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Suggested Citation:"Index." Institute of Medicine and National Research Council. 2005. Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis. Washington, DC: The National Academies Press. doi: 10.17226/11016.
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Index

A

AAC Consulting Group, Inc., 223

Access to breast imaging

cultural factors, 78

financial factors, 2, 4-5, 21, 69, 76, 78, 100, 103-106

legislation promoting, 80

patents and, 257

as quality assurance component, 4, 75-79

race/ethnicity and, 76

of risk assessments, 8

social factors, 76, 78

socioeconomic status and, 5, 76

and survival rates, 66-67

uninsured women, 5, 76, 78-79

waiting times, 7, 101

workforce issues, 4, 7, 21, 100, 101-102, 103-106, 115

Accuracy.

See also Analytical validity;

Sensitivity of technologies;

Specificity

of biological technologies, 156, 160, 161

biopsies, 161, 290, 299

CAD technology and, 202, 281

clinical trials of, 202-204

defined, 326

digital mammography, 21, 93

molecular profiling, 170

MRI, 32, 45, 92, 96-98, 294

of radiation technologists, 111-112

screen-film mammography, 21, 92

of specialists vs. generalists, 86, 89, 94-95, 101, 281

standards for reporting, 202

Adjuvant therapy, 1, 55, 299, 326

AdvaMed, 196

Advanced Mammography Systems, Inc., 223

Advanced Medical Laboratories, Inc., 222

Advocacy groups, 12-13, 79, 82, 210-211, 277

African Americans, 45, 76, 77, 78, 128, 133, 208

Age factors

at birth of first child, 8, 127

DCIS, 51, 52

density of breast tissue, 45, 86

efficacy of mammography, 42

incidence of breast cancer, 43, 50, 51, 142

menarche, 127

menopause, 127

mutations, 128

radiation sensitivity, 48

risk of breast cancer, 8, 20, 30, 31, 124, 125, 126, 127, 130, 137, 143-144, 199

sensitivity of mammography, 85, 87, 281

standard of care, 7, 40, 281

utilization of mammography, 20, 64

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2005. Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis. Washington, DC: The National Academies Press. doi: 10.17226/11016.
×

Agency for Healthcare Research and Quality, 11, 194, 195, 196, 199, 234, 276, 278

Alcohol intake, 127, 301

Allan, Janet D., 43

Alleles, 326

American Cancer Society, 13, 42, 114, 139, 190, 192, 211, 232, 297

American College of Radiology (ACR), 44, 74, 89, 91, 103, 233

Imaging Network (ACRIN), 93, 98, 99, 196, 203, 235-237

Mammography Accreditation Program, 82, 83

and radiological associate, 110-111

Task Force on Human Resources, 107

American Heart Association, 206, 232

American Italian Cancer Foundation, 42

American Medical Association, 196, 233

American Society of Clinical Oncology, 42, 96, 233

American Society of Radiological Technologists (ASRT), 110, 111

AmeriScan™, 32

Analytical validity, 326

Anatomical technologies

electrical-property-based, 288-290

mammography and its improvements, 280-283

MRI-based, 293-294

optical-property-based, 292-293

physical-property-based, 284-287

Androgens, 135, 136

Angiogenesis, 159, 165, 172, 173, 287, 326

Annas, George, 215

Anti-angiogenesis drugs, 172

Antibodies, 167, 175, 177

Antigens, 177, 326

Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), 205, 206-207, 208-209, 210, 253

APC gene, 137

Apoptosis, 165, 173, 175, 177

AR gene, 136

Arkansas Department of Health, 82

Artificial intelligence systems, 169

Ashkenazi Jewish women, 129, 130, 131

Asian Americans, 45, 128, 133

Association of American Medical Colleges, 12, 218

AstraZeneca, 206

Ataxia telangiectasia, 133

ATM gene, 133

Atypical hyperplasia, 52, 126, 326

Augmented breasts, 96, 294

Austin, Melissa, 130

Australia, 5, 65

Avon Foundation, 99, 190, 192

Axillary node dissection, 67

B

Balanced Budget Refinement Act of 1999, 233

Basement membrane, 50, 52

Benign lesions, 52, 97, 98, 170, 294

Berlin, Leonard, 89

Berwick, Donald, 249, 261

Beta-galactosidase, 177

BI-RADS®, 44, 83, 84, 91

Bias, 99

in clinical trials, 326-327

confounding, 324, 329

defined, 323-324

follow-up losses, 203, 324

interpretation, 315

lead-time, 201, 333

length, 201, 333

sampling, 129, 201, 333

systematic or measurement errors, 163, 324

Bioinfomatics, 235, 239, 327

Biologically based technologies. See also Biomarkers and biomarker assays;

Molecular imaging;

