No abstract

Residency training in breast imaging has improved in terms of time and curriculum. However, a majority of the residents would not consider a fellowship and did not want to interpret mammograms in their future practices.

Given the substantial upstage rate (11%) of papillary lesions diagnosed at imaging-guided CNB, surgical excision is an appropriate management decision; however, careful evaluation in concert with an expert breast pathologist may allow for observation in appropriately selected patients.

Common problems in clinical image quality have been identified. This information should be useful for educators and facilities striving to improve the quality of mammography.

Purpose Participation in therapeutic clinical trials rarely reflects the race and ethnic composition of the patient population. To meet National Institutes of Health-mandated goals, strategies to increase participation are required. We present a framework for institutional enhancement of minority clinical trial accrual. Methods We implemented structural changes on four levels to induce and sustain minority accrual to clinical trials: 1) leadership support, 2) center-wide policy change, 3) infrastructural process control, data analysis and reporting and 4) follow up with clinical investigators. A Protocol Review and Monitoring Committee reviews studies and monitors accrual, and the Program for the Elimination Cancer Disparities leads efforts for proportional accrual, supporting the system through data tracking, web tools and feedback to investigators. Results Following implementation in 2005, minority accrual to therapeutic trials increased from 12.0% in 2005 to 14.0% in 2010. The “rolling average” minority cancer incidence at the institution during this timeframe was 17.5%. In addition to therapeutic trial accrual rates, we note significant increase in the number of minorities participating in all trials (therapeutic and non-therapeutic) from 2005 to 2010 (346 to 552, 60% increase, p < 0.05) compared to a 52% increase for Caucasians. Conclusions Implementing a system to aid investigators in planning and establishing targets for accrual, while requiring this component as a part of annual protocol review and monitoring of accrual, offers a successful strategy that can be replicated in other cancer centers; an approach that may extend to other clinical and translational research centers.