Arsenic stress triggers active exudation of arsenic-phytochelatin complexes from Lupinus albus roots.

Arsenic contamination of soils threatens the health of millions globally through accumulation in crops. While plants detoxify arsenic via phytochelatin (PC) complexation and efflux of arsenite from roots, arsenite efflux mechanisms are not fully understood. Here, white lupin (Lupinus albus) was grown in semi-hydroponics and exudation of glutathione (GSH) derivatives and PCs in response to arsenic was scrutinised using LC-MS/MS. Inhibiting synthesis of PC precursor GSH with L-buthionine sulfoximine (BSO) or ABC transporters with vanadate drastically reduced (>22%) GSH-derivative and PC2 exudation, but not PC3 exudation. This was accompanied by arsenic hypersensitivity in plants treated with BSO and moderate sensitivity with vanadate treatment. Investigating arsenic-phytochelatin (As-PC) complexation revealed two distinct As-PC complexes, As bound to GSH and PC2 (GS-As-PC2) and As bound to PC3 (As-PC3), in exudates of As-treated lupin. Vanadate inhibited As-PC exudation, while BSO inhibited both the synthesis and exudation of As-PC complexes. These results demonstrate a role of GSH-derivatives and PC exudation in lupin arsenic tolerance and reveal As-PC exudation as a new potential mechanism contributing to active arsenic efflux in plants. Overall, this study uncovers insight into rhizosphere arsenic detoxification with potential to help mitigate pollution and reduce arsenic accumulation in crops.

Thermal properties of treatment wetlands operated under freezing conditions.

The use of treatment wetlands (TWs) presents particular challenges in regions with sub-zero winter temperatures, due to reduced biological activity and risk of pipe breakage or clogging due to freezing. We studied the vertical temperature distribution in four pilot-scale TWs exposed to winter temperatures in order to determine the impact of operational system parameters and the role of insulation on heat conservation inside the filtering bed. The overall temperature pattern was similar in all wetlands, with a trend of increasing temperature from the surface toward the bottom during the cold season. No freezing was detected in the wetlands despite average daily temperatures as low as -20 °C. Influent water temperature and hydraulic loading had a stronger influence on TW temperatures in winter than air temperature. The vertical distribution of temperatures in TWs is more sensitive to hydraulic loading variation in the percolating operating condition than in the saturated flow with forced aeration configuration. Our results suggest that TW systems can remain operational under cold winter conditions provided the surface is properly insulated by vegetation, mulch and/or snow.

Phytochelatin and coumarin enrichment in root exudates of arsenic-treated white lupin.

Soil contamination with toxic metalloids, such as arsenic, can represent a substantial human health and environmental risk. Some plants are thought to tolerate soil toxicity using root exudation, however, the nature of this response to arsenic remains largely unknown. Here, white lupin plants were exposed to arsenic in a semi-hydroponic system and their exudates were profiled using untargeted liquid chromatography-tandem mass spectrometry. Arsenic concentrations up to 1 ppm were tolerated and led to the accumulation of 12.9 µg As g-1 dry weight (DW) and 411 µg As g-1 DW in above-ground and belowground tissues, respectively. From 193 exuded metabolites, 34 were significantly differentially abundant due to 1 ppm arsenic, including depletion of glutathione disulphide and enrichment of phytochelatins and coumarins. Significant enrichment of phytochelatins in exudates of arsenic-treated plants was further confirmed using exudate sampling with strict root exclusion. The chemical tolerance toolkit in white lupin included nutrient acquisition metabolites as well as phytochelatins, the major intracellular metal-binding detoxification oligopeptides which have not been previously reported as having an extracellular role. These findings highlight the value of untargeted metabolite profiling approaches to reveal the unexpected and inform strategies to mitigate anthropogenic pollution in soils around the world.

Evaluation of long-term phosphorus uptake by Schoenoplectus californicus and Phragmites australis plants in pilot-scale constructed wetlands.

