Radiation dose, contrast and image quality for automatic beam quality selection (OPDOSE) with the Siemens Mammomat 3000 has been investigated for different breast thicknesses and compared with those found using manually set tube potentials and a molybdenum target and filter. Automatic beam quality selection was found to have a negligible effect for breasts with a compressed breast thickness of less than 45 mm. However, for larger breasts substantial dose savings were achieved for a loss in contrast. For mammograms of compressed breast with a thickness in excess of 60 mm the mean glandular dose (MGD) per film was 2.90 mGy for manually selected tube potentials with a molybdenum/molybdenum target filter combination as compared with 1.87 mGy using 26 kVp and a tungsten target with rhodium filtration. The contrast loss in using OPDOSE was measured with a test object to be about 10% for breast thicknesses in excess of 45 mm. The standard breast model, which assumes a 50% glandular content, did not provide a good fit to the MGD for women attending for breast screening in the age range 50 to 64 years.
The multistep model of carcinogenesis in the breast suggests a transition from normal epithelium to invasive carcinoma via non-atypical and atypical hyperplasia and in situ carcinoma. The introduction of mammographic screening has led to the increased detection of preinvasive disease, and this has highlighted deficiencies in the biology and classification of such lesions. The excitement surrounding the development of DNA microarray analysis and proteomics has raised expectations about the role of these techniques in understanding the biology and translating these data to clinical practice. Only a few years ago, scientists studied disease initiation and progression in a linear fashion, identifying and examining one cancer-related molecule at a time. The recent development of technologies that allow a large number of genes and gene products to be analysed simultaneously has brought renewed interest to breast cancer research, with the hope of identifying a unique 'fingerprint' for each tumour and hence individualised treatment. To date, histopathological assessment has been at the heart of clinical management-does the new technology herald the end? Hormone replacement therapy (HRT): indications and side effects
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