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1.
Medicine (Baltimore) ; 98(39): e17061, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574804

RESUMO

To study the imaging and clinical features of breast sclerosing adenosis (SA), and to enhance the recognition of this disease, as well as to help the clinic to give a correct diagnosis.Imaging findings were retrospectively reviewed in 47 women with SA lesions confirmed by pathology (including 39 cases of mammography, 40 cases of ultrasound [US], and 34 cases magnetic resonance imaging [MRI]).Of 47 patients confirmed with SA, 18 cases were pure SA, and 29 cases coexist with other proliferative lesions and malignancies; the maximum diameter of SA lesions was 0.5 to 3.5 cm with an average of 1.6 cm. On the mammogram of 39 SA cases, the percentage of architectural distortion, calcifications, mass/nodular, asymmetric density, and mass combining with calcifications were 30.8%, 23.1%, 17.9%, 12.8%, and 7.7%, respectively; and 3 cases had no abnormal findings. On the sonogram (excluding 5 normal finding cases), the majority of lesions showed regular shaped (57.1%), well defined margined (60.0%), heterogenous low echoed (71.4%) nodulus. 85.3% lesions showed high signal on T2-weighted images, and all lesions were enhanced markedly, including 82.4% lesions appearing mass-like enhancement (17 star-shaped enhanced masses included); and the percentage of the time-signal intensity curve in type 1, type 2, and type 3 were 52.9%, 41.2%, and 5.9%, respectively. If the category breast imaging-reporting and data system ≥4b was considered to be a suspicious malignant lesion, the misdiagnostic rates of mammography, US, and MRI would be 17.9%, 17.5%, and 35.3%, respectively.The SA lesions are small and can occur with other diseases histologically. The majority of SA lesions showed distortion or calcifications on mammograms, low echo-level nodules with heterogenous echo on US and mass-like lesion with or without star shape on enhanced MRI.


Assuntos
Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/patologia , Mama/diagnóstico por imagem , Mama/patologia , Adulto , Idoso , Calcinose/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Mamografia , Pessoa de Meia-Idade , Estudos Retrospectivos , Esclerose/diagnóstico por imagem , Ultrassonografia Mamária
2.
Isr Med Assoc J ; 21(9): 612-614, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31542907

RESUMO

BACKGROUND: Young women concerned about a breast cancer diagnosis will visit breast care centers and request breast cancer screening, including imaging studies, on their initial visit. OBJECTIVES: To explore the role of breast examination and breast ultrasound in self-referred asymptomatic women under the age of 40 years. METHODS: We identified 3524 women under the age of 40 at our medical clinic from 1 January 2010 until 1 June 2014. Of this group, 164 women with above average breast cancer risk were excluded and 233 were excluded because of breast complaints. Of 3127 women, 220 underwent breast ultrasound following the initial visit to the clinic and formed the study group. RESULTS: Of 220 women evaluated with ultrasound, 68 had prior positive clinical findings. Of this group 8 women had no sonographic findings, and in the remaining 60, a total of 30 simple cysts, 15 fibroadenomas, and 15 suspicious solid masses were identified. One infiltrating ductal carcinoma and one ductal carcinoma in situ were found in a biopsy. The remaining 152 of the 220 total women who underwent breast ultrasound without showing prior physical findings did not require follow-up. CONCLUSIONS: In the absence of clinical findings during physical breast examination, the addition of breast ultrasonography does not provide additional information to supplement the physical examination in self-referred women under age 40 who do not have any major risk factors for developing breast cancer.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/epidemiologia , Mamografia/estatística & dados numéricos , Ultrassonografia Mamária/estatística & dados numéricos , Adulto , Mama/diagnóstico por imagem , Feminino , Humanos , Israel/epidemiologia , Exame Físico/estatística & dados numéricos , Risco , Adulto Jovem
3.
Pan Afr Med J ; 33: 139, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31558937

RESUMO

Fibroadenomas are the most common breast disease that occurs usually in young. The coexistence of an invasive ductal carcinoma and a fibroadenoma in the ipsilateral breast is extremely rare. We present the case of a 52 years woman, presented to us for an upper-outer breast lump. Breast imaging concluded to tow contiguous lesions, one of them was suspicious. She had a conservative surgery. Histology concluded to a fibroadenoma and an invasive ductal carcinoma.


