Ladies…

Computer-Aided Reading of Mammograms Crashes

[The more we can get this information out, the better it will be.]

SACRAMENTO, April 4 — Computer-aided detection degrades the performance of screening mammography, reported a multicenter team.

In a study of more than 429,000 mammogram results, there was a significant drop in diagnostic specificity after computer-aided detection was introduced to various centers, reported Joshua J. Fenton, M.D., M.P.H., of the University of California at Davis, and colleagues, in the April 5 issue of the New England Journal of Medicine.

There was a significant increase in false-positive results and unnecessary biopsies, they added.

“In our observational study of large numbers of community-based mammography facilities and patients, the use of computer-aided detection was associated with increases in potential harms of screening mammography, including higher recall and biopsy rates, and was of uncertain clinical benefit,” they wrote.

Dr. Fenton and colleagues evaluated the association between the use of computer-aided detection and the performance of screening mammography from 1998 through 2002 at 43 facilities in three states. They evaluated data on a total of 429,345 mammograms in 222,135 women, of whom 2,351 had received a diagnosis of breast cancer within a year of screening.

The authors calculated the specificity, sensitivity, and positive predictive value of screening mammography with and without computer-aided detection. They also calculated the rates of biopsy and breast-cancer detection, and at the overall accuracy of screening, which they determined by the area under the receiver-operating-characteristic curve.

In all, seven of the 43 facilities started using computer-aided detection during the study period, and the remainder of facilities served as controls.

Among the computer-using centers, the diagnostic specificity of screening mammography declined significantly from 90.2% before computers, to 87.2% after. In addition, the positive predictive value decreased from 4.1% pre-computer to 3.2% with computer assistance (P=0.01).

Although computer-assisted detection increased the sensitivity of screening mammography compared with human-only review (from 80.4% before to 84.0% after), this difference was not statistically significant (P=0.32).

Adjusting for patient, facility, and radiologist characteristics also did not substantially change the outcome. Specificity and positive predictive value still significantly declined after computer aided detection was introduced, and sensitivity went up, but not significantly, the authors noted.

Biopsy rates among the seven facilities that implemented computer-aided detection went up by 20% after introduction of the technology, from 14.7 biopsies per 1,000 screening mammograms before to 17.6/1,000 after. But while there was a slight increase in the rate of cancer detection, including invasive breast cancers and ductal carcinoma in situ (from 4.15 cases per 1,000 screening mammograms before implementation, to 4.20 cases per 1,000 after), this difference was not significant (P=0.90).

“Analyses of data from all 43 facilities showed that the use of computer-aided detection was associated with significantly lower overall accuracy than was non-use (area under the ROC curve, 0.871 vs. 0.919; P=0.005),” the authors wrote.

The results add weight to the arguments in favor of a combination of different ascendant technologies: genetic risk profiling and breast MRI, suggested Ferris M. Hall, M.D., a diagnostic radiologist at Beth Israel Deaconess Hospital in Boston, in an accompanying editorial.

“Mammography is an inherently poor, two-dimensional projectional method being used to diagnose small, three-dimensional cancers,” he wrote. “It is least effective in the screening of dense breasts, which, as emphasized in another recent study, are a substantial risk factor for breast cancer.”

In contrast, MRI does not expose women to radiation, and it has a high sensitivity, although lower specificity than mammography for breast cancer, he noted.

“The major problems with MRI of the breast and related magnetic resonance spectroscopy are cost and interpretive expertise,” Dr. Hall wrote. “These same problems were involved with the acceptance of mammography as a screening method three decades ago. Here we go again.”

Additional Breast Cancer Coverage

The stuff we’re fed…

Eggs will raise your cholesterol, and other myths

Avoid eggs. Drink 8 glasses of water a day. Eating carbs will make you fat. Nutritional advice such as this has been touted for years — but is it accurate?

Not necessarily, according to Wendy Repovich, an exercise physiologist at Eastern Washington University in Cheyenne, Washington, who did her best to dispel several common nutrition misconceptions during an American College of Sports Medicine-sponsored health and fitness summit held recently in Dallas.”Eating eggs will raise your cholesterol.” This myth started because egg yolks have the most concentrated amount of cholesterol in any food, Repovich told Reuters Health. However, when eaten in moderation, eggs do not contain enough cholesterol to pose health risks, she said. “Most people avoid eggs and probably if they have any kind of cardiovascular risk their physicians tell them to avoid eggs,” Repovich said. “But really, there aren’t a whole lot of studies that show that one or two eggs a day really make a difference to cholesterol levels.””Eating carbohydrates makes you fat” is another myth. Cutting carbs from the diet may help a person shed pounds due to water loss from a decrease in carbohydrate stores, Repovich said, but eating carbs in moderation does not directly lead to weight gain.Here’s another myth. “Drink 8 glasses of water a day.” Repovich said people need to replace water lost through breathing, urinating, sweating each day — but that doesn’t necessarily total 64 ounces of water.”I see an awful lot of people carrying bottled water around,” Repovich said. “I think people are still under the impression that they have to drink 8 glasses of water a day, but most people don’t realize they get water from other sources in the diet.”And too much water can be harmful, Repovich warned, leading possibly to an imbalance in the body of sodium, a condition called hyponatremia. It’s also a myth, Repovich said, that everyone needs vitamin supplements, although she admits to popping a multivitamin each morning. People who eat a variety of fruits, vegetables, whole grains, along with moderate amounts of a variety of low-fat dairy and protein and the right quantity of calories, probably don’t need a vitamin supplement, she said. “But for the most part, we don’t eat the way we should so probably a simple multivitamin is good for most people,” Repovich said.

The value of the microchip…

LEE’S SUMMIT, Missouri (AP) — A Boston terrier named Mickey who disappeared four years ago from his suburban Kansas City backyard was found in Montana and reunited with his owners this week.

Cher Jarosz and her daughter Kari Mitchell thought they had lost Mickey forever — until they received a call from an animal shelter last week 1,100 miles away in Billings, Montana.

A microchip on Mickey helped the Billings Animal Shelter return him.

“Some lady from the public walked in the back door,” said Kristal Ward, office manager at the shelter. “She found the dog running up the street. She tossed him to me, and that’s how it started.”

Ward said she called Avid, a company that makes microchip identification systems, and was given the name of a veterinary clinic in Lee’s Summit, Missouri.

“I called that vet clinic because they were the one that should have a record of that chip,” Ward said. “I gave them the chip number, and the woman kind of started screaming.

“She goes, ‘Oh my God, is that a Boston terrier? Oh my God, it belongs to Kari Mitchell. She used to work here.”‘

Ward called Mitchell and confirmed that the dog was Mickey, she said.

After she talked to Mitchell, “Her mother called, and they were just beside themselves,” Ward said.

The family said he looks different and doesn’t remember his name. His teeth show signs of wear and tear.

Only Mickey knows how he wound up in Montana, and that’s fine by Mitchell.

“We’re happy to have him home,” she told KSHB-TV in Kansas City after Mickey caught a flight home. “I just hope whoever was taking care of him, I hope they were just glad he’s home.”

 — Now this is a story I like to read!

 

 

Coolest pics you’ll see this week…

Click on the thumbnails to see the larger images.

    

    

         

         

Click on the thumbnails to see the larger images.

These ‘animated’ images below are NOT animated images… Look closely…

    

         

 

Sometimes…

I wonder if god will ever forgive us for what we do to each other.

Then other times I take a good look around, and realize that god left this place a long time ago.

- paraphrased from Blood Diamond.