Waiting for a diagnosis after an abnormal screening mammogram. SMPBC diagnostic process workgroup. Screening Mammography Program of British Columbia.

Background: Women with abnormal screening mammograms require diagnostic assessment and experience anxiety until a diagnosis is established. This report evaluated the timeliness of diagnosis after an abnormal screening mammogram in the Screening Mammography Program of British Columbia (SMPBC).

Methods: Information on diagnostic interventions following an abnormal screen (N = 10,314) provided through 11 regional SMPBC services between January 1, 1993 and June 30, 1994 were abstracted and analyzed.

Standardized abnormal interpretation and cancer detection ratios to assess reading volume and reader performance in a breast screening program.

Purpose: To determine the relationship between annual screening volume and radiologist performance in the Screening Mammography Program of British Columbia, Canada.

Materials And Methods: Standardized abnormal interpretation ratios and standardized cancer detection ratios were constructed for 35 readers with at least 3 years of experience with the Screening Mammography Program of British Columbia. The ratios were used to compare individual reader performance with the mean program performance after adjustment for the age and screening history (first versus subsequent screening examinations) of the women who underwent screening.

A decision analysis of the effect of avoiding axillary lymph node dissection in low risk women with invasive breast carcinoma.

Background: Evidence that avoiding axillary lymph node dissection (AxD) strikes an appropriate balance between morbidity and recurrence risk in patients with invasive breast carcinoma generally is anecdotal and without a formally quantified basis. The current study presents a decision analysis of the difference in 5-year disease free survival (DFS) rate between treatment scenarios with and without routine AxD.

Methods: To derive quantitative estimates of the effect of avoiding AxD on 5-year DFS, the authors examined outcomes for women undergoing 2 treatment scenarios: AxD or no AxD with adjuvant therapy decisions based on risk factors in the primary tumor.

Effect of time interval between breast-conserving surgery and radiation therapy on ipsilateral breast recurrence.

Purpose: To examine the effect of the time interval (interval) between breast-conserving surgery (BCS) and the start of radiation therapy (RT) on the subsequent risk of ipsilateral breast cancer recurrence (IBR).

Methods And Materials: We reviewed interval and a number of prognostic and treatment factors among 1,962 women treated with BCS and RT for invasive breast cancer diagnosed between January 1, 1989 and December 31, 1993 in British Columbia, Canada. Subjects were female, less than 90 years old at diagnosis, not treated with chemotherapy, not stage T4 or M1, and had survived more than 30 days from diagnosis.

MR imaging of brachial plexopathy in breast cancer patients without palpable recurrence.

Objective: To investigate the role of MR imaging in detecting brachial plexus (BP) abnormalities in breast cancer patients with plexopathy but without palpable masses.

Design: MR imaging of the BP was performed on 26 breast cancer patients with brachial plexopathy without palpable regional masses, using 0.5 T and 1.

Functional assessment of cutaneous microvasculature after radiation.

Background And Purpose: To determine if laser Doppler flowmetry could be used to non-invasively evaluate microvasculature function after radiation therapy (RT), we assessed blood flow response to heating in women following RT after breast conservation.

Materials And Methods: Forty women with unilateral stage I/II breast cancer treated with conservative surgery and RT were evaluated at varying intervals post RT. Ten patients were retested after an interval of 55 to 57 months to assess reproducibility of the control data.

Prognosis, treatment, and recurrence of breast cancer for women attending or not attending the Screening Mammography Program of British Columbia.

Breast cancer screening programs have been initiated in many countries in the past decade. To determine the impact of the Screening Mammography Program of British Columbia (SMPBC), disease and treatment outcomes for women with breast cancer diagnosed in BC between 1989 and 1996 were compared on the basis of attendance at the SMPBC. An SMPBC attender was a women diagnosed with breast cancer within three years of an SMPBC screen, regardless whether the cancer was detected as a result of that screen.

Prognostic value of systemic blood pressure response during exercise in a community-based patient population with hypertrophic cardiomyopathy.

Objectives: The present study was designed to prospectively evaluate the prognostic relevance of abnormal blood pressure response to exercise (ABPR), defined as hypotension or failed blood pressure increase (<20 mm Hg) with exercise, in a community-based hypertrophic cardiomyopathy (HCM) population representative of the overall disease spectrum.

Background: Abnormal blood pressure response to exercise has been proposed as a marker for hemodynamic instability and increased risk for disease-related mortality in highly selected patient populations with HCM.

Methods: The study population comprised 126 patients (aged 42+/-14 years) who underwent maximal symptom-limited cycloergometer exercise testing as part of the standard evaluation at our institution, and who were followed systematically for 4.

Screening Mammography Program of British Columbia: pattern of use and health care system costs.

Background: The use of mammography for screening asymptomatic women has increased dramatically in the past decade. This report describes the changes that have occurred in the use of bilateral mammography in British Columbia since the provincial breast cancer screening program began in 1988.

Methods: Using province-wide databases from both the breast cancer screening program and the provincial health insurance plan in BC, the authors determined the number and costs of bilateral mammography services for women aged 40 years or older between Apr.

Clinical utility and safety of exercise testing in patients with hypertrophic cardiomyopathy.

Background: Exercise testing has long been employed in patients with hypertrophic cardiomyopathy (HCM), although concerns have constantly been expressed regarding its safety. This study reviews a large number of exercise tests performed in a community-based population with HCM, in terms of safety and clinical utility.

Methods: We analyzed a total of 243 maximal symptom-limited cycloergometer exercise tests performed at our institution in 138 patients with HCM (age 42 +/- 14 years, M/F 99/39), who were followed systematically for 9.