Assuntos
Neoplasias da Mama/diagnóstico , Carcinoma Ductal de Mama/diagnóstico , Fibroadenoma/diagnóstico , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/cirurgia , Feminino , Fibroadenoma/patologia , Fibroadenoma/cirurgia , Humanos , Mamografia/métodos , Pessoa de Meia-Idade
4.
Pan Afr Med J ; 33: 143, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31558941

RESUMO

Primary epidermoid carcinoma (PEC) also known as squamous cell carcinoma of the breast is a rare tumor accounting for 0.1% to 2% of all breast cancers. It is a metaplastic carcinoma; its histogenesis and prognosis are controversial as well as its clinical and mammographic appearances which are not characteristic compared to other cancers. PEC is characterized by a rapid evolution and treatment is not codified. The purpose of this study is to report the clinical and evolutionary features of a new case of PEC and to conduct a literature review.


Assuntos
Neoplasias da Mama/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Mamografia/métodos , Idoso , Neoplasias da Mama/patologia , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Mauritânia , Prognóstico
5.
Rev Bras Epidemiol ; 22: e190045, 2019 Sep 02.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31482984

RESUMO

INTRODUCTION: The study assessed interobserver reliability in the classification of record pairs formed during probabilistic linkage of health-related databases, a key step in the methodology validation to be used in a larger on-going study on inequalities in the access to breast and cervical cancer control activities in Brazil (DAAC-SIS). METHODOLOGY: The RecLink software was used to link two databases of the Breast Cancer Control Information System (SISMAMA) in the state of Minas Gerais, Brazil: a reference database, which included 301 screening mammograms with probable benign diagnosis (BI-RADS 3 category) recorded in October 2010, and a database comprising 158,517 mammograms registered in 2011. Subsequently, the 215 pairs of records that were not assigned the maximum RecLink score were independently classified as being true or false by ten independent evaluators from four participating centers. RESULTS: The Kappa coefficient ranged from 0.87 to 1.00. Six evaluators were in perfect agreement with one or more evaluators from the other centers. The global Kappa was 0.96 (95% confidence interval - 95%CI 0.94 - 0.99). DISCUSSION: Assessment of interobserver reliability is key to ensuring the quality of the record linkage, and it should be routine practice in studies of this nature. The disclosure of such results contributes to transparency in the conduct of such studies and in the reporting of their findings. CONCLUSION: Interobserver reliability in this study was excellent, indicating satisfactory team consistency in the classification of record pairs.


Assuntos
Neoplasias da Mama/prevenção & controle , Sistemas de Informação em Saúde , Registro Médico Coordenado , Brasil , Bases de Dados Factuais , Feminino , Humanos , Mamografia , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Integração de Sistemas
6.
Anticancer Res ; 39(9): 4941-4945, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519599

RESUMO

AIM: This study describes the demographic, socioeconomic, and tumor-specific characteristics of patients who refuse breast cancer surgery. MATERIALS AND METHODS: This is a retrospective study of breast cancer patients from 2004-2015 captured by the National Cancer Data Base. Demographic, socioeconomic, and tumor-specific predictors were compared between patients who refused breast cancer surgery versus those who agreed to surgery, using bivariate and multivariate models. RESULTS: A total of 2,445,870 patients met the inclusion criteria. On multivariate analysis, black and Asian patients had higher odds of refusing surgical treatment compared to whites (OR=2.16, CI=2.05-2.28, p<0.001), (OR=1.58, CI=1.41-1.76, p<0.001), respectively. Moreover, patients with government insurance (OR=1.97, CI=1.86-2.09, p<0.001) and uninsured patients (OR=3.91, CI=3.50-4.36, p<0.001) were found to have higher odds of surgical treatment refusal when compared to patients with private insurance. CONCLUSION: Specific demographic and disease-specific characteristics are related to refusing potentially life-saving breast cancer surgery.


Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mamografia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Razão de Chances , Estudos Retrospectivos , Fatores Socioeconômicos , Avaliação de Sintomas , Recusa do Paciente ao Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
7.
Medicine (Baltimore) ; 98(37): e17082, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517829

RESUMO

To compare the accuracy of breast lesion size measurement of cone-beam breast-CT (CBBCT), digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM).Patients scheduled for mastectomy due to at least 1 malignant breast lesion were included. Mastectomy specimens were examined by CBBCT, DBT, FFDM, and histopathology.A total of 94 lesions (40 patients) were included. Histopathological analyses revealed 47 malignant, 6 high-risk, and 41 benign lesions. Mean histopathological lesion size was 20.8 mm (range 2-100). Mean absolute size deviation from histopathology was largest for FFDM (5.3 ±â€Š6.7 mm) and smallest for CBBCT 50 mA, high-resolution mode (4.3 ±â€Š6.7 mm). Differences between imaging modalities did not reach statistical significance (P = .85).All imaging methods tend to overestimate breast lesion size compared to histopathological gold standard. No significant differences were found regarding size measurements, although in tendency CBBCT showed better lesion detection and cT classification over FFDM.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Tomografia Computadorizada de Feixe Cônico , Mamografia , Idoso , Mama/diagnóstico por imagem , Mama/patologia , Mama/cirurgia , Neoplasias da Mama/cirurgia , Humanos , Interpretação de Imagem Assistida por Computador , Mamografia/métodos , Mastectomia , Estudos Prospectivos , Estudos Retrospectivos , Carga Tumoral
10.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 48(2): 186-192, 2019 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-31309757

RESUMO

OBJECTIVE: To evaluate the value of digital breast tomosynthesis (DBT) in diagnosis of dense breast lesions. METHODS: Clinical and pathological data of 163 patients (58 benign lesions, 122 malignant lesions, and 180 lesions in total) with breast lesions undergoing surgical treatment in Shaoxing Central Hospital from January 2017 to December 2018 were retrospectively analyzed. The lesions were classified into non-homogeneous dense gland type and extremely dense gland type according to BI-RADS creterion. Breast MRI and DBT examinations were performed before the surgery. ROC curve was generated and the diagnostic efficacy of two examination methods for dense breast lesions was evaluated with pathological results as the gold standard. The detection rate, diagnostic accuracy of benign and malignant breast lesions were compared between two methods using chi-square test. The accuracy of lesion size preoperatively evaluated by MRI and DBT was analyzed by Pearson correlation. RESULTS: The detection rate and diagnostic accuracy for benign breast lesions by MRI were higher than those by DBT (91.4% vs. 75.9%, χ2=5.098, P<0.05 and 89.7% vs. 67.2%, χ2=8.617, P<0.01). But there were no significant differences in detection rate and accuracy for malignant lesions by MRI and DBT (98.4% vs. 95.1%, χ2=2.068, P>0.05 and 94.3% vs. 91.8%, χ2=0.569, P>0.05). The areas under the ROC curves of MRI, DBT based on BI-RADS classification were 0.910 and 0.832, respectively (Z=1.860, P>0.05). The sensitivities of MRI, DBT to breast lesions were 93.3% and 86.7%, and the specificities were 68.3% and 79.1%. DBT and MRI measurements were positively correlated with pathological measurements (r=0.887 and 0.949, all P<0.01). CONCLUSIONS: DBT can effectively diagnose benign and malignant breast lesions under dense gland background, and it has similar diagnostic efficacy with MRI for breast malignant lesions.


