Study objective-To determine whether mortality from breast cancer could be reduced by repeated mammographic screening.Design-Birth year cohorts of city population separately randomised into study and control groups.Setting-Screening clinic outside main hospital. Patients-Women aged over 45; 21088 invited for screening and 21 195 in control group.Interventions-Women in the study group were invited to attend for mammographic screening at intervals of 18-24 months. Five rounds of screening were completed. Breast cancer was treated according to stage at diagnosis.End point-Mortality from breast cancer. Measurements and main results-All women were followed up and classed at end point as alive without breast cancer, alive with breast cancer, dead from breast cancer, or dead from other causes. Cause of death was taken from national mortality registry and for patients with breast cancer was validated independently. Mean follow up was 8-8 years. Altogether 588 cases of breast cancer were diagnosed in the study group and 447 in the control group; 99 v 94 women died of all causes and 63 v 66 women died of breast cancer (no significant difference; relative risk 0-96 (95% confidence interval 0*68 to 1.35)). In the study group 29% more women aged <55 died of breast cancer (28 v 22; relative risk 1.29 (0.74 to 2.25)). More women in the study group died from breast cancer in the first seven years; after that the trend reversed, especially in women aged -55 at entry. Overall, women in the study group aged -55 had a 20% reduction in mortality from breast cancer (35 v 44; relative risk 0 79 (0.51 to 1.24)).Other findings-In the study group 100 (17%) cancers appeared in intervals between screenings and 107 (18%) in non-attenders; 51 of these women died from breast cancer. Cancers classed as stages II-IV comprised 33% (190/579) of cancers in the study group and 52% (231/443) in the control group.Conclusions -Invitation to mammographic screening may lead to reduced mortalify from breast cancer, at least in women aged 55 or over.

From January 1, 1976 to December 30, 1985, 1,966 cases of breast carcinoma were diagnosed and treated at Malmo General Hospital, Malmo, Sweden. Of these cases, 185 (9.4%) involved invasive lobular carcinoma (ILC). Mammography in 137 cases demonstrated the following findings: spiculated opacity (53%), architectural distortion (16%), poorly defined opacity (7%), normal or benign findings (16%), and parenchymal asymmetry (4%). Radiographic definition of the ILC lesion varied greatly with projection: The craniocaudal view demonstrated significant findings more frequently than either the oblique or lateral views. Secondary radiographic findings were present in 31%, microcalcifications were rare, and physical findings were present in 89%. Because of its diffuse growth pattern and tendency to form lesions with opacity equal to or less than that of the parenchyma, ILC can be extremely difficult to detect mammographically. Therefore, the radiologist must be alert for subtle mammographic signs of malignancy and highly suspicious of any abnormal physical findings regardless of the mammographic appearance.

308 consecutive patients with severe or complicated respiratory tract infections underwent fiber-optic bronchoscopy in the search for a microbiological etiology. Protected brush specimens were used for bacterial cultures and bronchoalveolar lavage (BAL) for virus isolation and cytological examination. Herpes simplex virus (HSV) was the most commonly found pathogen and was isolated in 37 patients. 20 (54%) of them also had serological and/or cytological signs of HSV infection. 132 patients required assisted ventilation (AV) and in this group 34 (92%) of the 37 HSV positive patients were found. Isolation of HSV was significantly (p less than 0.001) associated with AV compared to patients not requiring AV. Of all patients treated with AV 26% had positive HSV isolation in conjunction with suspected acute lower respiratory infection. Coinfection with HSV and bacteria occurred in only 8 (22%) patients. HSV was more common in patients with burns (47%) compared to other patient groups such as patients with AIDS (3%) or other immunodeficiencies (9%).

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Fine-needle aspiration for cytologic diagnosis was performed on 219 nonpalpable breast lesions by using a stereotactic localization technique. Cytologic results were correlated with mammographic findings, and therapeutic decisions were based on the results of both procedures. Representative cytologic material was obtained in 74% of the lesions. Strict criteria of representativeness were observed. If only cases with representative cytologic yield are considered, the sensitivity was 93% and the specificity was 97%. The predictive values were high except for the predictive value of a negative cytologic finding in a spiculated lesion (50%). Sampling errors caused by abundant fibrosis, needle deviation, and difficulty in defining the lesion on the stereoscopic views are discussed. Another source of sampling error may be the mixed nature of some lesions consisting of benign and malignant components. Fine-needle aspiration of 219 nonpalpable breast lesions by using a stereotactic localization device yielded representative cytologic samples in 74% of the lesions.