Molecular profiling;

specific technologies

clinical applications, 155, 156-157, 181-182, 274

costs of, 166, 297

FDA approval, 161, 181

Bioluminate, Inc., 306

Bioluminescent probes, 175, 176, 178

Biomarkers and biomarker assays. See also Genetic markers;

individual biomarkers

accuracy, 156, 160, 161

clinical applications, 157, 158-159, 160-161

as decision aid, 160-161, 169

defined, 157, 327

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2005. Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis. Washington, DC: The National Academies Press. doi: 10.17226/11016.
×

discovery and development, 9, 157, 161-164, 169, 204-205

for DNA stability, 335

handling of tissue samples, 163

ideal, 157, 160, 161-162

limitations, 157, 158-159, 160

as mammography complement, 155, 157, 160-161

molecular, 164, 170, 335

and risk stratification, 147

screening for candidates, 164, 169

validation, 162-163

Biomira, Inc., 222

Biopsy

accuracy and reliability, 161, 290, 299, 306

core needle, 52-53, 302, 304, 306, 329

defined, 303, 327

density of breast tissue and, 53

fine needle aspiration, 126, 299, 301, 304-305, 331

image-guided, 292, 303, 305

international comparisons, 68, 69, 70-71

LIN detection, 52

mammography sensitivity and, 21, 43, 48, 69

microcalcifications and, 53, 54

positive, 126

prior, as risk factor, 8

rates, 48, 70-71

risk factors for, 48

SmartProbe, 303, 305-306

specimen handling, 166

stereotactic, 52-53, 305, 339

supplemental technologies, 170, 305

surgical, 53, 69, 71, 302, 303-304, 306

ultrasound-guided, 54, 285

unnecessary or “excess,” 5, 48, 66, 68, 69

vacuum-assisted, 53-54

BioScanIR® Technologies, Inc., 222

Blood tests, 21, 142, 155-156, 182, 204

Blue Cross Blue Shield Association Technology Evaluation Center, 194, 228-229, 232, 258

Body mass index, 124, 127

Bone density screening, 79, 260

Bone marrow transplantation, 30

BRCA genes, 8, 49, 128, 129-131, 132, 139, 140, 144, 256-258, 261, 296, 327

Breast and Cervical Cancer Mortality Prevention Act, 81

Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA), 79, 80

Breast Cancer Action, 212

Breast Cancer Detection Demonstration Project, 8, 140

Breast Cancer Research Foundation, 193, 210

Breast Cancer Research Program (DoD), 22, 81, 190, 192

Breast-conserving surgery, 1, 54, 55, 67

Breast density

age and, 45, 86

and biopsy method, 53

ethnic variation, 45, 128

influential factors, 45, 86

mapping, 286

and risk of cancer, 127, 128

and sensitivity of screening technologies, 2, 44-45, 48, 86, 96, 99-100, 105, 281, 282, 294, 297, 298

Breast imagers. See also Radiologists

capacity-building strategies, 104

demand for, 103-106

shortages, 21, 101, 103, 106-107

Breast self-examination, 223, 327

Breast size, 53, 55, 96, 100

BreastScanIR™, 222

Bristol-Myers Squibb, 206

Brookhaven National Laboratory, 283

Brown University, 110

Burke, Wylie, 130

C

CA 15-3 protein, 160, 161, 327

CA 125 biomarker, 327

California Breast Cancer Research Program, 190, 192

Callback rates, 69, 75, 94, 271

Canada, 5, 64, 72, 88, 90, 143, 144

Cancer. See also other histological sites

defined, 327

registry data, 163-164

types, 327

Cancer Biomedical Informatics Grid, 235

Cancer Therapy Evaluation Program, 180

Carcinogens, 128, 131, 134, 301, 327

Carcinoma

defined, 327

in situ, 327;

see also Ductal carcinoma in situ

promoters, 128, 131

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2005. Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis. Washington, DC: The National Academies Press. doi: 10.17226/11016.
×

Case-control studies, 124, 125, 132, 204-205, 327-328

Case reports, 328

Catecholamine transmitters, 136

Cathepsin B, 175

Cathepsin D, 174, 175, 178

Catheter, 328

cDNA, 164, 170, 328

CEA biomarker, 327

Cell culture, 328

Cell cycle regulation, 165, 173

Cell proliferation activities, 174

Cell surface receptors, 173, 175, 177, 225

Center for Molecular Imaging Research, 178

Centers for Disease Control and Prevention, 42, 78

Centers for Medicare and Medicaid Services (CMS), 11, 29, 95, 110, 188, 194, 196, 208, 228, 230, 240, 252, 256, 276

Chaperone protein, 136

Chemoprevention, 300-301, 328.

See also Tamoxifen

Chemoprophylaxis, 328

Chemotherapy

defined, 328

high-dose, 30

mastectomy and, 1

Choline, 298

Chromosomes, 166, 328

Cigarette smoking, 140, 301

Circadian rhythm, 287

Cisplatin, 167

Clement, Tony, 257

Clinical breast examination, 78, 99, 286, 328

Clinical Imaging Drugs and Enhancers Program, 180

Clinical Laboratory Improvement Amendments, 225, 256

Clinical outcomes

defined, 328

predictors of, 161, 165

Clinical Research Affiliates Funding Trials, 213

Clinical Research Enhancement Act, 205

Clinical Trial Cooperative Groups, 180

Clinical trials. See also Methodological issues;

Research and development;