Assuntos
Neoplasias da Mama , Mamografia , Feminino , Humanos , Imagem por Ressonância Magnética , Curva ROC , Estudos Retrospectivos
11.
Can Assoc Radiol J ; 70(3): 282-291, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31300313

RESUMO

PURPOSE: Our purpose was twofold. First, we sought to determine whether 2 orthogonal oriented views of excised breast cancer specimens could improve surgical margin assessment compared to a single unoriented view. Second, we sought to determine whether 3D tomosynthesis could improve surgical margin assessment compared to 2D mammography alone. MATERIALS AND METHODS: Forty-one consecutive specimens were prospectively imaged using 4 protocols: single view unoriented 2D image acquired on a specimen unit (1VSU), 2 orthogonal oriented 2D images acquired on the specimen unit (2VSU), 2 orthogonal oriented 2D images acquired on a mammogram unit (2V2DMU), and 2 orthogonal oriented 3D images acquired on the mammogram unit (2V3DMU). Three breast imagers randomly assessed surgical margin of the 41 specimens with each protocol. Surgical margin per histopathology was considered the gold standard. RESULTS: The average area under the curve (AUC) was 0.60 for 1VSU, 0.66 for 2VSU, 0.68 for 2V2DMU, and 0.60 for 2V3DMU. Comparing AUCs for 2VSU vs 1VSU by reader showed improved diagnostic accuracy using 2VSU; however, this difference was only statistically significant for reader 3 (0.73 vs 0.63, P = .0455). Comparing AUCs for 2V3DMU vs 2V2DMU by reader showed mixed results, with reader 1 demonstrating increased accuracy (0.72 vs 0.68, P = .5984), while readers 2 and 3 demonstrated decreased accuracy (0.50 vs 0.62, P = .1089 and 0.58 vs 0.75, P = .0269). CONCLUSIONS: 2VSU showed improved accuracy in surgical margin prediction compared to 1VSU, although this was not statistically significant for all readers. 3D tomosynthesis did not improve surgical margin assessment.


Assuntos
Neoplasias da Mama/cirurgia , Imagem Tridimensional/métodos , Mamografia/métodos , Margens de Excisão , Mastectomia Segmentar , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
12.
Cancer Imaging ; 19(1): 46, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269987

RESUMO

BACKGROUND: Mammography (MG) is highly sensitive for detecting microcalcifications, but has low specificity. This study investigates whether establishing a preoperative nomogram including ultrasonographic findings can help predict the likelihood of malignancy in patients with mammographic microcalcification. METHODS: Between May 2012 and January 2017, 475 patients with suspicious microcalcifications detected on MG underwent ultrasonography (US). The χ2 test was used to screen risk factors among the variables. Then, a multivariate logistic regression analysis was performed to identify independent predictors of malignant microcalcifications. A mammographic nomogram (M nomogram) and mammographic-ultrasonographic nomogram (M-U nomogram) were established based on multivariate logistic regression models. The discriminatory ability and clinical utility of both nomograms were compared by the receiver operating characteristics curve and decision curve analysis. The calibration ability was evaluated using a calibration curve. RESULTS: Among the cases, 68.2% (324/475) were pathologically diagnosed as breast cancer and 31.8% (151/475) were benign lesions. Based on multivariate logistic regression analysis, age, clinical manifestation, morphology and distribution of microcalcifications on MG and lesions associated with microcalcifications on US were confirmed as independent predictors of malignant microcalcifications. In terms of discrimination ability, the C-index of the M-U nomogram was significantly higher than that of the M nomogram (0.917 vs 0.897, p = 0.006). The bias-corrected curve was close to the ideal line in the calibration curve. Decision curve analysis suggested that the M-U nomogram was superior to M nomogram. CONCLUSIONS: Combining mammographic parameters with ultrasonographic findings in a nomogram provided better performance than an M nomogram alone, especially for dense breasts, which suggests the value of ultrasonographic finding for individualized prediction of malignancy in patients with microcalcifications.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Mamografia/métodos , Ultrassonografia/métodos , Adulto , Idoso , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Calcinose/complicações , Calcinose/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Nomogramas , Período Pré-Operatório , Sensibilidade e Especificidade
13.
Br J Radiol ; 92(1102): 20190057, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31287719