The aim of this study was to evaluate long-term phosphorus (P) retention in a pilot-scale system made of four horizontal subsurface flow (HSSF) constructed wetlands for wastewater treatment. Each wetland had an area of 4.5 m2 and was operated for nearly 8 years (2833 days). Two wetlands with Schoenoplectus californicus (HSSF-Sch) and the other two with Phragmites australis (HSSF-Phr) were planted. The P removal efficiency was 18% for both types of HSSF wetlands. The primary factors that correlated with long-term P retention efficiency in HSSF were phosphorus loading rate (PLR), hydraulic loading rate (HLR) and dissolved oxygen (DO). Average biomass production of HSSF-Phr and HSSF-Sch was 4.8 and 12.1 kg dry weight (DW)/m2, respectively. The P uptake by the plant increased over the years of operation from 1.8 gP/m2 to 7.1 gP/m2 for Phragmites and from 3.2 to 7.4 gP/m2 for Schoenoplectus over the same periods. Moreover, the warm season (S/Sm) was more efficient reaching 14% P uptake than the cold season (F/W) with 9%. These results suggest that both plants' P retention capacity in HSSF systems represents a sustainable treatment in the long term.Novelty statement Long-term (8 years) phosphorus uptake by Schoenoplectus californicus and Phragmites australis and retention in pilot-scale constructed wetlands are evaluated. Schoenoplectus californicus is an uncommon species that has been less studied for phosphorus uptake compared to Phragmites australis, a globally known species in constructed wetlands. Moreover, some studies evaluating the performance of constructed wetland systems for domestic wastewater treatment are usually limited in time (1-3 years). Therefore, this long-term study demonstrates that the plant plays an important role in phosphorus retention, especially the species Schoenoplectus californicus. So, the phosphorus uptake by plants can contribute between 9 and 14% of the phosphorus load of constructed wetland systems in early years of operation.

Co-planting of Salix interior and Trifolium pratense for phytoremediation of trace elements from wood preservative contaminated soil.

Phytoextraction potential of a co-planting system was evaluated using a shrub and an herbaceous species and compared with monocultures. A greenhouse experiment with Salix interior and Trifolium pratense grown in combination or alone was conducted for 120 days in soil either uncontaminated or contaminated with wood preservatives containing mixed chromated copper arsenate and pentachlorophenol (PCP). The results showed that the plant species produced similar amounts of dry biomass per pot in monoculture and co-planting, whether growing in contaminated or uncontaminated soil. Arsenic (As), chromium (Cr) and copper (Cu) concentrations in root tissue of S. interior increased 8.6%, 65.9% and 4.5%, respectively, in co-planting compared to its monoculture. T. pratense had superior concentration of As (14% higher) in root tissue when co-planted. However, the higher trace elements concentrations in the plant tissues did not translate into measurable differences in total trace element removal per pot, except for As. The bioconcentration factor for Cu and As was high in the belowground portions of the plants in co-planting. PCP levels in the soil decreased to values near the limit of detection in all treatments. These results suggest that co-planting S. interior with T. pratense could lead to higher phytoextraction potential than monoculture.

Plant diversity effect on water quality in wetlands: a meta-analysis based on experimental systems.

