Digital zoom of the full-field digital mammogram versus magnification mammography: a systematic review.

OBJECTIVES: To summarise and compare the performance of magnification mammography and digital zoom utilising a full-field digital mammography (FFDM) system in the detection and diagnosis of microcalcifications. METHODS: We ran an extended search in MEDLINE, EMBASE, CINAHL, Engineering Village and Web of Science. Diagnostic test studies, experimental breast phantom studies and a Monte Carlo phantom study were included. A narrative approach was selected to summarise and compare findings regarding the detection of microcalcifications, while a hierarchical model with bivariate analysis was used for the meta-analysis of sensitivity and specificity for diagnosing microcalcifications. RESULTS: Nine studies were included. Phantom studies suggested that the size of microcalcifications, magnification or zoom factor, exposure factors and detector technology determine whether digital zoom is equivalent to magnification mammography in the detection of microcalcifications. Pooled sensitivity for magnification and zoom calculated from the diagnostic test studies was 0.93 (95% CI 0.84-0.97) and 0.85 (95% CI 0.70-0.94), respectively. Pooled specificity was 0.55 (95% CI 0.51-0.58) and 0.56 (95% CI 0.50-0.62), respectively. The differences between the sensitivities and specificities were not statistically significant. CONCLUSIONS: Digital zoom may be equivalent to magnification mammography. Diagnostic test studies and phantom studies using newer detector technology would contribute additional knowledge on this topic. KEY POINTS: • The performance of digital zoom is comparable to magnification for detecting microcalcifications when newer detector technology and optimised imaging procedures are utilised. • The accuracy of digital zoom appears equivalent to geometric magnification in diagnosing microcalcifications.

Health-related quality of life, anxiety and depression related to mammography screening in Norway.

AIM AND OBJECTIVES: To measure health-related quality of life, anxiety and depression ahead of mammography screening and to assess any differences in health-related quality of life compared to reference population. BACKGROUND: The study of health-related quality of life among attendees prior to mammography screening has received little attention, and increased knowledge is needed to better understand the overall health benefits of participation. DESIGN: A two-group cross-sectional comparative study was performed. METHODS: The samples comprised 4,249 attendees to mammography screening and a comparison group of 943 women. We used the SF-36 Health Survey to assess health-related quality of life. Linear regression was used to study any differences between the groups with adjustment for age, level of education, occupation, having children and smoking status. Other normative data were also used. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. RESULTS: Attendees scored statistically significant higher on the SF-36 than the comparison group but were in line with normative data. Attendees had anxiety mean 4·1 and depression mean 2·6. CONCLUSIONS: The majority of the attendees have a high health-related quality of life, low anxiety and depression ahead of screening. Anxiety and depression were less than shown in normative data from Norway. Despite a high health-related quality of life, low anxiety and depression among the majority, healthcare workers should pay special attention to the few women who are anxious and depressed, and have a lower health-related quality of life. Omitted from mammography screening may be women who are unemployed, have lower socioeconomic status, are anxious and are depressed. Further research should be performed with non-attendees and subgroups to improve the screening programme. RELEVANCE TO CLINICAL PRACTICE: It is important to identify which patients have the greatest need for support and caring in an organised mammography screening and who may be overlooked.

Effects of false-positive results in a breast screening program on anxiety, depression and health-related quality of life.

BACKGROUND: Decreased anxiety has been reported among women with false-positive results in mammography screening programs. No long-term effects have been fully demonstrated, and the findings for anxiety and depression are contradictory. Few studies have addressed changes in health-related quality of life (HRQOL). OBJECTIVE: The objective was to study the short- and long-term effects such as changes in anxiety, depression, and HRQOL among women with false-positive results. METHODS: With a longitudinal study design, data were collected on anxiety and depression (Hospital Anxiety and Depression Scale) and HRQOL (Short-Form 36 [SF-36] Health Survey) among women with false-positive results before screening, at recall, and at 3 and 6 months after screening. Controls (negative results in screening) were measured before screening and at 6 months after. RESULTS: Women with false-positive results (n = 128) showed increased anxiety at recall (mean, 4.6 [SD, 3.7]) versus before screening (P = .04), but this decreased until 6 months after screening. Depression was increased until 6 months after screening (not statistically significant). Women with false-positive results scored lower than did control subjects on general health (P = .02) and mental health (P = .03) and higher on depression (P = .045) at 6 months after screening. CONCLUSIONS: Efforts should be made to minimize anxiety at recall and depression after screening. Further research is needed on the long-term effects of recall and any effects on HRQOL. IMPLICATIONS FOR PRACTICE: Information about the prevalence of false-positive results and time until unambiguous diagnostic results should be improved. Information leaflet based on evidence needs to be continually updated.

Mammography screening from the perspective of quality of life: a review of the literature.

AIMS: The purpose of this literature review was to explore how women attending a national mammography screening programme reacted to the screening process on quality of life (QoL). The research question was what implications regarding true-negative results and false-positive results from mammography screening were found among women? Quality of life including life domains as psychological, physical and social was the theoretical reference in the study. METHOD: Guided by the concept of QoL on mammography screening a database search of Medline, Cinahl and Cochrane was carried out. Search terms such as QoL, anxiety and mammography have been used. FINDINGS: A review of studies between 1995 and 2007 showed that the implications regarding a negative result were less than those regarding false-positive one. It was found that women with negative results after mammography screening experience minor negative psychological consequences, and some women have even measured less anxiety following mammography than before because of the reassurance given by a clear negative result. False-positive result and recalls were a problem for many women. The process following recalls do affect women emotionally, decrease their wellbeing and QoL for weeks and even months. CONCLUSION: Future research should be directed at measuring the short-term outcomes in representative populations for whom screening and prevention are indicated. This knowledge would be useful for the organisation of the mammography programmes and for communication with the general population, the women coming for screening and those who do not attend.