The shifting nature of women’s experiences and perceptions of ductal carcinoma in situ

Aim: This paper is a report of a descriptive qualitative study of the evolution of women’s perceptions and experiences of ductal carcinoma in situ from the period near to diagnosis to one year later. Background: Ductal carcinoma in situ is a non-invasive breast condition where cancer cells are detected but confined to the ducts of the breast. With treatment, the condition has a positive prognosis but ironically patients undergo treatment similar to that for invasive breast cancer. There is a lack of longitudinal qualitative research studying women’s experiences of ductal carcinoma in situ, especially amongst newly diagnosed patients and how experiences change over time. Methods: Forty-five women took part in an initial interview following a diagnosis of ductal carcinoma in situ and twenty-seven took part in a follow-up interview 9-13 months later. Data were collected between January 2007 and October 2008. Transcripts were analysed using a hybrid approach to thematic analysis. Findings: Women’s early perceptions of ductal carcinoma in situ merged and sometimes conflicted with their lay beliefs of breast cancer. Perceptions and experiences of the condition shifted over time. These overriding aspects were evident within four themes identified across the interviews: 1) perceptions of DCIS versus breast cancer, 2) from paradox to acceptance, 3) personal impact, and 4) support and interactions with others. Conclusion: This study represents one of the few longitudinal qualitative studies with newly diagnosed patients, capturing women’s initial and shifting experiences and perceptions of the condition. The issues identified need to be recognised in clinical practice and supported appropriately

Radiographer involvement in mammography image interpretation: a survey of United Kingdom practice

Breast cancer is most often diagnosed using x-ray mammography. Traditionally mammography images have been interpreted and reported by medically qualified practitioners - radiologists. Due to radiologist workforce shortages in recent years some nonmedical practitioners, radiographers, now interpret and report mammography images. The aims of this survey were to describe the characteristics and practices of radiographers who interpret and report mammography images in NHS hospitals in the UK, and in particular to establish the extent of their practice beyond low-risk asymptomatic screening cases. This service evaluation demonstrated that UK radiographers are interpreting and reporting images across the full spectrum of clinical indications for mammography including: low-risk population screening, symptomatic, annual surveillance, family history and biopsy / surgical cases. The survey revealed that radiographers are involved in a diverse range of single and double reading practices where responsibility for diagnostic decision making is shared or transferred between radiologists and / or other radiographers. Comparative analysis of subgroup data suggested that there might be differences in the characteristics and practices of radiographers who interpret only low-risk screening mammograms and those who interpret and report a wider range of cases. The findings of this survey provide a platform for further research to investigate how and why the roles and responsibilities of radiographers who interpret and report mammograms vary between organisations, between practitioners and across different examinations. Further research is also needed to explore the implications of variation in practice for patients, practitioners and service providers

Breast compression – An exploration of problem solving and decision-making in mammography

Objective: Breast compression decreases radiation dose and reduces potential for motion and geometric unsharpness, yet there is variability in applied compression force within and between some centres. This article explores the problem solving process applied to the application of breast compression force from the mammography practitioners' perspective. Methods: A qualitative analysis was undertaken using an existing full data set of transcribed qualitative data collected in a phenomenological study of mammography practitioner values, behaviours and beliefs. The data emerged from focus groups conducted at six NHS breast screening centres in England (participant n = 41), and semi-structured interviews with mammography educators (n = 6). A researcher followed a thematic content analysis process to extract data related to mammography compression problem solving, developing a series of categories, themes and sub-themes. Emerging themes were then peer-validated by two other researchers, and developed into a model of practice. Results: Seven consecutive stages contributed towards compression force problem solving: assessing the request; first impressions; explanations and consent; handling the breast and positioning; applying compression force; final adjustments; feedback. The model captures information gathering, problem framing, problem solving and decision making which inform an ‘ideal’ compression scenario. Behavioural problem solving, heuristics and intuitive decision making are reflected within this model. Conclusion: The application of compression should no longer be considered as one single task within mammography, but is now recognised as a seven stage problem solving continuum. This continuum model is the first to be applied to mammography, and is adaptable and transferable to other radiography practice settings

Association between age and access to immediate breast reconstruction in women undergoing mastectomy for breast cancer.