Coronary vasodilator reserve is impaired in patients with hypertrophic cardiomyopathy and left ventricular dysfunction.

Background: We tested the hypothesis that a reduced delivery of blood to the myocardium is involved in the development of systolic dysfunction of patients with hypertrophic cardiomyopathy (HCM).

Methods And Results: Eighty-four patients with HCM (62 men, age 43 +/- 12 years) were studied. Left ventricular dimensions and function (fractional shortening) were evaluated by 2-dimensional echocardiography.

Utility of an integrated clinical, echocardiographic, and venous ultrasonographic approach for triage of patients with suspected pulmonary embolism.

The potential role of ultrasound techniques in diagnosing acute pulmonary embolism (PE) has been investigated in severe cases with hemodynamic compromise, but is still unclear for the whole clinical spectrum of patients with suspected PE. The aim of this study was to assess the utility of an integrated bedside evaluation for PE based on the combination of a clinical score, 2-dimensional echocardiography, and color venous duplex scanning. A group of 117 consecutive patients with suspected PE was assessed using a clinical likelihood score, echocardiography, and venous duplex scanning in order to obtain a preliminary diagnosis of PE, which was subsequently compared with the final diagnosis obtained by lung perfusion scintigraphy and angiography.

Prediction of axillary lymph node involvement of women with invasive breast carcinoma: a multivariate analysis.

Background: The increasing use of systemic therapy for women with lymph node negative breast carcinoma and earlier stage of disease at mammographic detection raises questions regarding the need for routine axillary lymph node dissection. Predictive modeling for lymph node involvement may be one way to reduce the need for axillary lymph node dissection and its morbidity.

Methods: A multivariate analysis of 12 factors predictive of axillary lymph node involvement was conducted in a population-based cohort of 4312 women with invasive breast carcinoma diagnosed between January 1, 1993 and December 31, 1996.

Prognostic value of non-sustained ventricular tachycardia and the potential role of amiodarone treatment in hypertrophic cardiomyopathy: assessment in an unselected non-referral based patient population.

Background: Amiodarone has been reported to reduce the likelihood of sudden death in patients with hypertrophic cardiomyopathy (HCM). However, data regarding the clinical course in HCM have traditionally come from selected referral populations biased toward assessment of high risk patients.

Aims: To evaluate antiarrhythmic treatment for sudden death in an HCM population not subject to tertiary referral bias, closely resembling the true disease state present in the community.

[Clinical course of hypertrophic cardiomyopathy in a non selected population. The Experience of the Italian Multicenter Cardiomyopathy Study].

Background: Most of the information available on the clinical course and prognosis of hypertrophic cardiomyopathy (HCM) is based on data generated from international referral centres and as a result, it constitutes a potentially biased perspective of the disease process in this complex and diverse condition. A multicentric study was therefore set up with the aim of providing information on unselected patient populations with HCM.

Methods: The study group comprised 330 patients from 5 non-referral hospitals (mean age 42 +/- 16 years, M/F 226/104, 74-22%-obstructive, 299-91%-in NYHA class I-II) who were followed up regularly for 9.

Syncope and ventricular arrhythmias in hypertrophic cardiomyopathy are not related to the derangement of coronary microvascular function.

Unlabelled: Non-sustained ventricular tachycardia on Holter and syncope have been considered risk factors for sudden death in hypertrophic cardiomyopathy.

Aims: In these patients the coronary vasodilator reserve is impaired despite normal coronaries, so we evaluated the correlation between the severity of coronary vasodilator reserve impairment and the occurrence of syncope and non-sustained ventricular tachycardia.

Methods And Results: Eighty-four patients with hypertrophic cardiomyopathy (62 males, age 43 +/- 12 years) had a two-dimensional echocardiographic study and a 48-h Holter.

Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer.

Background: Radiotherapy after mastectomy to treat early breast cancer has been known since the 1940s to reduce rates of local relapse. However, the routine use of postoperative radiotherapy began to decline in the 1980s because it failed to improve overall survival. We prospectively tested the efficacy of combining radiotherapy with chemotherapy.

Risk for atrial fibrillation in patients with hypertrophic cardiomyopathy assessed by signal averaged P wave duration.

Objective: To assess the relation between P wave duration and the occurrence of atrial fibrillation in hypertrophic cardiomyopathy (HCM).

Design: High resolution signal averaged electrocardiography was used in 110 patients with HCM to determine whether patients at risk for paroxysmal atrial fibrillation could be detected during sinus rhythm by measuring P wave duration. Filtered P wave duration was measured manually, over an average of 300 beats per patient.

The association between population-based treatment guidelines and adjuvant therapy for node-negative breast cancer. British Columbia/Ontario Working Group.

This study evaluated the impact of province-wide treatment guidelines on consistency of adjuvant therapy for node-negative breast cancer. A retrospective population-based cohort study was conducted in the Canadian provinces of British Columbia, which has province-wide guidelines, and Ontario, which does not. All eligible 1991 incident cases of node-negative breast cancer in British Columbia (n = 942) and a similar number of randomly selected 1991 incident cases in Ontario (n = 938) were reviewed.

Patterns of initial management of node-negative breast cancer in two Canadian provinces. British Columbia/Ontario Working Group.

Objective: To describe the patterns of initial management of node-negative breast cancer in Ontario and British Columbia and to compare the characteristics of the patients and tumours and of the physicians and hospitals involved in management.

Design: Retrospective, population-based, cohort study.

Participants: All 942 newly diagnosed cases of node-negative breast cancer in 1991 in British Columbia and a random sample of 938 newly diagnosed cases in Ontario in the same year.