Mary E. Costanza

American Cancer Society Guidelines for Breast Cancer Screening: Update 2003

In 2003, the American Cancer Society updated its guidelines for early detection of breast cancer based on recommendations from a formal review of evidence and a recent workshop. The new screening recommendations address screening mammography, physical examination, screening older women and women with comorbid conditions, screening women at high risk, and new screening technologies.

Breast cancer screening by mammography: utilization and associated factors.

The status of mammography screening experience and factors related to utilization were examined in six towns serviced by physician staffs at five hospitals. Data were collected via random digit dial telephone interview of a probability sample of 1184 women, aged 45-75 years. The results showed that 55% of the women reported ever having had a mammogram. Of those who had ever had a mammogram, 21% reported that the mammogram in the past year was their first one. Of those women who are over 50 and had ever had a mammogram, 57% reported one in the past year. Analyses demonstrated that a combination of demographic factors, certain beliefs and knowledge, having a regular physician, social interaction and media exposure are independently related to ever having a mammogram, and to having one in the past year. Despite anecdotal and empirical evidence that the proportion of women ever having had a mammogram has substantially increased in the past several years, increasing utilization among older and lower-income women provides a challenge for public health.

Interval adherence to mammography screening guidelines

The objectives of this research were to document adherence to mammography screening guidelines among women over 50 years of age and to investigate factors related to adherence. Selected sociodemographic variables—personal breast health history, provider-related variables, and medical care utilization—were studied. Data were collected through a random digit dial telephone survey of 693 women from two geographic areas. While 48% had had a mammogram in the last year, only 20% reported at least two recent mammograms at yearly intervals. Adherence was significantly associated with having a higher income, being white, being 51 to 64 years old and having had breast symptoms and/or a family history of breast cancer. Additionally, women who had a regular physician, higher frequency of clinical breast examination, and a recent physician visit were more adherent. Women enrolled in Health Maintenance Organizations (HMOs) and/or covered by commercial plans were more adherent than women with no insurance or with entitlement coverage only. These relationships were generally maintained in multivariate analysis. While this study is consistent with others that demonstrate increasing adoption of mammographic screening, it also illustrates that the goal of regular screening according to guidelines has yet to be achieved.

5-Fluorouracil-associated cardiotoxicity

Cardiotoxicity manifested as myocardial ischemia is not generally recognized as a side effect of 5‐fluorouracil. However, there have been at least 35 cases reported since 1975. In only one of these cases was a somewhat detailed evaluation done to rule out underlying coronary disease. The case reported here of 5‐FU cardiotoxicity included an extensive cardiac evaluation to rule out underlying coronary disease and to assess spasm. The literature on 5‐FU cardiotoxicity is also reviewed, and its possible mechanisms are analyzed.

Changes in mammography use : economic, need, and service factors

OBJECTIVES The purpose of this study was to document changes in mammography use between 1987 and 1990 and assess the relationship of use to selected economic, need, and health system factors. METHODS Independent random-digit-dialed telephone surveys of women between 52 and 75 years of age were conducted. RESULTS Between 1987 and 1990, the proportion of women who had had a mammogram in the past year increased from 31% to 51%. Though income was significantly related to overall patterns of use, it was not associated with recent mammogram use in 1990. Women with a family history of breast cancer reported greater use at both times, as did women who reported having a regular physician (particularly a gynecologist or internist). When all other variables were controlled for, women were over nine times more likely to have had multiple and recent mammograms in 1990 than in 1987. CONCLUSIONS Mammography use dramatically increased between 1987 and 1990. There were strong relationships between the type of regular physician and mammography screening and between economic and personal history and repeated and recent mammography use.

The risk factors of age and family history and their relationship to screening mammography utilization

To study the association of two well known risk factors for breast cancer and the association of knowledge of those risk factors with mammography utilization.