RESUMO

Breast cancer is the most common cancer among females worldwide and large volumes of breast images are produced and interpreted annually. As long as radiologists interpret these images, the diagnostic accuracy will be limited by human factors and both false-positive and false-negative errors might occur. By understanding visual search in breast images, we may be able to identify causes of diagnostic errors, find ways to reduce them, and also provide a better education to radiology residents. Many visual search studies in breast radiology have been devoted to mammography. These studies showed that 70% of missed lesions on mammograms attract radiologists' visual attention and that a plethora of different reasons, such as satisfaction of search, incorrect background sampling, and incorrect first impression can cause diagnostic errors in the interpretation of mammograms. Recently, highly accurate tools, which rely on both eye-tracking data and the content of the mammogram, have been proposed to provide feedback to the radiologists. Improving these tools and determining the optimal pathway to integrate them in the radiology workflow could be a possible line of future research. Moreover, in the past few years deep learning has led to improving diagnostic accuracy of computerized diagnostic tools and visual search studies will be required to understand how radiologists interact with the prompts from these tools, and to identify the best way to utilize them. Visual search in other breast imaging modalities, such as breast ultrasound and digital breast tomosynthesis, have so far received less attention, probably due to associated complexities of eye-tracking monitoring and analysing the data. For example, in digital breast tomosynthesis, scrolling through the image results in longer trials, adds a new factor to the study's complexity and makes calculation of gaze parameters more difficult. However, considering the wide utilization of three-dimensional imaging modalities, more visual search studies involving reading stack-view examinations are required in the future. To conclude, in the past few decades visual search studies provided extensive understanding about underlying reasons for diagnostic errors in breast radiology and characterized differences between experts' and novices' visual search patterns. Further visual search studies are required to investigate radiologists' interaction with relatively newer imaging modalities and artificial intelligence tools.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Mama/diagnóstico por imagem , Erros de Diagnóstico , Reconhecimento Visual de Modelos/fisiologia , Radiologistas , Atenção/fisiologia , Aprendizado Profundo , Diagnóstico por Computador/métodos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Mamografia/métodos , Pesquisa , Ultrassonografia Mamária/métodos
14.
Br J Radiol ; 92(1102): 20190074, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31317763

RESUMO

OBJECTIVE: To identify the predictive factors of cancer invading into the nipple. METHODS: Patients with breast cancer undergoing mastectomy between May 2009 and March 2019 were reviewed retrospectively. Of these, those with breast cancer within 2 cm of the nipple areolar complex on ultrasonography were included in this study. Clinicopathological data of the primary tumor and imaging findings from mammography, ultrasonography, and MRI were compared between cases with and without nipple involvement by cancer. RESULTS: In total, 156 of the 821 patients identified were included in the analysis. Of them, 29 had nipple involvement by cancer. Univariate analysis revealed that the following imaging results were significantly associated with nipple involvement: perineural invasion, lymphovascular invasion, lymph node metastasis; relation type between the tumor and the nipple on ultrasonography; periareolar skin thickening on mammography; and short tumor-nipple distance, continuous enhancement between the nipple and tumor, skin enhancement, and nipple enhancement on MRI. However, on multivariate logistic regression analysis, only invasion type of tumor on ultrasonography and nipple enhancement and short tumor-nipple distance on MRI were significantly correlated with nipple involvement by cancer. CONCLUSION: Imaging findings on preoperative mammography, ultrasonography and MRI are effective predictors for nipple involvement by cancer. ADVANCES IN KNOWLEDGE: Preoperative mammography, ultrasonography, and MRI help predict nipple involvement by breast cancer.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Imagem por Ressonância Magnética , Mamografia , Mamilos/diagnóstico por imagem , Ultrassonografia Mamária , Adulto , Análise de Variância , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/patologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Mamografia/métodos , Pessoa de Meia-Idade , Mamilos/patologia , Análise de Regressão , Estudos Retrospectivos , Ultrassonografia Mamária/métodos
15.
Artigo em Espanhol | PAHO-IRIS | ID: phr-51393

