-administered, pretested, structured, close-ended questionnaire was used for data collection. Statistical Analysis was performed using Predictive Analytic Software (PASW 17). Results: The participants' age ranged between 20 and 59 years. Fifty percent of the participants strongly agreed with the early detection of breast cancer by performing breast self examination. Thirty-nine percent were of the opinion that women aged 40 years and older should have a mammogram every year and continue to do so and 25.3% strongly felt that women in their 20s and 30s should have clinical breast examination as part of their periodic health examination by health professionals. 33.8% of the respondents strongly agree on providing information on the benefits and limitations of BSE to the female population. Twenty-six percent of the participants strongly agree that women at high risk should get magnetic resonance imaging and mammogram done every year. Conclusion: The present study indicates the need for providing workplace training programs thus equipping them with better knowledge and enhancing their service among the general population.

Uso de la mamografía de tamizaje en las pacientes con diagnóstico con cáncer de seno en el Hospital Universitario San Ignacio, Centro Javeriano de Oncología / Use of screening mammograms in patients diagnosed with breast cancer at Hospital Universitario San Ignacio, Centro Javeriano de Oncología

Introducción. Actualmente el cáncer de seno ha logrado trascender en la salud de las mujeres colombianas, por ser una enfermedad con alta mortalidad. Hoy por hoy, se ofrece tamizaje de oportunidad con mamografía para mujeres mayores de 50 años, pero aún es escasa la información sobre cómo se están detectando los nuevos casos en Colombia. Objetivo. Determinar el uso de la mamografía de tamizaje en mujeres diagnosticadas con cáncer de seno que acudieron a su primera consulta con el especialista en el Hospital Universitario San Ignacio de Bogotá, Colombia, entre el 2004 y 2007. Materiales y métodos. Se llevó a cabo un estudio observacional descriptivo, retrospectivo, de 232 nuevos casos de cáncer de seno, de los cuales se recolectaron los siguientes datos: edad en el momento del diagnóstico, motivo de consulta, tiempo de evolución de la sintomatología, tamaño del tumor al examen físico, adenopatías, tipo histológico y estadio clínico. Para el análisis de inferencias, se aplicaron las pruebas t de student y ×2 al cuadrado, según fuera apropiado, estableciendo como significativo un valor p menor de 0.05. Resultados. En nuestra población, sólo 18,1% de las pacientes fueron remitidas por hallazgos anormales en mamografías de tamizaje; la mayoría consultó por síntomas mamarios asociados a estadios más avanzados de la enfermedad. Aquellas que consultaron por masa, en comparación con las que lo hicieron por anormalidades en la mamografía de tamizaje, tuvieron tumores más grandes (5,1 cm versus 3,3 cm p<0,05), con mayor compromiso linfático (46,1% versus 14,3%, p<0,05) y tendencia hacia estadios localmente avanzados (estadio III, 43,3% versus 9,5%, p<0.05). Las mujeres mayores de 50 años tuvieron poco uso de la mamografía de tamizaje (24,7%) y se demoraron dos veces más tiempo en consultar que las menores de 50 años (p<0,05)...

Introduction: Breast cancer has currently become a health issue amongst Colombian women due its high mortality rate. Nowadays opportunity screening is offered with mammograms for women over 50, nonetheless little information is available on how new cases are being detected in Colombia. Objective: Determine the use of screening mammograms in women with breast cancer who had an initial consultation with breast surgeons at Hospital Universitario San Ignacio in Bogotá, Colombia, between 2004 and 2007. Methods: A retrospective, descriptive observational study of 232 newly diagnosed breast cancer cases was carried out in which the following data were collected: age at time of diagnosis, chief complaint, duration of symptoms, tumor size on clinical breast examination, lymph nodes, histological type, and clinical stage. For inferential analysis student´s T and chi square test were used. Significance was set at p<0.05. Results: In this population, only 18.1% of the patients were referred due to abnormal findings on screening mammograms, while the vast majority had breast symptoms as a consequence of advanced disease. Those who had lumps, in comparison to asymptomatic patients, had larger tumors (5.1 cm versus 3.3 cm, p<0.05), larger lymph node involvement (46.1% versus 14.3%, p<0.05), and had a stronger tendency of locally advanced disease (stage III 43.3% versus 9.5%, p<0.05). Women over 50 had a low use of screening mammograms (24.7%) and waited twice as much before having an appointment with a specialist, when compared to those less than 50 (p<0.05). Conclusions: The majority of breast cancer cases were symptomatic, and early detection was small in this population; as a consequence, advanced disease was diagnosed in a larger proportion. These results contribute to support the growing need to develop strategies to teach women and health professionals about the benefits of mammograms, breast self exam, and clinical breast exam as tools for early detection.

Exames de mamografia em Mato Grosso do Sul: análise da cobertura como componente de equidade / Mammograms in Mato Grosso do Sul: an analysis of coverage as an equity factor

Este artigo analisa a cobertura da mamografia em Mato Grosso do Sul em 2004, considerando sua variação nas regiões e nos municípios que referenciam e realizam o exame. Para tanto, foi desenvolvido um estudo utilizando dados secundários como fontes de informações referentes ao ano de 2004. Foram analisados os 77 municípios do estado de Mato Grosso do Sul. A coleta dos dados e sua análise obedeceram à seguinte classificação: municípios sem serviços de mamografia que encaminham as mulheres para o exame; municípios com serviços de mamografia (municípios-referência) que realizam os exames. A análise dos resultados foi feita sobre as três regiões do estado. Os resultados apontaram: a oferta de exames é inferior ao necessário; a cobertura é desigual para as diferentes regiões; os termos de compromisso pactuados na PPI não atendem às recomendações do Consenso para Controle do Câncer de Mama. Foi possível concluir que somente em uma região a cobertura dos exames é homogênea. A região que tem maior concentração de mamógrafos apresenta acentuada desigualdade de cobertura.

Identification of masses in digital mammogram using gray level co-occurrence matrices

Digital mammogram has become the most effective technique for early breast cancer detection modality. Digital mammogram takes an electronic image of the breast and stores it directly in a computer. The aim of this study is to develop an automated system for assisting the analysis of digital mammograms. Computer image processing techniques will be applied to enhance images and this is followed by segmentation of the region of interest (ROI). Subsequently, the textural features will be extracted from the ROI. The texture features will be used to classify the ROIs as either masses or non-masses. In this study normal breast images and breast image with masses used as the standard input to the proposed system are taken from Mammographic Image Analysis Society (MIAS) digital mammogram database. In MIAS database, masses are grouped into either spiculated, circumscribed or ill-defined. Additional information includes location of masses centres and radius of masses. The extraction of the textural features of ROIs is done by using gray level co-occurrence matrices (GLCM) which is constructed at four different directions for each ROI. The results show that the GLCM at 0º, 45º, 90º and 135º with a block size of 8X8 give significant texture information to identify between masses and non-masses tissues. Analysis of GLCM properties i.e. contrast, energy and homogeneity resulted in receiver operating characteristics (ROC) curve area of Az = 0.84 for Otsu’s method, 0.82 for thresholding method and Az = 0.7 for K-mean clustering. ROC curve area of 0.8-0.9 is rated as good results. The authors’ proposed method contains no complicated algorithm. The detection is based on a decision tree with five criterions to be analysed. This simplicity leads to less computational time. Thus, this approach is suitable for automated real-time breast cancer diagnosis system