Technology assessment

ACRIN, 93, 98, 99, 196, 203, 235-237

advantage of participating, 208-209

ALLHAT model, 205, 206-207, 208-209, 210, 253

bias in, 326-327

of biomarkers, 163-164, 204-205

blind study, 99, 206, 324, 327

comparative, 205-207, 230, 236, 253

costs, 11, 206

defined, 328

design of, 23-24, 107, 164, 198-199

FDA-required, 206, 221, 224, 231, 243

with elderly participants, 228

follow-up studies, 203, 215, 324

funding, 205, 206, 243

HIPAA and, 12, 21, 162-164, 171, 211, 213-217

large-scale, multicenter, 23, 96, 98, 99-100, 202, 205-218, 235-237, 243-244, 274-275

multiple reader multiple case ROC, 319-321

prevention, 140

protected health information, 214-215

quality of, 11-12, 198-199, 202

radiologists’ contributions to, 107, 109

randomized, 42, 164, 201, 202, 206, 328, 338

recruitment of subjects, 12-13, 207-211, 212-213, 260, 277

reporting adverse events, 239

reviews by expert groups, 41-44

of screening and diagnostic accuracy, 202-204

of screening modality, 201-202, 236

statistical analysis, 314-321

surrogate endpoints, 100, 339

Clinical utility, defined, 328

Clinical validity, 162-163, 328

Cloning, positional, 337

Cohort studies, 124, 125, 328-329

Colorado Mammography Project, 264-266

Community-based programs, 79

Comprehensive Cancer Centers, 243-244

Computed tomography, 176, 177, 178, 291, 292, 329, 332, 339

Computer-aided detection (CAD)

accuracy, 202, 281, 317-318

benefits, 94-96, 271, 281

defined, 329

description, 280, 281

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2005. Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis. Washington, DC: The National Academies Press. doi: 10.17226/11016.
×

FDA-approved systems, 21, 94, 222, 279, 281

image archive and, 240-241

and interpretation of mammograms, 6-7, 93-96, 271-272

reimbursement policy, 95, 258

risk of breast cancer and use of, 92

sensitivity, 94, 95

workflow impact, 95, 96

COMT gene, 136

Confounding factors, 324, 329

Consolidated Appropriations Act for FY 2004, 83

Contrast agents, 96-97, 177, 283, 329, 332

Controlled observational studies, 329

Cost-benefit analysis, 329

Cost-effectiveness of technologies, 100, 170, 197, 232, 236, 265, 330

Costs, 166

of biological technologies, 166, 297

of clinical trials, 206

of compliance with MQSA, 101-102

of digital mammography, 93

of false positives, 4-5, 46, 75

of genetic testing, 131

of malpractice insurance, 98, 294

quality assurance, 101-102

of screening mammography, 75

Cowden syndrome, 133

Critical Assessment of Microarray Data Analysis, 171

Cross-sectional comparison, 330

Cultural factors, 78

Cummings, Steven, 142

Cy5.5-cathepsin D sensitive peptide protected graft copolymer, 174

Cy5.5 poly L-lysine monooxypolyethylene glycol, 174

CYP17 gene, 135

CYP19 gene, 135

CYP1A1 gene, 134

CYP1B1 gene, 135

CYP2D6 gene, 135

Cysts, 52, 98, 285, 299, 304, 305

Cytogenetics, 330

Cytokines, 136

Cytological screening, 126, 330

Cytology, 330

D

D-Luciferin, 178

Databases and data repositories, 66, 163-164, 171, 180, 215, 234, 235, 240-242, 276

Decision aids, 160-161, 169, 197

Density. See Breast density

Deoxyribonucleic acid. See DNA

Department of Defense, 278

funding for breast cancer research, 10, 22, 81, 191, 192

Medical Research Program, 22, 190

radiology training program, 110

Department of Health and Human Services, 13, 277

Detection, early, 1, 2, 67, 69, 75, 282, 330

Detoxification enzymes, 134

Diagnostic mammography

adjunct technologies, 298

defined, 37, 281, 330

financial losses from, 103

interpretation of mammograms, 85, 112

technologies, 24-27, 96

Diagnostic testing, 330

Dietary factors, 124, 301

Diffraction enhanced imaging, 280, 283

Diffuse optical tomography, 173, 291-292

Digital Imaging and Communications in Medicine, 242

Digital Mammographic Imaging Screening Trial (DMIST), 93, 203, 205, 208, 229, 236, 253, 258, 282

Digital mammography. See Full-field digital mammography

Digital tomosynthesis mammography, 282-283

DNA

defined, 330

exons, 331

hybridization techniques, 164, 166-167

imaging, 175

methylation, 166, 335

microarrays, 164, 165-167, 170, 171, 299

microsatellites, 335

oligonucleotides, 164, 165, 170, 335, 336

radiation damage, 49

repair defects, 49, 128, 129, 166, 301

stability, 335

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2005. Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis. Washington, DC: The National Academies Press. doi: 10.17226/11016.
×

Dopamine, 136

Dose-response relationship, 49, 330

Dosimetry, 330

Drug-eluting stents, 259

DucPrep™ Breast, 222

Ductal carcinoma in situ (DCIS)