RESUMO

[RESUMEN]. Se presentan los resultados del Plan de calidad en mamografía del Programa Nacional del Cáncer de Mama del Instituto Nacional del Cáncer de la República Argentina, enfocado en mejorar la calidad de la mamografía en el sector público de salud e implementar el tamizaje de cáncer de mama por este método diagnóstico. El Plan se comenzó a ejecutar en 2011 con base en la premisa de que una mamografía de mala calidad impide el diagnóstico temprano del cáncer de mama. En ese momento, en Argentina existía poca conciencia sobre la importancia de los controles de calidad, y los continuos cambios en los niveles jerárquicos del sistema de salud tendían a obstaculizar el desarrollo organizado del programa. El Plan consistió en la revisión y el control de calidad de las instalaciones de mamografía, la capacitación de recursos humanos técnicos y médicos y la puesta en marcha de un sistema de acreditación de los servicios de mamografía por parte del Instituto Nacional del Cáncer. La percepción de la importancia de la calidad en el personal involucrado ha mejorado y se obtuvo un panorama general del estado de la mamografía a nivel nacional en cuanto a la calidad, la tecnología, la cantidad de equipos y las posibilidades de implementación del tamizaje. Se capacitó al personal técnico y médico mediante el uso de diferentes metodologías y se impulsó la unificación de la lectura mamográfica en las provincias intervinientes.


[ABSTRACT]. This paper presents results from the mammography quality plan of the National Breast Cancer Program at Argentina’s National Cancer Institute, which focused on improving mammography quality in the public healthcare sector and on using mammography to implement breast cancer screening. Plan implementation started in 2011, based on the premise that poor quality mammography impedes early diagnosis of breast cancer. At the time, there was little awareness in Argentina of the importance of quality control, and constant changes in lines of authority in the health system tended to hinder organized implementation of the program. The plan consisted of quality review and control of mammography facilities, training of technical and medical human resources, and implementation of an accreditation system for mammography services by the National Cancer Institute. Perception by involved personnel of the importance of quality improved; an overview was obtained of the state of mammography at the national level regarding quality, technology, quantity of equipment, and opportunities for implementation of screening; technical and medical personnel were trained using different methods; and standardization of mammography reading was promoted in the participating provinces.


[RESUMO]. São apresentados os resultados do Plano de qualidade em mamografia do Programa Nacional do Câncer de Mama do Instituto Nacional do Câncer da República Argentina, com o objetivo de melhorar a qualidade da mamografia na rede pública de saúde e implementar a prevenção do câncer de mama por este método diagnóstico. O Plano foi implementado em 2011 baseado na premissa de que a mamografia de má qualidade impede o diagnóstico precoce do câncer de mama. Havia, naquele momento na Argentina, pouca conscientização sobre a importância do controle de qualidade e as constantes mudanças na hierarquia do sistema de saúde eram um obstáculo ao desenvolvimento organizado do programa. O Plano compreendeu a avaliação e o controle de qualidade das instalações para mamografia, a capacitação do pessoal médico e técnico e a implantação de um sistema de credenciamento pelo Instituto Nacional do Câncer dos serviços de mamografia. Houve melhora na percepção da importância da qualidade entre o pessoal envolvido e se obteve um panorama geral da situação da mamografia ao nível nacional quanto à qualidade, recursos tecnológicos, volume de equipamentos e possibilidades de implementação do programa de prevenção. Foi realizada a capacitação do pessoal médico e técnico com o uso de diferentes metodologias e incentivada a uniformização da leitura mamográfica nas províncias consideradas.