The ecological literature reports little empirical evidence from biodiversity-ecosystem functioning (BEF) experiments in wetland systems, even though wetlands are widely known for their water filtering capacity. Experiments comparing the effect of plant monocultures and mixtures on water quality to improve pollutant removal efficiency in treatment wetlands share the characteristics of classical BEF experiments, and so could provide insights for wetland management. To add to our understanding of BEF relationships in wetlands, we evaluated plant diversity effects on water purification through a meta-analysis of freshwater experimental wetlands comparing monocultures to mixtures. We found 28 studies that matched our criteria for BEF analysis, for a total of 561 diversity effects on pollutant removal. Overall, the meta-analysis shows no significant effect of plant richness on removal of total suspended solids, but a positive effect on chemical oxygen demand and total nitrogen removal, and a marginal effect on phosphorus removal. Thus, the results of this meta-analysis are consistent with reports of an overall positive biodiversity effect on ecosystem properties. An analysis of moderator variables shows that the experimental context (size of the experimental units, nutrient load, duration of the experiment) does not explain much of the residual variance. For pollutants that benefit from a positive plant richness effects on removal, mixtures do not perform better than the best monoculture. We found no evidence that plant richness effects are due to functional complementarity among species rather than to the presence of particularly efficient species. Complementarity effects may be less prevalent in highly productive, nutrient-rich wetlands, compared to nutrient-limited environments such as natural grasslands. Although findings must be confirmed by long-term field experiments under natural conditions, result from experimental wetland systems may contribute to a better understanding of biodiversity effect on ecosystem functions in wetlands, in addition to guide practices in natural wetland restoration and the use of constructed wetlands for water treatment.

Establishment and potential use of woody species in treatment wetlands.

Plant species selection is an important criterion for improving treatment wetland performance. The aim of this work was to evaluate removal efficiency and potential uses of woody species in treatment wetlands during the establishment year. Plant development, removal efficiency and evapotranspiration rate of five woody species (Salix interior, Salix miyabeana, Sambucus canadensis, Myrica gale, Acer saccharinum) and four herbaceous taxa typically used in treatment wetlands (Typha angustifolia, Phragmites australis australis, Phragmites australis americanus, Phalaris arundinacea) were compared in a mesocosm-scale study during one growing season. Woody species showed significantly slower growth, but displayed several characteristics of interest for treatment wetland applications: good adaptation to wetlands conditions; high organic matter removal (76-88%); high nutrient accumulation in tissues and high evapotranspiration capacity. During the establishment year, herbaceous species showed greater biomass development (above- and belowground parts), higher evapotranspiration rate (>3.84 L m-2 d-1 compared to <3.23 L m-2 d-1 for woody species) and overall pollutant removal efficiency. These characteristics confirm the high efficiency of treatment wetlands planted with herbaceous species even in the first growing season. However, given their greater potential biomass development, woody species could represent an excellent alternative for improving treatment wetlands long-term performance.

Willows for environmental projects: A literature review of results on evapotranspiration rate and its driving factors across the genus Salix.

Willows are increasingly used for a wide range of environmental projects, including biomass production, leachate treatment, riparian buffers and treatment wetlands. Evapotranspiration (ET), assumed to be high for most willow species used in environmental projects, affects hydrological cycles and is of key interest for project managers working with willows. Here, we present a comprehensive review of ET rates provided in the literature for the genus Salix. We aim to summarize current knowledge of willow ET and analyze its variability depending on context. We compiled and analyzed data from 57 studies, covering 16 countries, 19 willow species and dozens of cultivars. We found a mean reported ET rate of 4.6 ±â€¯4.2 mm/d, with minimum and maximum values of 0.7 and 22.7 mm/d respectively. Although results reported here varied significantly between some species, overall interspecific standard deviation (±3.6 mm/d) was similar to intraspecific variation (±3.3 mm/d) calculated for S. viminalis, suggesting a greater influence of the growing context on ET than species identity. In terms of environmental and management variables, water supply, fertilization and contamination were identified as driving factors of ET across willow species. Effects of root age, experimental context, planting density and soil type were more nuanced. Our findings provide synthetic data regarding willow ET. We encourage practitioners who use ET data from the literature to be aware of the main drivers of ET and to consider the influence of the experimental aspects of a study in order to interpret data accurately and improve project planning.

Screening Sensitivity According to Breast Cancer Location.