age and, 51, 52

classification, 52, 53

defined, 330-331, 333

diagnosis, 50-54, 305

effectiveness of treatment, 50

incidence, 49-50, 51, 52, 55-56

and invasive breast cancer, 50, 54, 126

microcalcifications, 52, 53, 54, 55, 99, 285

multicentric, 97, 294

nonprogressive, 55-56

overtreatment concerns, 1, 21-22, 54-56

prognosis, 144-145

recurrence rates, 55

risk assessment, 140

treatment guidelines, 55

treatment methods, 54-55

screening technology, 96-97

Ductal lavage, 164, 222, 295, 297, 331

Ducts

defined, 330

necrotic debris, 53

Duke University, 110

E

ECRI, 195

Effectiveness of mammography screening

controversy over, 3-4, 22, 41-44

defined, 249-250, 331

measure of, 40-41

of national programs, 42

technology assessment, 249, 251

Efficacy of screening

age and, 42

CAD technology, 94, 95

defined, 249-250, 331

MRI, 98

technology assessment, 249, 251

ultrasound, 100

Elastography, 26-27, 284-285, 286, 331

Electrical impedance imaging, 26-27, 222, 255, 261, 288, 289-290, 331

Electrical potential measurements, 26-27, 288, 289, 331

Electronic palpation, 284, 286, 331

Elscint, Inc., 223

Epidemiological studies, 49

data sources, 242

defined, 331

molecular, 335

recruitment for, 208, 211, 277

of risk factors for breast cancer, 123, 125, 131, 137, 211

Epigenetic changes, 158, 165, 331

Epinephrine, 136

Epithelial cells, 50, 52, 331

ER genes, 135, 174

erbB2 gene, 167

erbB2 protein, 167

erbB2 receptor, 161

Esserman, Laura, 63

Estonia, 66

Estrogen, 76, 124, 125, 132, 134, 135-136, 142, 158, 161, 174

Ethnicity. See Race/ethnicity

Etiology of breast cancer, 132, 331

EUROCARE data set, 66

European Code Against Cancer, 5, 74

European Commission, 42

European Institute of Oncology, 42

European Society for Medical Oncology, 42

Evaluation of detection technologies. See also Clinical trials;

Technology assessment

by health care payers, 227-234

Evidence Practice Centers, 194

Eyre, Harmon, 114-115

F

False negative results

defined, 331

density of breasts and, 45

risk of, 2

False positive results

and biopsy, 43

CAD and, 94, 95

costs of, 4-5, 46, 75

defined, 331

density of breasts and, 45

electrical-property-based technologies, 290

intervals between screening and, 69, 72

malpractice concerns and, 4, 89

and mammogram utilization, 47-48

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2005. Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis. Washington, DC: The National Academies Press. doi: 10.17226/11016.
×

MRI, 98

psychological effects, 47

risk of, 2, 38-39, 45

second opinions and, 74

specialists vs. generalists, 89

Family history of breast cancer, 8, 124, 126, 127, 128, 129, 131, 139, 141, 143, 144, 148, 300, 331.

See also Genetic risk factors

Fat, dietary, 124

FDA Modernization Act, 224, 225

FDA review and approval

accelerated, 14, 226-227, 231, 239

advertising claims and, 221, 225, 256

analyte-specific reagents, 225

approved technologies, 21, 24-27, 92, 94, 96, 98, 161, 173, 222-223, 279, 281, 282, 284, 286, 287, 289, 295, 297

classification of devices, 219-221

clinical studies, 206, 211, 224, 231, 243, 252

devices not requiring, 165-166, 218, 224-226, 256

guidance documents, 227

home-brew in vitro diagnostics, 225, 256-257

humanitarian device exemptions, 226

improvements to, 226-227

inexperience with molecular technologies, 181

industry interactions with, 211, 224, 239

intended use and, 221, 222-223

investigational device exemption, 224

mock 510(k) application, 224

“off-label” use, 225

potential safety risk and, 219-221

premarket approval application, 221, 224

process, 218-227, 255-256, 320-321

role of, 218

time for, 227

Federal Employees Benefits Program, 260

Feigal, David, 221, 227

Fibrocystic breast disease, 52, 204

Financial factors, 46, 80.

See also Costs;

Health insurance coverage;

Malpractice issues

access to screening, 2, 21, 69, 76, 78, 100, 103-106

diagnostic mammography losses, 103

in facility closures, 4, 103-106

Fischer Imaging Corp., 222

Florida, 101

Fluorochrome, 175

Fluorodeoxyglucose, 173, 174, 298

Fluoroestradion, 174

Fluoroscopy, 126

Fluorothymidine, 174

Food and Drug Administration. See also FDA review and approval

Center for Devices and Radiological Health, 221

Center for Drug Evaluation and Research, 181

CMS coordination with, 240

Device Advice group, 227

reporting adverse events, 239

standard setting for facilities, 82, 83

Fox, Nelene, 260

France, 66, 242

Friends…you can count on, 193

Frost & Sullivan, 258

Full-field digital mammography

accuracy, 21, 93, 202

CAD use with, 94

clinical trials, 93, 202, 203, 282

costs, 93, 258

defined, 332

description, 24-25, 280, 282

FDA-approved systems, 21, 221, 222, 279, 282

insurance coverage, 228-229, 232, 258

revenues, 259

risk of breast cancer and use of, 92

specificity, 93

and workflow, 93

Functional imaging, 173

Funding

basic medical research, 22, 189-191, 192-193, 209-210

clinical trials, 205, 206, 243

technology development, 234

G

Gail, Mitchell, 140

Gamma camera/single-emission photon emission computed tomography, 173

Gastrointestinal tract cancers, 160, 228, 327

Gel electrophoresis, 332

GenBank, 225

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2005. Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis. Washington, DC: The National Academies Press. doi: 10.17226/11016.
×

Gene. See also specific genes

amplification, 166, 167, 168, 326

copying alterations, 168

defined, 332

positional cloning, 337

profiling, 296, 299

in susceptibility to breast cancer, 126, 129-137, 327

therapy, 172, 175

tumor suppressor, 137, 166, 299-300, 336, 340

Gene expression

altered, 158

data repository, 171

molecular imaging of, 173, 175, 178

multidrug resistance, 173

profiling, 164, 165-166, 170, 296

Gene product interactions, 132

General Accounting Office, 80, 83

General Electric Medical Systems, 222, 282

Genetic linkage analysis, 129, 334

Genetic markers, 129, 131, 147, 157, 158-159, 332

Genetic risk factors. See also Mutations

autosomal traits, 326

biomarkers, 129, 131, 147, 157, 158-159, 332

BRCA genes, 126, 129-131, 140, 141, 144, 146-147, 327

breast density, 128

counseling, 148

environmental factors and, 129-130

modeling, 8-9, 140-141, 144, 146-147, 149, 157, 167

polymorphisms, 131-137, 167, 158

preventive interventions, 130

rare genetic syndromes, 133

Genetic testing, 131, 141, 148, 158, 208, 225, 256-258, 261, 296, 299-301

Genome

defined, 332

screening, 132

transcriptome, 340

Genomics of breast cancer, 164.

