Certain performance values arising from mammographic test set readings correlate well with clinical audit.

INTRODUCTION: Test sets have been increasingly utilised to augment clinical audit in breast screening programmes; however, their relationship has never been satisfactorily understood. This study examined the relationship between mammographic test set performance and clinical audit data. METHODS: Clinical audit data over a 2-year period was generated for each of 20 radiologists. Sixty mammographic examinations, consisting of 40 normal and 20 cancer cases, formed the test set. Readers located any identifiable cancer, and levels of confidence were scored from 2 to 5, where a score of 3 and above is considered a recall rating. Jackknifing free response operating characteristic (JAFROC) figure-of-merit (FOM), location sensitivity and specificity were calculated for individual readers and then compared with clinical audit values using Spearman's rho. RESULTS: JAFROC FOM showed significant correlations to: recall rate at a first round of screening (r = 0.51; P = 0.02); rate of small invasive cancers per 10 000 reads (r = 0.5; P = 0.02); percentage of all cancers read that were not recalled (r = -0.51; P = 0.02); and sensitivity (r = 0.51; P = 0.02). Location sensitivity demonstrated significant correlations with: rate of small invasive cancers per 10 000 reads (r = 0.46; P = 0.04); rate of DCIS (ductal carcinoma in situ) per 10 000 reads (r = 0.44; P = 0.05); detection rate of all invasive cancers and DCIS per 10 000 reads (r = 0.54; P = 0.01); percentage of all cancers read that were not recalled (r = -0.57; P = 0.009); and sensitivity (r = 0.57; P = 0.009). No other significant relationships were noted. CONCLUSION: Performance indicators from test set demonstrate significant correlations with specific aspects of clinical performance, although caution needs to be exercised when generalising test set specificity to the clinical situation.

Use and perceived helpfulness of smoking cessation methods: results from a population survey of recent quitters.

BACKGROUND: Increasing rates of smoking cessation is one of the most effective measures available to improve population health. To advance the goal of increasing successful cessation at the population level, it is imperative that we understand more about smokers' use of cessation methods, as well as the helpfulness of those methods in real-world experiences of quitting. In this survey of recent quitters, we simultaneously examined rates of use and perceived helpfulness of various cessation methods. METHODS: Recent quitters (within 12 months; n = 1097) completed a telephone survey including questions relating to 13 cessation methods. Indices of use and perceived helpfulness for each method were plotted in a quadrant analysis. Socio-demographic differences were explored using bivariate and multivariate analyses. RESULTS: From the quadrant analysis, cold turkey, NRT and gradual reduction before quitting had high use and helpfulness; GP advice had high use and lower helpfulness. Prescribed medication and online programs had low use but high helpfulness. Remaining methods had low use and helpfulness. Younger quitters were more likely to use unassisted methods such as cold turkey; older or less educated quitters were more likely to use assisted methods such as prescribed medication or advice from a general practitioner. CONCLUSIONS: The majority of recent quitters quit cold turkey or cut down before quitting, and reported that these methods were helpful. Efforts to influence population smoking prevalence should attempt to provide support and motivation for smokers choosing these methods, in addition to assessing the effectiveness and accessibility of other methods for smokers who need or choose them.

Squeezing new life out of an old Sponge: how to modernise an anti-smoking media campaign to capture a new market.

OBJECTIVES: The iconic Sponge anti-smoking television advertisement was first made in Sydney, Australia, in 1979. In 2007, it was re-made for a new generation of smokers. This paper examines the impact of the re-made Sponge advertisement. METHODS: Qualitative evaluation of the original Sponge ad by younger and older smokers (n=51) was followed by an online pre-test survey of the modernised version (n=301). A continuous tracking telephone survey of smokers and recent quitters (quit in past 12 months) over 18 years monitored performance of the modernised version while on air in late 2007 (total n=453; seen ad n=380). RESULTS: Qualitative research found that the concept of the original Sponge ad may motivate younger smokers--who had not previously seen the ad--to quit. Online pre-testing demonstrated that the modernised version provided new information to 54% of 18-24 year olds (compared to 31% of older smokers). Tracking survey results indicated that believability of the modernised version was highest among 18-24 year olds (92%), that the ad was 'attention-grabbing' (86%), and that it was effective at influencing quitting intentions. Effects were amplified by the generation of pressure from family and friends. IMPLICATIONS: The re-made Sponge advertisement had a positive impact on smokers, and was particularly effective among the new market of smokers aged less than 40 years. Adapting successful mass media campaign material can be an effective and economical strategy to influence smokers.

Mammography image quality: model for predicting compliance with posterior nipple line criterion.

