Breast screening uptake rates: does access to Saturday sessions lead to improvements?

Offering women the option of attending for breast screening on Saturday did not increase the rate of uptake in a study performed in a city site in Manchester, UK.

Can preoperative factors predict for residual malignancy after breast biopsy for invasive cancer?

The presence of malignancy at the resection margins of a malignant breast biopsy requires difficult therapeutic decisions about whether a re-excision biopsy is necessary. The aim of this study was to determine the factors predisposing to the involvement of the resection margins in 280 women undergoing breast biopsy for invasive malignancy from a single breast screening practice. Resection margins were assessed independently by a single pathologist who noted either the presence of tumour at the margins of the biopsy specimen or in the shavings taken from the biopsy cavity. Resection margin involvement (RMI) occurred in 113 patients. Mammographic microcalcification (MM) was seen in 87 women with invasive cancer and RMI occurred in 53 (61%) compared with 60/193 invasive cancers without MM (P < 0.001). If RMI was present the patients underwent a second procedure to ensure complete tumour excision, and 68% of re-excision specimens from tumours with MM and 36% of tumours without MM contained residual malignancy (P < 0.005). Statistical analysis demonstrated that these observations were independent of tumour size, grade, type, and axillary node status. The presence of mammographic microcalcification therefore indicates that wider than usual surgical resection margins should be taken.

Mammographic appearances in Paget's disease of the breast.

The mammographic appearances in 17 patients with Paget's disease of the breast were retrospectively reviewed. Appearances were normal in only five cases. Microcalcification was present in 10 including one where it encircled the nipple. A radiologically-visible tumour was seen in nine breasts with carcinoma being diagnosed in a further three by the pattern of calcification alone. Multifocal tumours were present in four breasts but no lymphadenopathy or contralateral tumours were seen. Despite high quality radiography a tumour was only detected in 71% of cases of Paget's disease and radiographers should be trained to recognize the condition clinically. Patients without a visible tumour may be suitable for radiotherapy.

Treatment of the axilla in patients with screen-detected breast cancer.

Management of the axillary lymph nodes in patients with screen-detected breast cancer is controversial. Optimal treatment should combine accurate determination of node status and avoidance of unnecessary morbidity. This study attempted to determine whether axillary node status could be accurately predicted using selected criteria in women with screen-detected breast cancer. Of 223 breast cancers excised in the Greater Manchester breast screening programme, 180 were invasive and 40 of these had associated lymph node metastases. The presence of involved nodes was associated with large tumour size, high tumour grade and the absence of mammographic microcalcification. Multiple logistic regression analysis revealed that each of these three factors was independently significant. Women with a screen-detected breast cancer < 1 cm in diameter or those with grade I tumours < 3 cm (35 per cent of the total) could be spared axillary surgery with an expected reduction in morbidity and operating time.

Response by women aged 65-79 to invitation for screening for breast cancer by mammography: a pilot study.

OBJECTIVE: To determine whether there is sufficient benefit to be gained by offering screening for breast cancer with mammography to women aged 65-79, who are not normally invited for screening. DESIGN: Pilot study of women eligible for screening but not for personal invitation. The results of this study were compared with the results of routinely screened younger women (aged 50-64) from the same general practice. SETTING: One group general practice in south Manchester. PATIENTS: The 631 women aged 65-79 on the practice list. A total of 42 (7%) were excluded by the general practitioner, and 22 (4%) invitation letters were returned by the post office. MAIN OUTCOME MEASURES: Response rates to invitation for screening assessed by three indices: crude population coverage ratio, crude invited population coverage ratio, and corrected invited population coverage ratio. RESULTS: 344 Patients aged 65-79 (61% of those invited, excluding those who could not be traced) were screened compared with 77% of women aged 50-64. The three response indices were higher for younger women than older: crude population coverage ratio = 66.5%, crude invited population coverage ratio = 69.3%, corrected invited population coverage ratio = 76.8% for women aged 50-64, compared with 54.5%, 58.4%, and 60.7% respectively for women aged 65-79. All four biopsies done in the older women gave positive results, giving a cancer detection rate of 11.6/1000 compared with 4.1/1000 among younger women. CONCLUSIONS: These results show that there is a potential for high attendance at routine screening by older women if they are invited in the same way as younger women. If these results are found elsewhere the costs and benefits of screening older women should be reassessed.