See also Molecular profiling;

Proteomics of breast cancer

barriers to clinical use, 170-172

cancer clues, 166-167

expression profiles, 164, 165-166, 170

signaling circuitry, 159, 167-169

Genotype, 332, 336

Germany, 242

Global Summit on Mammographic Screening, 41, 42-43

Glucose transporter-1 (Glut 1), 174

Gotzsche, Peter, 41-43

Gradishar, William J., 96

GSTM1 gene, 134

GSTP1 gene, 134

GSTT1 gene, 134

H

Hall-effect imaging, 26-27

Harvard Medical School, 236

Hayes, Inc., 195

Health Care Financing Administration, 196

Health care payers.

See also Medicare evaluation of new technologies, 227-234

Health Industry Manufacturers Association, 196

Health insurance coverage

and access to screening, 5, 76, 78-79, 103-104

and clinical research participation, 208

clinical utility evaluations by payers, 227-234

conditional, 231

CPT codes and, 232, 233, 258

delays in decisions, 259

reimbursement policies, 103-104, 231, 232, 233-234, 239, 258

and technology adoption, 95, 188, 227-228, 230, 257-259

for treatment, 80

and utilization of mammography, 76, 78-79, 149

Health Insurance Portability and Accountability Act Privacy Rule

and bioscience industry, 217-218

and clinical research, 12, 13, 21, 163-164, 171, 211, 213-217

complexity of, 217

and grant and contract review, 217

monitoring effects of, 12, 13, 218

obtaining protected health information, 214-217, 242

personal health information identifiers, 214

Program Announcements and Requests for Applications, 217

purpose, 213

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2005. Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis. Washington, DC: The National Academies Press. doi: 10.17226/11016.
×

and telemammography, 217

and tissue and data repositories, 215, 242

Health maintenance organizations, 332

Herceptin, 167, 210

Heterogeneous characteristics, 159, 161, 332

Heterozygosity

defined, 332

loss of, 158, 167, 334

Hexokinase 1, 174

HFE/HH gene, 136

HGF/SF60, 174

High-dose chemotherapy with bone marrow transplantation, 210, 260

Hispanics, 76

Histology, 126, 161, 332

History of breast cancer, 126

Hodgkin’s disease, 126

Hollebeek, Robert, 242

Holologic, Inc., 222, 223, 283

Hormone receptor positive cancer, 125

Hormone replacement therapy, 45, 86, 125, 127, 281

HRAS1 gene, 133

HSP70 gene, 132, 136

Hyperplasia

atypical, 52, 126, 326

defined, 332

lobular, 52

I

IBM, 242

iCAD, Inc., 21, 94, 222

Illinois, 82

ImageChecker M1000®, 21, 94, 222, 281

Imaging agents, 332-333

Immune response to cancer, 131, 136

Immunocytochemistry, 333

Immunohistochemical assay, 161, 167, 333

Immunology, 333

Immunomodulatory pathways, 136

In situ, defined, 333.

See also Ductal carcinoma in situ;

Lobular carcinoma in situ

In Vivo Cellular and Molecular Imaging Centers, 180

Incidence of breast cancer

DCIS, 49-50, 51, 52, 55-56

defined, 333

as endpoint, 199

rates, 1, 31, 43, 50, 51, 76, 77, 142

screens, 67

and survival, 199, 200

Indian Health Care Improvement Act, 1992 Amendments, 81

Indian Health Service, 80

Infiltrating ductal carcinoma, 165, 333

Inflammatory breast cancer, 333

InfoWorld, 240-241

Infrared Sciences Corp., 222

Infrared thermography, 222, 285, 286-287

Institute of Medicine, 80, 106, 193, 230

Instrumentarium Corp., 223

Insurance. See Health insurance coverage;

Medicaid;

Medicare

Intelligent Systems Software, 21, 94

Interagency Council on Biomedical Imaging in Oncology, 234, 237-240

Intergenerational harm, 46

International Agency for Research on Cancer, 41, 42

International Breast MRC Consortium, 98

International Union Against Cancer, 42

Internet2 (Next Generation Internet), 241, 242

Interpretation. See Mammogram interpretation

Invasive breast cancer, 19

age and, 51, 124

biomarkers, 159, 298-299

DCIS and, 52, 54, 126

defined, 333

ductal carcinoma, 54-55, 333

incidence, 51

international comparisons, 71

lobular carcinoma, 333

malpractice litigation, 105

mammogram appearance, 52

men, 139

prognosis, 159

sensitivity of screening technologies, 97, 99, 299

survival rates, 71

treatment, 260

Inventive Products, Inc., 223

131/125Iodine, 174

Iodobenzamide, 174

Iowa, 82

Iron metabolism, 136

Italy, 66

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2005. Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis. Washington, DC: The National Academies Press. doi: 10.17226/11016.
×

