Breast cancer in New South Wales in 1972-1995: tumor size and the impact of mammographic screening.

To examine the use of mammographic screening in women in New South Wales (NSW), we measured uptake of initial mammograms and estimated the proportions of breast cancers that were screen detected. To see if mammographic screening has been associated with reductions in advanced breast cancers and mortality from breast cancer, we analyzed trends in age-specific and age-standardized breast cancer incidence and mortality from 1972 to 1995 and tumor size in 1986, 1989, 1992 and April to September 1995. Between 1984 and the end of 1995, an estimated 72% of NSW women in their 50s and 67% in their 60s had had at least 1 mammogram and, in 1995, an estimated 39% of invasive breast cancers in women in these age groups were detected by mammography. Before 1989, breast cancer incidence increased only slightly (+1.3% annually) but then, from 1990 to 1995, increased more rapidly (+3.1% annually). Between 1986 and 1995, rates of small cancers (< 1 cm) increased steeply by 2.7 times in women 40-49 years of age and 5.6 times in women 50-69 years of age. The incidence of large breast cancers (3+ cm), after little apparent change to 1992, fell by 17% in women 40-49 years of age and 20% in those 50-69 years of age to 1995. Breast cancer mortality increased slightly between 1972 and 1989 (+0.5% annually) but then fell (-2.3% annually) from 1990 to 1995. We concluded that breast cancer rates had been influenced in expected directions by the introduction of mammographic screening in women resident in NSW. We expect that recent falls in incidence of larger breast cancers and breast cancer mortality will become steeper as screening coverage increases in the second half of the 1990s.

High-resolution ultrasound in the preoperative and postoperative assessment of distal metatarsal osteotomy. Preliminary report.

High-resolution sonography was used to study eight patients with suspected plantarflexed metatarsals and associated painful pedal callousities to determine metatarsal head position as the etiology of the pressure keratosis. Ultrasonography demonstrated a plantarflexed metatarsal head in all eight patients. Using both 5 and 10 MHz transducers, the plantarflexed metatarsal position could be accurately assessed and thus could aid in determining the degree of surgical correction necessary to properly realign the depressed metatarsal. Ultrasonography also allowed a noninvasive and accurate assessment of the surgical correction postoperatively in five of the eight patients. This preliminary study suggests that high-resolution sonography has applicability in accurately assessing metatarsal position. In addition, this new technique is noninvasive and presents insights concerning the amount of surgical correction necessary for realignment without increased risk or pain to the patient.