BACKGROUND: National guidelines state that patients with breast cancer undergoing mastectomy in England should be offered immediate breast reconstruction (IR), unless precluded by their fitness for surgery or the need for adjuvant therapies. METHODS: A national study investigated factors that influenced clinicians' decision to offer IR, and collected data on case mix, operative procedures and reconstructive decision-making among women with breast cancer having a mastectomy with or without IR in the English National Health Service between 1 January 2008 and 31 March 2009. Multivariable logistic regression was used to examine the relationship between whether or not women were offered IR and their characteristics (tumour burden, functional status, planned radiotherapy, planned chemotherapy, perioperative fitness, obesity, smoking status and age). RESULTS: Of 13 225 women, 6458 (48·8 per cent) were offered IR. Among factors the guidelines highlighted as relevant to decision-making, the three most strongly associated with the likelihood of an offer were tumour burden, planned radiotherapy and performance status. Depending on the combination of their values, the probability of an IR offer ranged from 7·4 to 85·1 per cent. A regression model that included all available factors discriminated well between whether or not women were offered IR (c-statistic 0·773), but revealed that increasing age was associated with a fall in the probability of an IR offer beyond that expected from older patients' tumour and co-morbidity characteristics. CONCLUSION: Clinicians are broadly following guidance on the offer of IR, except with respect to patients' age

Mammographic density adds accuracy to both the Tyrer-Cuzick and Gail breast cancer risk models in a prospective UK screening cohort

This work was supported by the National Institute for Health Research (NIHR) and Genesis Breast Cancer Prevention Appeal (references GA10-033 and GA13-006). This article presents independent research funded by the NIHR under its Programme Grants for Applied Research (grant RP-PG-0707-10031). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The authors also acknowledge the support of Medical Research Council Health eResearch Centre grant MR/K006665/1

Predictors of malignancy in screen-detected breast masses with indeterminate/equivocal (grade 3) imaging features

Background: The mammographic grading system used by BreastScreen Australia accredited programs requires needle biopsy of lesions with indeterminate features (grade 3). We wished to determine the predictors of malignancy for these common lesions, so as to reduce surgery for benign lesions. Design: Grade 3 masses assessed between Jan 1996–Dec 2005 are included. New or changing lesions were identified through film review. Imaging, demographic and final outcome data were tabulated. Statistical analysis was performed to determine the predictors of malignancy. Results: 1181 lesions, including 623 new or changing masses are assessed. Of these 98 (8.3%) were malignant. Malignancy was found in 3% first round masses versus 13% of new or changing lesions. Withholding needle biopsy results, interval change (OR 2.85, p = 0.0001), increasing age (p = 0.0001) and diameter were independent predictors of malignancy, lesion diameter having an inverse relationship with malignancy. Once needle biopsy results were included, this parameter became the sole predictor of malignancy as other factors lost significance in a multivariate model. Conclusion: Surgical biopsy is not indicated in well-sampled grade 3 masses with benign needle biopsy results. Surgery is valuable for diagnosis or treatment of the remaining such masses without benign needle biopsy results.Gelareh Farshid, Adrienne Walker, Glenda Battersby, Thomas Sullivan, P. Grantley Gill, Steve Pieterse, Peter Downe

Comparison of the clinical performance of three digital mammography systems in a breast cancer screening programme

This study compares the clinical performance of three digital mammography system types in a breast cancer screening programme. 28 digital mammography systems from three different vendors were included in the study. The retrospective analysis included 238 182 screening examinations of females aged between 50 and 64 years over a 3-year period. All images were double read and assigned a result according to a 5-point rating scale to indicate the probability of cancer. Females with a positive result were recalled for further assessment imaging and biopsy if necessary. Clinical performance in terms of cancer detection rate was analysed and the results presented. No statistically significant difference was found between the three different mammography systems in a population-based screening programme, in terms of the overall cancer detection rate or in the detection of invasive cancer and ductal carcinoma in situ. This was shown in both prevalent and subsequent screening examination categories. The results demonstrate comparable cancer detection performance for the three imaging system types operational in the screening programme