J

Japan, 242

Johns Hopkins University, 166

K

Kaiser Permanente, 194

Kaplan-Meier method, 199, 200

Kopans, Daniel, 283

Korea, 45

L

Laser-Assisted In Situ Keratomileusis (LASIK) surgery, 226

Legislation. See also Mammography Quality Standards Act;

other individual statutes

access-promoting, 80

breast cancer-related, 79-82

Lesions

anaplastic, 52

comedo, 53

defined, 333

margin visibility, 282

precancerous lesions, 286-287, 337

Leukemia, 204, 327

Lewin Group, 259

Li-Fraumeni syndrome, 133

Liotta, Lance, 182

LKB1 gene, 133

L-myc gene, 134

Lobular carcinoma in situ, 52, 126, 333, 334

Lobular intraepithelial neoplasia (LIN), 52

Loma Linda University, 111

Long Island Breast Cancer Research Project, 208

Lorad Digital Breast Imager, 222

Lumpectomy. See Breast-conserving surgery

Lung cancer, 1, 160, 327

Lymphoma, defined, 327

M

Magnetic resonance imaging

accuracy, 32, 45, 92, 96-98, 202, 294

clinical applications, 96-98, 177, 294, 303

clinical trials, 236, 293-294, 325

contrast-enhanced, 96-97, 293, 294, 332

costs, 98, 294

deceptive marketing of, 30, 31-32, 98, 279

defined, 334

description, 24-25, 293-294

elastographic, 286

FDA approval, 96, 98, 279

functional, 177

image storage, 242

molecular imaging, 174, 175, 176, 177-178

utilization, 258

Magnetic resonance spectroscopy, 26-27, 175, 295, 298-299, 334

Magnetomammography, 26-27

Malignant transformation, 334

Malignant tumors, 334

Malpractice litigation

and access to services, 4, 102-103, 104-106

and biopsy rates, 48

CAD and, 95-96

insurance costs, 5, 102-103, 104, 113

international comparisons, 67-68, 69

interpretation-related claims, 91, 105

physician extenders and, 112-113

public expectations and, 105

reporting of radiologist performance and, 91-92

settlement of frivolous cases, 89

tort reform, 104, 106

and workforce shortages, 91-92, 104-106

MAMM, 212

Mammogram

defined, 281

image archives, 234, 240-242

Mammogram interpretation. See also Sensitivity of technologies

BI-RADS® scale, 44, 83, 84, 91, 242

bias, 315

CAD technology and, 6-7, 93-96, 271-272

case variation and, 85-87

communicating results to patients, 80, 83

context and organizational factors, 67, 86, 89

decision thresholds, 314-319

diagnostic vs. screening, 85, 112

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2005. Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis. Washington, DC: The National Academies Press. doi: 10.17226/11016.
×

double readings, 64-65, 67, 75, 86, 94, 95, 111, 112, 113, 271

first screens vs. subsequent screens, 85, 87

improving, 80, 90-92, 114

legislation, 80

microcalcifications and, 85, 94, 283

by nonphysicians, 111-114, 115, 271-273

options for improving, 90-92

outsourcing to overseas radiologists, 109-110

professional development, 73

quality of, 6-7, 66, 67, 69, 73, 74, 80, 86-89, 103-106

radiologist volume, 91

reporting of performance results, 80, 91-92

ROC analysis, 314-321

self-assessment programs, 74, 271

by specialists vs. generalists, 86, 89, 94-95, 101, 281

standardization of, 45, 69, 83, 91, 98

training, 73, 86, 89, 92, 271, 283

variability among radiologists, 83, 84, 86

volume of procedures and, 69, 87-89, 90, 265

workforce issues, 103-104, 112-113, 271-272

Mammography. See also Diagnostic mammography;

Screening mammography;

specific technologies

defined, 334

facilities, 21

personnel, see Breast imagers;

Radiologists

technologies, 280-283

Mammography Accreditation Program, 74

Mammography and Beyond report, 2, 109

improvements since issuance of, 21

research recommendations, 10-11, 190-191

technologies reviewed in, 24-27

Mammography Interpretive Skills Assessment, 74

Mammography Quality Standards Act (MQSA), 47, 64

1998 Reauthorization, 80, 83

2003 Reauthorization, 80

costs of compliance, 101-102

criticisms of, 74

data collection requirements, 5

personnel requirements, 113, 272

positive results of, 74, 83, 271

purpose, 61, 79

requirements, 81, 82-83, 113

volume standards, 6, 90, 265

MammoReader®, 21, 94, 222

Marathons, 210-211

Mass media

on benefits of mammography, 2-4, 29, 31-32, 41

and “breakthrough” technologies, 4, 30, 31-32

risk portrayal, 3, 29, 30-31, 49, 143

Mass spectroscopy, 334

Massachusetts General Hospital, 178, 283

Mastectomy

for DCIS, 55

modified radical, 1, 67

prophylactic bilateral, 19, 130, 144, 273, 301, 337

Maynard, C. Douglas, 107-108

MBF Sales LLC, 223

McGill Pain Questionnaire, 46

MDR1 Pgp, 174

Medicaid, 76, 80, 233, 334.

See also Centers for Medicare and Medicaid Services

Medical physicist, 113

Medicare, 64, 78, 79, 81.