Radiation dose to patient and staff during percutaneous nephrostolithotomy.

The radiation dose to the patient and to members of staff was monitored during 18 procedures for the percutaneous removal of renal stones. It was found that the radiation dose to the patient was minimal and was about the same as for an IVU. The overall dose to the staff was acceptably low and within safety limits. It was concluded that PCNL is a safe procedure from the radiation point of view but it may be advisable to take certain precautions if the workload is high.

Renal imaging: a comparison of radionuclide, ultrasound, and computed tomographic scanning in investigation of renal space-occupying lesions.

Two studies were carried out in which 27 and 23 patients respectively with renal space-occupying lesions were assessed by different techniques and the results compared. Instead of proceeding to renal arteriography after the lesion had been found on urography, radionuclide and ultrasound scanning were used in the first study to clarify the nature of the lesions, while in the second study computed tomography was used as well. Results were good with all three methods, although ultrasonography and radionuclide scanning cannot resolve lesions of under 2 cm in diameter and the radiation dose with computed tomography is similar to that used in renal arteriography. Probably the best method of evaluating renal space-occupying lesions after urography is to use both ultrasound and radionuclide scanning. If further information is required computed tomography or arteriography is indicated.

An atmospheric pressure ionography system suitable for mammography.

Ionography is a possible replacement for silver halide based imaging systems in diagnostic radiology. This type of imaging depends upon the ionisation produced in a gas by incident x-radiation. The ions formed are collected on a plastic foil and the image is made visible by a suitable development process. The physical design properties which can affect sensitivity and image quality of an ionography system are outlined in this paper. Based upon the requirements of adequate sensitivity and resolution an atmospheric pressure ionography system is described which has been designed primarily for use in mammography. Freon 13B1 gas was chosen as the x-ray absorbing medium because it contains a relatively high atomic number atom (bromine, Z = 35) and also has a high density. It is a relatively cheap gas, has a high breakdown potential and has satisfactory resolving capability, particularly when employed at atmospheric pressure with low energy x-ray beams. The performance of the system is discussed in terms of sensitivity and resolution. Problems associated with an atmospheric pressure system are outlined and possible solutions described. Preliminary clinical results obtained with the system are also presented.

A quantitative evaluation of film and film/screen combinations for mammographic examination.

A test phantom containing simulated micro-calcifications was constructed. This was imaged by seven systems suitable for use in mammography, firstly in scatter-free conditions and secondly with the addition of tissue-equivalent scattering material. The ability of the systems to resolve micro-particles of known size was assessed using the techniques of signal detection theory. The resultant receiver operating characteristic curves separated the systems into three major groups. Firstly, high resolution systems requiring high radiation dose techniques; secondly at the other extreme, a mediocre imaging system producing its results at low radiation levels; and thirdly a larger middle group producing intermediate resolution of fine particles at similar, acceptable dose levels. The ability to image small particles does not increase linearly with the radiation dose. Scatter did not affect all of the systems to the same extent.

Radiation dosage to the breast in well-women screening surveys.

The D.H.S.S. is supporting research in several centres to determine the feasibility of establishing a nationwide Breast Cancer Screening Programme. This paper answers the questions "What is the radiation dose produced by mammography, and is it safe?". In the context of well-women screening surveys a maximum skin dose of 2 R has been recommended. The variation of dose across the breast surface is recorded and the reasons for this enumerated. The lowest mean dose recorded with industrial quality film was 4-9 R, so that such fine-grain film cannot be used for this purpose. Doses within the recommended safety limit are achieved by the use of vacuum-packed film-screen combinations. The new rare-earth phosphor screens produce the lowest dose (0-2 R). There was no significant gonad dose. It is concluded that mammographic examination of well-women can be performed at safe radiation levels.