PURPOSE: To examine the relation between breast cancer location and screening mammogram sensitivity, and assess whether this association is modified by body mass index (BMI) or breast density. METHODS: This study is based on all interval cancers (n = 481) and a random sample of screen-detected cancers (n = 481) diagnosed in Quebec Breast Cancer Screening Program participants in 2007. Film-screening mammograms, diagnostic mammograms, and ultrasound reports (when available) were requested for these cases. The breast cancer was then localised in mediolateral oblique (MLO) and craniocaudal (CC) projections of the breast by 1 experienced radiologist. The association between cancer location and screening sensitivity was assessed by logistic regression. Adjusted sensitivity and sensitivity ratios were obtained by marginal standardisation. RESULTS: A total of 369 screen-detected and 268 interval cancers could be localised in MLO and/or CC projections. The 2-year sensitivity reached 68%. Overall, sensitivity was not statistically associated with location of the cancer. However, sensitivity seems lower in MLO posterior inferior area for women with BMI ≥ 25 kg/m2 compared to sensitivity in central area for women with lower BMI (adjusted sensitivity ratio: 0.58, 95% confidence interval [CI]: 0.17-0.98). Lower sensitivity was also observed in subareolar areas for women with breast density ≥ 50% compared to the central areas for women with lower breast density (for MLO and CC projections, adjusted sensitivity ratio and 95% CI of, respectively, 0.54 [0.13-0.96] and 0.46 [0.01-0.93]). CONCLUSIONS: Screening sensitivity seems lower in MLO posterior inferior area in women with higher BMI and in subareolar areas in women with higher breast density. When interpreting screening mammograms, radiologists need to pay special attention to these areas.

Plant growth and nutrient uptake in treatment wetlands for water with low pollutant concentration.

The objective of this study was to determine how macrophytes commonly used in treatment wetlands (TWs) respond to water with low pollutant concentration. We measured pollutant removal efficiency and compared growth and nutrient uptake of five macrophytes in demonstration scale units (volume >40 m3) irrigated by water with pollutant concentrations representative of average urban stormwater quality. All species showed a strong productivity gradient along the beds, starting with high biomass - high density near the inlet, then decreasing progressively with distance. Cyperus was by far the most productive species. Phragmites and Thalia had higher biomass in the first few metres of the beds than Typha and Arundo. In terms of pollutant removal, decreasing plant growth may be interpreted as indicative of high efficiency when caused by nutrient depletion. Differences in aboveground biomass between species did not translate into measurable differences in removal efficiency at the outlet. Although Phragmites australis is the species most commonly used in TWs, under the low nutrient load, Cyperus had twice its biomass, and higher N and P uptake. These results highlight the importance of considering wastewater characteristics when selecting macrophyte species for TWs.

Mammography Clinical Image Quality and the False Positive Rate in a Canadian Breast Cancer Screening Program.

PURPOSE: The study sought to determine if mammography quality is associated with the false positive (FP) rate in the Quebec breast cancer screening program in 2004 and 2005. METHODS: Mammography quality of a random sample of screen-film mammograms was evaluated by an expert radiologist following the criteria of the Canadian Association of Radiologists. For each screening examination, scores ranging from 1 (poor quality) to 5 (excellent quality) were attributed for positioning, compression, contrast, exposure level, sharpness, and artifacts. A final overall quality score (lower or higher) was also given. Poisson regression models with robust estimation of variance and adjusted for potential confounding factors were used to assess associations of mammography quality with the FP rate. RESULTS: Among 1,209 women without cancer, there were 104 (8.6%) FPs. Lower overall mammography quality is associated with an increase in the FP rate (risk ratio [RR], 1.4; 95% confidence interval [CI], 1.0-2.1; P = .07) but this increase was not statistically significant. Artifacts were associated with an increase in the FP rate (RR, 2.1; 95% CI, 1.3-3.3; P = .01) whereas lower quality of exposure level was related to a reduction of the FP rate (RR, 0.4; 95% CI, 0.1-1.0; P = .01). Lower quality scores for all other quality attributes were related to a nonstatistically significant increase in the FP rate of 10%-30%. CONCLUSIONS: Artifacts can have a substantial effect on the FP rate. The effect of overall mammography quality on the FP rate may also be substantial and needs to be clarified.

Clinical Image Quality and Sensitivity in an Organized Mammography Screening Program.