See also Centers for Medicare and Medicaid Services

CPT codes, 232, 233

defined, 335

delays in coverage decisions, 259

reimbursement policies, 103, 229

requirements for coverage, 228-229

spending relative to health outcomes, 230

withdrawal of coverage, 231

Medicare Catastrophic Coverage Act of 1988, 79, 81

Medicare Coverage Advisory Committee, 194

Medicare Prescription Drug and

Modernization Act, 80

Men, breast cancer, 139

Menarche, 8, 127, 335

Menopause, 45, 86, 127, 142, 335

Menstrual cycle, 45

Messenger RNA (mRNA), 335, 340

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2005. Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis. Washington, DC: The National Academies Press. doi: 10.17226/11016.
×

Met tyrosine kinase, 174

Meta-analyses, 132, 199, 335

Metaplasia, 335

Metastatic cancer, 52, 160, 161, 298, 299, 335

Methodological issues

bias, 99, 129, 163, 201-202, 323-324, 329, 333

control groups, 323

cross-country comparisons, 69

descriptions of diagnostic or therapeutic techniques, 325

endpoints, 199-201, 323

extrapolation of results, 204-205

generalizability, 320

Gotzsche-Olsen study, 41-43

and meta-analyses, 132, 199, 335

patient population characteristics, 322-323

reference standard, 203

in risk assessments, 123, 124, 131, 199

sample size, 131, 203, 320

statistical analysis and reporting of results, 202, 203, 205, 320, 325, 339

variability in cancer detection tests, 319-321

5-Methylcytosine, 335

Mettlin, Curtis J., 115

Microarrays. See also DNA, microarrays;

Protein, microarrays

comparative genomic hybridization, 166-167

costs, 166

defined, 335

regulatory challenges, 181

sample handling, 170

statistical analysis of data, 170-171

Microcalcifications, 32, 44

and biopsy, 53, 54

DCIS and, 52, 53, 54, 55, 99, 285

defined, 285, 335

and mammogram interpretation, 85, 94, 283, 290

Microwave imaging, 26-27, 288, 290

Midwestern State University, 111

Mikulski, Barbara, 82

MMP2, 174

Molecular imaging

affinity probes, 173-175

animal studies, 9, 172-173, 175, 176, 180, 181

clinical applications, 172, 179, 181-182

clinical research, 236, 237

defined, 172

FDA approval, 177

functional imaging technologies and, 173

MRI, 177-178

multimodal, 176, 177, 178

NCI initiatives, 179-180

noninvasive, 175

optical, 178

radiological, 175-177

research and development, 9, 172-173, 178-180

targets and agents, 174

Molecular Imaging Central, 179

Molecular Imaging Database, 180

Molecular markers, 164, 170, 335.

See also Genetic markers

Molecular profiling

analysis and interpretation of data, 170-171

applications, 164, 165, 168-169, 170

barriers to clinical use, 9, 170-172

clinical trials, 164

high-throughput techniques, 164

limitations, 166, 170, 171-172, 302

regulatory challenges, 181

Monoclonal antibodies, 225

Morbidity, 335

Mortality rates, 19, 20

DCIS and, 50

defined, 336

early detection and, 67

as endpoint, 164, 199, 201

international comparisons, 67, 69, 71, 72

quality of services and, 69, 72, 76

race/ethnicity and, 76, 77

screening and, 1, 40-41, 43, 49, 66

treatment and, 1, 66

Mouse Models of Human Cancer Consortium, 180

Mucin-1 glycoprotein (MUC1), 174

Mucins, 160

Multidisciplinary Clinical Research Workforce Training Program, 238-239

Multidrug resistance, 173, 174, 175

Multifocal breast cancer, 96

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2005. Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis. Washington, DC: The National Academies Press. doi: 10.17226/11016.
×

Mutations

age factors, 128

on BRCA genes, 8, 49, 128, 129-131, 139, 144, 225, 256-258, 261, 296, 299, 327

cellular control disruptions, 168

defined, 336

DNA repair mechanisms, 49, 128, 129, 166

in estrogen pathways, 135-136

germ-line, 126, 128, 158, 332

in immunomodulatory pathways, 136

in iron metabolism, 136

in metabolic pathways, 132, 134-135

microsatellite, 335

mitigating influences, 130

penetrance, 129-130, 133-134, 144, 336

radiation-induced, 130

random, 128

and screening technology, 96

somatic, 128, 158, 167, 339

in tumor suppressor genes, 340

My Best Friend Breast Self-exam Pad, 223

Myriad Genetics, Inc., 257

N

NAT1/NAT2 genes, 134

National Alliance of Breast Cancer Organizations, 212

National Breast and Cervical Cancer Early Detection Program, 78, 80

National Breast Cancer Coalition, 210, 212-213

National Cancer Institute, 10, 13, 22, 42, 93, 182, 208, 234, 236

Breast Cancer Research Progress Group, 10, 190

Cancer Imaging Program, 98, 179-180

Center for Bioinfomatics, 235

Early Detection Research Network, 162-163

funding for research, 189-190, 191, 192, 205, 235

leadership role, 270, 275

National Center for Biotechnology Information, 171

National Center for Health Care Technology, 196

National Center for Health Services Research, 196

National Center for Healthcare Technology, 196

National Digital Mammography Archive, 234, 240-242

National Health Service Breast Screening Programme (UK), 5, 72-73

National Heart, Lung, and Blood Institute, 206

National Institute of Biomedical Imaging and Bioengineering, 108, 196

National Institutes of Health, 11, 107, 225, 230, 276, 278

center programs, 243, 244

Clinical Research Associates, 239

Consensus Development Program, 194, 196

funding for breast cancer research, 22, 23, 80-81, 190

Office on Women’s Health, 98

Roadmap for Medical Research, 195, 237, 238-239

National Library of Medicine, 171, 241

National Surgical Adjuvant Breast and Bowel Project Study of Tamoxifen and Raloxifen, 140, 301

