Mammographic calcifications and risk of subsequent breast cancer.

Background: Women with proliferative benign breast lesions are at increased risk of breast cancer, and some studies have provided evidence that microscopic calcifications in such lesions enhance the risk.

Purpose: This study was performed to determine whether calcifications on mammograms are predictive of subsequent breast cancer.

Methods: Data for this study were collected on women enrolled at four of the clinics that participated in the Breast Cancer Detection and Demonstration Project (BCDDP).

Early detection of breast cancer.

Breast cancer is the most common malignancy in North American women. The incidence rate is increasing by about 2% annually, while the mortality rate has remained stable for 50 years. Screening by physical examination and mammography can decrease the mortality rate in women over 50 by 30%.

Racial differences in the early detection of breast cancer in metropolitan Detroit, 1978 to 1987.

This population-based study presents trends in stage at diagnosis of invasive female breast cancer during the decade from 1978 to 1987 in the Detroit metropolitan area. Its purpose is to determine whether there has been an increase in early breast cancers: those that are smaller than 2 cm at diagnosis and have no axillary lymph node involvement. Trend analyses of tumor size, node status, year of diagnosis, age, and race were performed for 17,216 incident cases drawn from the Metropolitan Detroit Cancer Surveillance System (MDCSS).

The process of recovery from breast cancer for younger and older patients. Changes during the first year.

A representative community sample of 274 breast cancer (BC) patients from the Metropolitan Detroit Cancer-Surveillance System was studied longitudinally during the year after their BC diagnosis. The adjustment of these patients to their disease was examined in terms of (1) the changes in their physical and mental health functioning; and (2) the factors that predict or facilitate the recovery process, including the independent and interactive effects of age. Comparison of the outcomes at 4 and 10 months after diagnosis manifested a significant and consistent improvement in physical functioning.

Physical and psychosocial functioning and adjustment to breast cancer. Long-term follow-up of a screening population.

The effects of age, recency of breast cancer (BC) diagnosis, and severity of the disease on adjustment outcomes were investigated in a sample of 349 women from the 10,056 women screened for BC by the University of Michigan Breast Cancer Detection Demonstration Project between 1974 and 1981. In the 1985 follow-up, data were collected from the 173 surviving BC patients who had invasive BC, and from a matched control group of 176 women who were asymptomatic of BC. Fifty-five percent of the BC patients were 5 years past diagnosis and treatment at the time of data collection.

Effective breast cancer detection with film-screen mammography.

Non-visualization of the retromammary space and ribs has been a source of concern to mammographers. In six years, 186 cancers were detected in our experience of 10 034 self-referred asymptomatic women at the University of Michigan Breast Cancer Detection Demonstration Project. These cancers were used to analyze the need to visualize the retromammary space and ribs, or both sites, if adequate technical factors were used.

Incidence of mammary intra-arterial calcification: an age-matched control study.

Mammary intra-arterial calcification (MIAC) was seen on the mammograms of 13 of 150 (8.7%) known diabetic patients and 21 of 300 (7.0%) age-matched control patients.

The relationship between Wolfe's classification of mammograms, accepted breast cancer risk factors, and the incidence of breast cancer.

Data collected between 1973 and 1984 on 696 incident cases of breast cancer and 1,376 matched controls from four Breast Cancer Detection Demonstration Project clinics in the United States were used to assess the role of mammographic parenchymal pattern as a risk factor and its relationship with other, accepted, risk factors. The data confirm previous reports of the influence of benign breast biopsy, age at first live birth, family history of breast cancer, and duration of menstruation on the incidence of breast cancer. Height is also found to be an influential factor.

Wolfe mammographic parenchymal patterns. A study of the masking hypothesis of Egan and Mosteller.

Wolfe defined four different classes of breast parenchymal patterns and claimed that they were associated with different risks for the subsequent development of breast cancer. Egan and Mosteller suggested that these patterns did not constitute a true risk factor, rather the effect was caused by the greater difficulty of detecting breast cancers in the dense (P2, DY) patterns compared with the fatty (N1, P1) patterns. Similarly, Mendell believed that a bias was introduced into Wolfe's work by requiring a negative mammogram before a patient entered the study.

Breast cancer prediction and the Wolfe classification of mammograms.