PURPOSE: The study sought to examine the association between clinical image quality of mammograms and screening sensitivity. METHODS: Four radiologists evaluated the clinical image quality of 374 invasive screen-detected cancers and 356 invasive interval breast cancers for which quality evaluation of screening mammograms could be assessed from cancers diagnosed among participants in the Quebec Breast Cancer Screening Program in 2007. Quality evaluation was based on the Canadian Association of Radiologists accreditation criteria, which are similar to those of the American College of Radiology. The association between clinical quality and screening sensitivity was assessed by logistic regression. Adjusted sensitivity and adjusted sensitivity ratios were obtained through marginal standardization. No institutional review board approval was required. RESULTS: A proportion of 28% (206 of 730) of screening mammograms had lower overall quality for the majority of assessments. Positioning was the quality attribute that was the most frequently deficient. The 2-year screening sensitivity reached 68%. Sensitivity of screening was not statistically associated with the overall quality (ratio of 2-year sensitivity = 1.03; 95% confidence interval: 0.93-1.15) or with any quality attributes (positioning, exposure, compression, sharpness, artifacts, contrast). Results were similar for the 1-year sensitivity. CONCLUSIONS: Although not all mammograms in the Quebec screening program met the optimum quality required by the Canadian Association of Radiologists or American College of Radiology accreditation, the screening mammograms produced in this population-based organized screening program reached a high enough level of quality so that the remaining variation in quality is too little to impair screening sensitivity.

Standard Period Life Table Used to Compute the Life Expectancy of Diseased Subpopulations: More Confusing Than Helpful.

Life expectancy (LE) based on a period life table (PLT) traditionally serves as a general population summary metric. It is, however, becoming more frequently reported for chronically afflicted subpopulations. In general populations, there is always an obvious real cohort sharing the hypothetical PLT cohort characteristics, and the LE estimate is intuitively understood as that real cohort mean survival time, assuming constancy of death risks. In diseased subpopulations, the correspondence between the hypothetical cohort and a real cohort is not straightforward. Furthermore, the excess mortality of chronic diseases usually changes according to age at onset and time since onset. The standard PLT method does not allow for proper control of these issues, so the LE estimate can only be deemed valid under specific assumptions. Without clear statements about the real cohort to whom the estimate is intended and the assumptions allowing disregard of the effect of age at onset and time since onset, LEs of afflicted subpopulations computed with the PLT are only abstract numbers summarizing mortality rates. If called "life expectancy," they can be seriously misleading. The same applies to health-adjusted LE.

Light acclimation strategies change from summer green to spring ephemeral as wild-leek plants age.

PREMISE OF THE STUDY: Spring-ephemeral forest-herbs emerge early to take advantage of the high-light conditions preceding canopy closure; they complete their life cycle in a few weeks, then senesce as the tree canopy closes. Summer greens acclimate their leaves to shade and thus manage to maintain a net carbon gain throughout summer. Differences in phenology among life stages within a species have been reported in tree saplings, whose leaf activity may extend beyond the period of shade conditions caused by mature trees. Similar phenological acclimation has seldom been studied in forest herbs. METHODS: We compared wild-leek bulb growth and leaf phenology among plants from seedling to maturity and from under 4 to 60% natural light availability. We also compared leaf chlorophyll content and chl a/b ratio among seedlings and adult plants in a natural population as an indicator of photosynthetic capacity and acclimation to light environment. KEY RESULTS: Overall, younger plants senesced later than mature ones. Increasing light availability delayed senescence in mature plants, while hastening seedling senescence. In natural populations, only seedlings acclimated to the natural reduction in light availability through time. CONCLUSIONS: Wild-leek seedlings exhibit a summer-green phenology, whereas mature plants behave as true spring ephemerals. Growth appears to be more source-limited in seedlings than in mature plants. This modulation of phenological strategy, if confirmed in other species, would require a review of the current classification of species as either spring ephemerals, summer greens, wintergreens, or evergreens.