Initial clinical trials of the subrenal capsule assay as a predictor of tumor response to chemotherapy

Retrospective and prospective clinical trials were performed to determine the usefulness of the 6‐day subrenal capsule (SRC) assay for the prediction of response to chemotherapy. Evaluable assays were obtained in 86% of 1000 consecutive specimens obtained from a variety of solid malignancies. Analysis of chemotherapeutic sensitivity in this assay gave reproducible and consistent results. The overall predictive accuracy of the assay in 62 retrospective clinical trials in 55 patients was 85%. Of 37 evaluable patients with chemotherapy refractory cancers treated in a prospective trial with single agent chemotherapy as determined by the assay, 14 (38%) responded. Greater degrees of tumor regression in the assay were associated with a higher probability of clinical response. The SRC assay shows potential value as a rapid predictive test for chemotherapeutic selection on an individual patient basis. However, additional prospective clinical trials are necessary to document its ultimate utility. Cancer 52:2185‐2192, 1983.

Underutilizers of mammography screening today: Characteristics of women planning, undecided about, and not planning a mammogram

Using concepts from the Precaution Adoption Process Model, we identified behavioral factors, sociodemographic and psychosocial variables, and beliefs about breast cancer that discriminated among women at different stages with regard to their intention to obtain mammography screening. An independent survey company conducted telephone interviews with 2,507 women aged 50 to 80 who were identified as underutilizers of mammography screening. Each underutilizer was assigned to one of three stages with regard to intention to get a mammogram: (a) definitely planning, (b) thinking about, and (c) not planning. Estimated actual risk of breast cancer, perceived risk to breast cancer, worry about breast cancer, and fear of learning from a mammogram that one has breast cancer were variables found to be significantly associated with intention to obtain a mammogram for several subgroups of underutilizing women. There are significant behavioral and psychosocial variables, beliefs and feelings about breast cancer, and demographic characteristics that distinguish underutilizing women at various stages with regard to intention to obtain mammography screening. Our findings provide new information that could help the health care professional motivate women who are not planning to utilize this preventive health measure to become regular utilizers.

Promoting mammography: results of a randomized trial of telephone counseling and a medical practice intervention

BACKGROUND Despite widespread promotion of mammography screening, a distinct minority of women have remained underusers of this effective preventive measure. We sought to measure the effects of barrier-specific telephone counseling (BSTC) and a physician-based educational intervention (MD-ED) on mammography utilization among underusers of mammography screening. DESIGN This was a randomized controlled trial. Women meeting criteria for mammography underuse at baseline (grouped by practice affiliation) were randomized to a reminder control condition (RC group received annual mailed reminders), BSTC or MD-ED interventions and followed for 3 years. Underuse was defined by failure to get two annual or biannual mammograms over a 2- to 4-year period prior to a baseline survey. PARTICIPANTS AND SETTING The study included 1655 female underusers of mammography aged 50-80 years who were members of two health maintenance organizations (HMO) in central Massachusetts. INTERVENTIONS BSTC consisted of periodic brief, scripted calls from trained counselors to women who had not had a mammogram in the preceding 15 months. Women could receive up to three annual calls during the study. MD-ED consisted of physician and office staff trainings aimed at improving counseling skills and office reminder systems. MAIN OUTCOME MEASURE Self-report of mammography use during the study period was the main outcome measure. Regular use was defined as > or =1 mammogram every 24 months. RESULTS Forty-four percent in each intervention group became regular users compared to 42% in the RC group. Among subjects who had prior but not recent mammograms at baseline, BSTC was effective (OR=1.48; 95% CI=1.04; 2. 10), and MD-ED marginally effective (OR=1.28; 95% CI=0.88, 1.85). Most recent users at baseline and few never users became regular users (61% and 17%, respectively) regardless of intervention status. CONCLUSIONS Among mammography underusers BSTC modestly increases utilization for former users at a reasonable cost (

Physician Compliance With Mammography Guidelines: Barriers And Enhancers

726 per additional regular user).