Mammographic parenchymal patterns have been proposed as a method of determining women at high risk of developing breast cancer. Wolfe's original report of relative risks as high as 37:1 for "dysplastic" breasts (DY) as compared with adipose breasts (N1), with intermediate values of P1 and P2, were not uniformly confirmed by others. (Relative risks are used here as the equivalent of odds ratios.

Characteristics of breast cancer in an incident cancer population.

The effectiveness of film mammography is a source of concern to radiologists because neither the ribs nor retromammary space is included on the films in good quality examinations. One hundred seven incident cancers were detected in 10,034 self-referred women followed at the University of Michigan Breast Cancer Detection Demonstration Project (UM-BCDDP) for 5 years. These cancers were analyzed for location on the film, method of detection, size, histology, and the number of films required for detection.

Relationship of mammographic intra-arterial calcifications and diabetes.

Mammary intra-arterial calcification (MIAC) as a predictor of occult diabetes has been suggested in the medical literature. However, the incidence of arteriosclerosis and atherosclerosis increases with age, as well as with hypertension and diabetes. The mammograms of 169 known diabetic women were reviewed for MIAC.

Mammographic intra-arterial calcifications.

There is controversy about the significance of intra-arterial mammographic calcification ( MIAC ). Radiographic MIAC was found in mammograms of 78 of a total of 914 patients. The patients were analyzed for risk factors associated with arteriosclerosis, i.

Reproducibility and consistency in classification of breast parenchymal patterns.

The Wolfe Classification System of evaluating risk of developing breast cancer from analysis of mammographic parenchymal patterns (MPP) has received worldwide attention. In addition to confirming its validity, it is necessary to establish the ability of radiologists to apply the classification of mammograms consistently and reproducibly. This paper reports the results of 12 radiologists associated with the former Breast Cancer Detection Demonstration Projects (BCDDP) in Ann Arbor, Honolulu, Seattle, and Tucson.

Tumor location and detectability in mammographic screening.

The adequacy of a film mammogram that does not visualize the retromammary space or ribs has concerned radiologists. The 79 prevalent cancers detected in the 10,000 self-referred woman at the University of Michigan Breast Cancer Detection Demonstration Project were analyzed for number of films required to detect the cancer, relationship of the cancer to the posterior edge of the film, number of occult lesions, tumor size, histologic type, sensitivity of detection method, and number of interval carcinomas. The mammograms were obtained using a dedicated mammographic machine and the upright position, with visualization of the anterior axillary fold on the mediolateral view.

Association between mammographic parenchymal pattern classification and incidence of breast cancer.

Wolfe has suggested that the mammographic parenchymal patterns can be used to identify a group with high incidence of breast cancer. To evaluate this claim, mammograms of women with breast cancer that was detected at the University of Michigan Breast Cancer Detection Demonstration Project have been classified and compared with a randomly selected control group from the same project. The basic mammographic classifications as defined by Wolfe were used with further refinements made in the DY and QDY groups.

A simple device for dependent compression mammography.

The authors describe an inexpensive device which displaces the dependent breast from the chest wall for optimum and uniform compression of breast tissue during mammography. Exposure is reduced, detail is enhanced, and superimposed structures are spread out. The filming time is about five minutes, and repeat or additional views are rarely necessary.

Percutaneous needle localisation of breast lesions prior to biopsy: analysis of failures.

Mammography can detect clinically occult breast cancer. But with minimal or no physical findings the lesion can be quite difficult for the surgeon to find within the recumbent breast at biopsy. Percutaneous needle localisation, the placement of a needle in or in the vicinity of such a clinically silent lesion, provides an internal landmark to assist the surgeon.

Criteria for obtaining and interpreting breast thermagrams.

The thermal and graphic criteria which should be used to evaluate breast thermograms are outlined. Thermograms are then categorized as normal, suspicious, or abnormal on the basis of the criteria outlined. It is hoped that these criteria can be used widely to standardize breast thermographic evaluation.

Percutaneous needle localization of clustered mammary microcalcifications prior to biopsy.

Mammography occasionally reveals the presence of suspicious appearing clustered microcalcifications without an associated mass. Clinical localization of these microcalcifications within the breast is difficult, even using the 2 dimensional effect of a mammogram. Percutaneous needle localization of these microcalcifications is recommended for its accuracy, patient acceptance, and reduction in size of the biopsy specimen.