Detection Rate, Recall Rate, and Positive Predictive Value of Digital Compared to Screen-Film Mammography in the Quebec Population-Based Breast Cancer Screening Program.

PURPOSE: The study sought to compare performance indicators of computed radiography (CR) using different plate readers, digital direct radiography (DR), and screen-film mammography (SFM) in a population-based screening program. METHODS: This analysis involved women 50-69 years of age who participated in the breast screening program of Quebec (Canada) and who had screening mammogram between January 1, 2007, and September 30, 2012. The detection rate, recall rate, and positive predictive value of CR (n = 672,125 mammograms) and DR (n = 60,023) were compared to SFM (n = 782,894) using mixed-effect logistic regression, adjusting for potential confounders. No institutional review board approval was required. RESULTS: CR was not associated with change in cancer detection rate (odds ratio [OR]: 0.95; 95% confidence interval [CI]: 0.88-1.03), but with a small increase in recall rate (OR: 1.03; 95% CI: 1.01-1.06) compared to SFM. The association of CR with recall rate varies with the CR plate reader manufacturer (P < .0001). DR was not associated with change in detection rate (OR: 1.06; 95% CI: 0.89-1.25), but with an increase in the recall rate (OR: 1.25; 95% CI: 1.19-1.30) compared to SFM. CONCLUSIONS: In our screening program, digital mammograms gave detection rates equivalent to those of SFM, but with an increase of recall rate, particularly for DR. If this situation persists, the adoption of DR may increase the adverse effects of screening with little or no benefit for women.

Frequency and Determinants of a Short-Interval Follow-up Recommendation After an Abnormal Screening Mammogram.

PURPOSE: After imaging assessment of an abnormal screening mammogram, a follow-up examination 6 months later is recommended to some women. Our aim was to identify which characteristics of lesions, women, and physicians are associated to such short-interval follow-up recommendation in the Quebec Breast Cancer Screening Program. METHODS: Between 1998 and 2008, 1,839,396 screening mammograms were performed and a total of 114,781 abnormal screens were assessed by imaging only. Multivariate analysis was done with multilevel Poisson regression models with robust variance and generalized linear mixed models. RESULTS: A short-interval follow-up was recommended in 26.7% of assessments with imaging only, representing 2.3% of all screens. Case-mix adjusted proportion of short-interval follow-up recommendations varied substantially across physicians (range: 4%-64%). Radiologists with high recall rates (≥15%) had a high proportion of short-interval follow-up recommendation (risk ratio: 1.82; 95% confidence interval: 1.35-2.45) compared to radiologists with low recall rates (<5%). The adjusted proportion of short-interval follow-up was high (22.8%) even when a previous mammogram was usually available. CONCLUSIONS: Short-interval follow-up recommendation at assessment is frequent in this Canadian screening program, even when a previous mammogram is available. Characteristics related to radiologists appear to be key determinants of short-interval follow-up recommendation, rather than characteristics of lesions or patient mix. Given that it can cause anxiety to women and adds pressure on the health system, it appears important to record and report short-interval follow-up and to identify ways to reduce its frequency. Short-interval follow-up recommendations should be considered when assessing the burden of mammography screening.

Interactions between abiotic constraint, propagule pressure, and biotic resistance regulate plant invasion.

With multiple species introductions and rapid global changes, there is a need for comprehensive invasion models that can predict community responses. Evidence suggests that abiotic constraint, propagule pressure, and biotic resistance of resident species each determine plant invasion success, yet their interactions are rarely tested. To understand these interactions, we conducted community assembly experiments simulating situations in which seeds of the invasive grass species Phragmites australis (Poaceae) land on bare soil along with seeds of resident wetland plant species. We used structural equation models to measure both direct abiotic constraint (here moist vs. flooded conditions) on invasion success and indirect constraint on the abundance and, therefore, biotic resistance of resident plant species. We also evaluated how propagule supply of P. australis interacts with the biotic resistance of resident species during invasion. We observed that flooding always directly reduced invasion success but had a synergistic or antagonistic effect on biotic resistance depending on the resident species involved. Biotic resistance of the most diverse resident species mixture remained strong even when abiotic conditions changed. Biotic resistance was also extremely effective under low propagule pressure of the invader. Moreover, the presence of a dense resident plant cover appeared to lower the threshold at which invasion success became stable even when propagule supply increased. Our study not only provides an analytical framework to quantify the effect of multiple interactions relevant to community assembly and species invasion, but it also proposes guidelines for innovative invasion management strategies based on a sound understanding of ecological processes.