Assuntos
Mamografia , Neoplasias da Mama , Garantia da Qualidade dos Cuidados de Saúde , Acreditação , Argentina , Mamografia , Neoplasias da Mama , Garantia da Qualidade dos Cuidados de Saúde , Acreditação , Neoplasias da Mama , Garantia da Qualidade dos Cuidados de Saúde , Acreditação
16.
Medicine (Baltimore) ; 98(24): e15869, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31192918

RESUMO

Higher trait optimism and/or lower cynical hostility are associated with healthier behaviors and lower risk of morbidity and mortality, yet their association with health care utilization has been understudied. Whether these psychological attitudes are associated with breast cancer screening behavior is unknown. To assess the association of optimism and cynical hostility with screening mammography in older women and whether sociodemographic factors acted as mediators of these relationships, we used Women's Health Initiative (WHI) observational cohort survey data linked to Medicare claims. The sample includes WHI participants without history of breast cancer who were enrolled in Medicare Parts A and B for ≥2 years from 2005-2010, and who completed WHI baseline attitudinal questionnaires (n = 48,291). We used survival modeling to examine whether screening frequency varied by psychological attitudes (measured at study baseline) after adjusting for sociodemographic characteristics, health conditions, and healthcare-related variables. Psychological attitudes included trait optimism (Life Orientation Test-Revised) and cynical hostility (Cook Medley subscale), which were self-reported at study baseline. Sociodemographic, health conditions, and healthcare variables were self-reported at baseline and updated through 2005 as available. Contrary to our hypotheses, repeated events survival models showed that women with the lowest optimism scores (i.e., more pessimistic tendencies) received 5% more frequent screenings after complete covariate adjustment (p < .01) compared to the most optimistic group, and showed no association between cynical hostility and frequency of screening mammograms. Sociodemographic factors did not appear to mediate the relationship between optimism and screenings. However, higher levels of education and higher levels of income were associated with more frequent screenings (both p < .01). We also found that results for optimism were primarily driven by women who were aged 75 or older after January 2009, when changes to clinical guidelines lead to uncertainty about risks and benefits of screening in this age group. The study demonstrated that lower optimism, higher education, and higher income were all associated with more frequent screening mammograms in this sample after repeated events survival modeling and covariate adjustment.


Assuntos
Mamografia/estatística & dados numéricos , Otimismo/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Idoso , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Revisão da Utilização de Seguros , Estudos Longitudinais , Medicare , Fatores Socioeconômicos , Estados Unidos , Saúde da Mulher
17.
Pol Merkur Lekarski ; 46(275): 195-204, 2019 May 27.
Artigo em Polonês | MEDLINE | ID: mdl-31152530

RESUMO

Breast cancer is the most common cancer in women. Family history of breast cancer, age at menarche, number of pregnancies and births, history of breast biopsies, use of hormone replacement therapy and time from the last menstrual period are the key events to note. In addition, a high percentage of cases has been demonstrated in women with a genetically conditioned cancer, i.e. mutations in genes BRCA1, BRCA2, syndromes of Li-Fraumeni, Cowden and Peutz-Jeghers. Over 90% of cases are local or regional when detected. The diagnostics approach consists of self-control, breast palpation by the doctor, breast imaging usually with ultrasound, mammography and magnetic resonance. To confirm the diagnosis, a fine-, core-needle or mammotome biopsy is performed. The final diagnosis is based on a wide panel of immunohistochemical and cytogenetic tests. Histological examination provides accurate assessment of the tumor type, grade, estrogen and progesterone hormone receptor status, HER2 overexpression and Ki67 proliferation index. The data makes possible to qualify to one of four groups of breast cancer biological subtypes, which allows individualized treatment of the patient.


Assuntos
Neoplasias da Mama , Biópsia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/genética , Feminino , Humanos , Mamografia , Mutação
20.
Radiology ; 292(3): 550-551, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31211632

Assuntos
Mama , Leitura , Mamografia
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