Mammography—misunderstood and underutilized

Abstract

A mammography screening program for breast cancer carried out in Sacramento by the University of California Davis School of Medicine, Davis, was canceled because of negative public reaction to sensationalized reports in the lay press on the potential carcinogenic risks of the radiation exposure, along with passivity on the part of the medical community in defending the procedure and the program. Disappointment in this occurrence spurred us to explore physician's knowledge of and attitudes toward breast cancer and mammography. The results confirmed our suspicions that a significant number of physicians lack accurate knowledge of breast cancer and of the extremely high benefit-to-risk ratio of mammography as a means of early detection.

Clinicians’ Expectations of the Benefits and Harms of Treatments, Screening, and Tests

“…The finding of more instances of clinicians underestimating harms and overestimating benefits than the opposite provides some support for the existence of therapeutic illusion ("an unjustified enthusiasm for treatment on the part of both doctors and patients" 62(p1328) ), which is a proposed contributor to the inappropriate use of 11 Efficacy of Serum Screening for Down Syndrome (Screening All Women) 37,a Efficacy of Serum Screening for Down Syndrome (Women at Increased Risk) 37,a Detection of Severe Conditions at Birth by Routine Testing 31 Reduced Stroke Risk From Carotid Endarterectomy Post TIA 12 ARR of CV Events From Statins After MI (GPs) 6 ARR of CV Events From Statins After MI (Cardiologists) 6 RRR of CV Events From Statins After MI (GPs) 6 RRR of CV Events From Statins After MI (Cardiologists) 6 Reduced Stroke Risk From Aspirin for AF 27 Reduced Stroke Risk From Warfarin for AF 27 Reduction in Mortality From HRT 30 Reduction in Hip Fracture From HRT 30 Reduction in Colon Ca From HRT 30 Pain Reduction From Antibiotics for Tonsillitis 21 Fever Reduction From Antibiotics for Tonsillitis 21 Pain Reduction From Antibiotics in Children With AOM 21 Fever Reduction From Antibiotics for AOM 21 Peritonsillar Abscess Prevention From Antibiotics for Tonsillitis 21 Mastoiditis Prevention From Antibiotics for AOM 21 interventions. 63 Other potential contributors include the oftenmisleading portrayal of intervention benefits and absence of harms data in journal articles 64 and information from commercial sources, such as pharmaceutical advertisements in medical journals.…”

“…The studies were published between 1981 11 and 2015 12 ; came from 17 countries, with 16 from the United States; had sample sizes ranging from 30 11 to 1310 13 ; and included a total of 13 011 participating clinicians. Twenty studies addressed treatments [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] (Table 1), 8 addressed tests or screening (5 cancer screening, 3 antenatal tests and screening) 11,[31][32][33][34][35][36][37] (Table 2), and 20 addressed medical imaging [38][39][40][41][42][43][44][45][46][47][48][49][50][51][52]...…”

“…Five studies examined screening for breast cancer, 11,33,36 colorectal cancer, 35 and prostate cancer. 34 One study measured benefit and harm expectations, 35 3 measured only benefit expectations, 11,33,34 and 1 phrased the question neutrally.…”

“…Five studies examined screening for breast cancer, 11,33,36 colorectal cancer, 35 and prostate cancer. 34 One study measured benefit and harm expectations, 35 3 measured only benefit expectations, 11,33,34 and 1 phrased the question neutrally. 36 For the 8 benefit outcomes, the proportion of correct responses ranged from 17% to 56%, overestimation of benefit responses ranged from 1% to 56%, and underestimation responses ranged from 22% to 53%.…”

A Non-Linear Osteometric Modeling Method for Three-Dimensional Mandibular Morphological Changes During Growth: One-Year Monitoring of Miniature Pigs Using Cone-Beam Computed Tomography

“…On the other hand, the use of cephalograms in monitoring the growth of the maxillofacial regions of miniature pigs has been well documented because they are similar to humans in the morphology of the mandible (size and shape) and their bone metabolism rate ( Ström et al, 1986 ; Langenbach et al, 2002 ; Huh et al, 2006 ) ( Ide et al, 2013 ; Holton et al, 2015 ). More recent development in computed tomography (CT) enables accurate three-dimensional (3D) reconstruction of the bone and the measurement of its morphology ( Adams et al, 2004 ; Cavalcanti et al, 2004 ) ( Broadbent, 1981 ; Mah and Hatcher, 2003 ; Adams et al, 2004 ). Three-dimensional CT has been used to study human mandibular growth using cadaveric specimens of different growth stages ( Kelly et al, 2017 ; Schipper et al, 2021 ), or in patients with diseases that require follow-up with CT imaging ( Cavalcanti et al, 2004 ; Carvalho et al, 2010 ).…”