PURPOSE: To develop a model using measurements of pectoral muscle width and length together with the acceptability of the posterior nipple line criteria (PNL) to predict the acceptability of the presentation of the pectoral muscle in the mediolateral oblique view of the breast. METHOD: A total of 400 mediolateral oblique mammogram images were randomly selected from BreastScreen NSW South West, Australia. Measurements of length and width of the pectoral muscle and the acceptability of the pectoral muscle position relative to the PNL were recorded. Data analysis involved logistic regression and ROC analysis to test the predictors of width and length and the performance of the model. The model was then used to predict the outcome of acceptable or unacceptable PNL criterion for each case. RESULTS: The estimated odds ratio for an increase of 10mm was 1.98 (CI=1.68, 2.34) for the length predictor and 2.14 (CI=1.56, 2.93) for the width predictor. A cut off point of 0.6083 was derived from the training set and applied with the developed model to the test set. The area under the ROC curve was 0.9339 demonstrating an accurate model. CONCLUSION: This paper describes a model to predict the acceptability of the PNL criterion using the width and length of the pectoral muscle. This model could be used in the automated assessment of image quality which has the potential to enhance the consistency in mammographic image quality evaluation. Optimising image quality contributes to increased accuracy in radiological interpretation, which maximises the early detection of breast cancer and potentially reduces mortality rates.

The case for recycling and adapting anti-tobacco mass media campaigns.

Effective mass media campaigns are hard to come by. A delicate blend of art and science is required to ensure content is technically accurate as well as being creatively engaging for the target audience. However, the most expensive component of a media campaign is not its development but its placement at levels that allow smokers to see, engage and respond to its content. This paper uses two examples to illustrate the process of adapting existing effective material to maximise the expenditure of precious resources on the placement of material.

Annual or biennial mammography screening for women at a higher risk with a family history of breast cancer: prognostic indicators of screen-detected cancers in New South Wales, Australia.

OBJECTIVE: This study examined whether offering annual mammography screening for women with the risk factor of a family history of breast cancer resulted in more favorable prognostic indicators of diagnosed cancers than the usual approach of biennial screening. METHODS: The study involved women aged 50-69 years with a family history of breast cancer, defined as having > or = 1 first-degree relative diagnosed with breast cancer, who were diagnosed with a screen-detected invasive breast cancer between 1998 and 2004 in BreastScreen New South Wales (n = 590). The women were grouped according to whether they screened in an area offering annual screening to women with a family history, or were offered the standard biennial screening. The odds of having favorable tumor size, grade, and nodal status prognosis were compared between these screening groups using logistic regression. A comparison group of women without a family history, all offered biennial screening, was also evaluated based on the same area groupings to examine whether any differences were due to the area, rather than the screening interval policy. RESULTS: Women with a family history who were offered annual screening at BreastScreen NSW were significantly more likely than those who were offered biennial screening to be diagnosed with a tumor < or = 20 mm in size (adjusted odds ratio (AOR) = 1.91, 95% CI: 1.21-3.02), and to have a node-negative tumor (AOR = 1.61, 95% CI: 1.03-2.50). There were also significantly higher odds of being diagnosed with tumors < or = 15 mm (p < 0.001) and < or = 10 mm in size (p = 0.011) in women offered annual screening. There was no significant difference in the odds of a Grade 1 tumor being detected (AOR = 1.26, 95% CI: 0.87-1.81), although the direction of the effect was consistent with that seen for size and nodal status. No significant differences were found in the comparison group of women without a family history. CONCLUSIONS: Offering annual screening for women aged 50-69 years with a family history of breast cancer significantly increased the odds of being diagnosed with a smaller, node-negative tumors. Further investigation is required to assess whether the improved prognostic indicators translate into significantly better mortality outcomes for women with a family history offered annually screening.

Risk factor, pattern, etiology and outcome in ischemic stroke patients with cancer: a nested case-control study.

BACKGROUND: Coagulation disorders are seen in cancer patients, but it is not clear whether cancer predisposes stroke patients to unique characteristics. The aim of the study was to investigate risk factors, pattern,etiology and outcome in stroke patients with cancer. METHODS: A retrospective review of all ischemic stroke (IS) patients with cancer (n = 56) admitted to Bankstown-Lidcombe Hospital, Sydney, Australia, between January 1999 and December 2004 was conducted and comparison made to age- and gender-matched noncancer IS patients admitted to the same hospital during the same period. RESULTS: Vascular risk factors and stroke pattern were comparable in cancer and noncancer groups. Post-stroke thrombotic episodes (myocardial infarction, deep vein thrombosis or pulmonary emboli) were more common in the cancer group than in the noncancer group (11 vs. 0%, p = 0.031). Depression was also more common in the cancer group than in the noncancer group (14 vs. 2%, p = 0.039). There was a tendency for more patients in the cancer group to die in hospital (30 vs. 14%, p = 0.078). CONCLUSIONS: Coagulation disorders were more likely to be seen in stroke cancer patients, and patients with cancer tended to have a higher in-hospital post-stroke mortality. Larger sample size studies may identify further differences in the characteristics of stroke patients with cancer.