Smoking at time of diagnosis and breast cancer-specific survival: new findings and systematic review with meta-analysis.

INTRODUCTION: In women with breast cancer who smoke, it is unclear whether smoking could impair their survival from the disease. METHODS: We examined the relation of smoking at diagnosis to breast cancer-specific and overall survival among 5,892 women with invasive breast cancer treated in one Canadian center (1987 to 2008). Women were classified as never, former or current smokers. Current smokers were further classified according to total, intensity and duration of smoking. Deaths were identified through linkage to population mortality data. Cox proportional-hazards multivariate models were used. A systematic review with meta-analysis combines new findings with published results. RESULTS: Compared with never smokers, current smokers at diagnosis had a slightly, but not statistically significant, higher breast cancer-specific mortality (hazard ratio = 1.15, 95% confidence interval (CI): 0.97 to 1.37). Among current smokers, breast cancer-specific mortality increased with total exposure to, intensity and duration of smoking (all Ptrend <0.05). Compared to never smokers, breast cancer-specific mortality was 32 to 56% higher among heavy smokers (more than 30 pack years of smoking, more than 20 cigarettes per day or more than 30 years of smoking). Smoking at diagnosis was associated with an increased all-cause mortality rate. A meta-analysis of all studies showed a statistically significant, 33% increased mortality from breast cancer in women with breast cancer who are smokers at diagnosis compared to never smokers (hazard ratio = 1.33, 95% CI: 1.12 to 1.58). CONCLUSIONS: Available evidence to date indicates that smoking at diagnosis is associated with a reduction of both overall and breast cancer-specific survival. Studies of the effect of smoking cessation after diagnosis on breast cancer-specific outcomes are needed.

Clinical image quality in daily practice of breast cancer mammography screening.

OBJECTIVE: To assess the quality of screening mammograms performed in daily practice in the Quebec Breast Cancer Screening Program. SUBJECTS AND METHODS: Clinical image quality of a random subsample of 197 screening mammograms performed in 2004-2005 was independently evaluated by 2 radiologists based on the criteria by Canadian Association of Radiologists (CAR). When disagreement occurred for overall judgement or positioning score, the mammograms were reviewed by a third radiologist. Cohen's kappas for interrater agreement were computed. Multivariable robust Poisson regression models were used to study associations of overall quality and positioning with body mass index (BMI) and breast density. RESULTS: The CAR criteria were not satisfied for 49.7% of the mammograms. Positioning was the quality attribute most often deficient, with 37.2% of mammograms failing positioning. Interrater agreement ranged from slight (kappa = 0.02 for compression and sharpness) to fair (kappa = 0.30 for exposure). For overall quality, women with a BMI ≥ 30 kg/m(2) had a failure proportion of 67.5% compared with 34.9% for women with a BMI<25 kg/m(2) (risk ratio 2.1 [95% confidence interval, 1.5-3.0]). For positioning, women with a BMI ≥ 30 kg/m(2) had a failure proportion of 53.8% compared with 27.9% for women with a BMI < 25 kg/m(2) (risk ratio 1.9 [95% confidence interval, 1.2-3.1]). Effects of breast density on image quality differed among radiologists. CONCLUSION: Despite measures to ensure high-quality imaging, including CAR accreditation, approximately half of this random sample of screening mammograms failed the CAR quality standards. It would be important to define quality targets for screening mammograms carried out in daily practice to interpret such observations.