Native American Breast and Cervical Cancer Treatment Technical Amendment Act, 80

Native Americans, 45, 80, 81

Near-infrared fluorochromes, 178

Negative predictive value, 39, 97

Neoangiogenesis, 287

Neoplasm, defined, 336

Netherlands, 5-6, 65, 66, 74, 165, 271

Network for Cooperative Development of Imaging Technology, 93, 98, 99, 196, 203, 235-237

New York City, 101

Nipple aspiration, 126, 302, 336

Node-negative breast cancer, 159

Nordic Cochrane Center, 41

Norepinephrine, 136

North Carolina Breast Cancer Screening Program, 79

Novel Imaging Technologies Program, 180

Nurse practitioners, 110

O

Oak Ridge National Laboratory, 240

Obesity, 45, 86, 124, 130, 301

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2005. Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis. Washington, DC: The National Academies Press. doi: 10.17226/11016.
×

Observational studies, defined, 336

Occult cancer, 96, 97, 160, 336

Olsen, Ole, 41-43

Omnibus Budget Reconciliation Act of 1990, 79, 81

OmniCorder, 222

Office of Health Technology Assessment, 196

Office of Human Research Protections, 239

Office of Medical Applications of Research, 194, 196

Office of Personnel Management, 260

Office of Technology Assessment, 196

Oncogenes, 132, 175, 337

Oncotype DX, 165, 225

Optical imaging

animal studies, 176

applications, 173, 174, 178, 291-292

defined, 336

description, 26-27, 291-292

multimodal, 178

of near-infrared absorption by hemoglobin, 173, 174, 291-292

probes, 173, 174, 175, 176, 178, 291-292

Oral contraceptives, 140

Osteoporosis, 260

Outcomes. See also Clinical outcomes;

Screening outcomes

intermediate, 333

OvaCheck, 225

Ovarian cancer, 129, 156, 160, 169-170, 204, 225, 300, 302, 327

P

Paget’s disease of the nipple, 111, 336

Pakastanis, 133

Pancreatic cancer, 160, 327

Pap smear, 78, 336

Papanicolaou, George N., 336

Paramagnetic atom, 175, 177

Parity, 45

Patents

as barriers to technology adoption, 256-257

composition of matter, 257, 329

methods of use, 257, 335

Patient-provider relationship, 147-148

Paulsen, Keith, 290

Penetrance, 129-130, 133-134, 144, 336

PERFORMS (PERsonal perFORmance in Mammographic Screening), 73, 74, 88

Personnel. See Breast imagers;

Radiologists;

Screening personnel

Petricoin, Emmanuel, 171

Peutz-Jeghers syndrome, 133

Pfizer, 206

Phelps, Michael, 177

Phenotype, 336, 337

Phillips Medical Systems, Inc., 223

Phosphorylation, 167, 168

Photonics, 337

Physician assistants, 110

Physicians Data Query, 42

Physicians Insurers Association of America, 105

Polycyclic aromatic hydrocarbons, 134, 135

Polymerase chain reaction, 164, 337

Polymorphisms, 131-137, 337

Positive predictive value

of biomarkers, 162-163, 205

for biopsy, 67

calculation, 39-40

defined, 39, 337

MRI, 98

prevalence of disease and, 39, 40, 98

Positron emission tomography (PET)

applications, 173, 228, 295, 298

defined, 337

description, 26-27, 295, 298

FDA approval, 228, 279

molecular imaging techniques, 173, 174, 175-177, 333

multimodal, 177

reimbursement policy, 228, 258

PR gene, 135

Practice guidelines, 73, 109, 137-138

Precancerous lesions, 158, 160, 286-287, 337

Prevalence

defined, 39, 337

positive predictive value and, 39, 40, 98

screens, 67

Prevention of breast cancer, 2, 19

clinical trials, 140

defined, 337

primary, 200

secondary, 79, 199-200

Pritzker, Kenneth, 161-162

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2005. Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis. Washington, DC: The National Academies Press. doi: 10.17226/11016.
×

Probability. See also Risk of breast cancer

lifetime, 129, 300, 334

p value, 338

ProDuct Catheter, 222

ProDuct Health, Inc., 222

Progesterone, 76, 124, 125, 135, 161

Prognosis

biomarkers, 159

DCIS, 144-145

defined, 337

molecular imaging, 173

molecular profiling, 165, 166, 299

perceptions of, 144-145

Progression of disease, 337

Proprietary rights, 337

Prostate cancer, 22, 190, 225, 327, 337

Prostate-specific antigen (PSA) testing, 79, 160, 224-225, 228, 337

Protected health information, 214-215

Protein

microarrays, 164, 167-169, 170

phosphorylation, 167, 168

post-translational processing, 168

probes, 177, 178

recombinant, 175

Protein kinase, 133

Proteomics of breast cancer. See also Protein;

Serum, proteomic profiling

defined, 337

Proto-oncogenes, 132, 133-134, 337-338

PSA biomarker, 327

Psychological issues, 47

PTEN gene, 133

Public expectations, 3, 29-32, 41, 105

Public interest in breast cancer, 29, 82

Q

Qualia Computing, Inc., 222

Quality Assessment of Diagnostic Accuracy Studies (QUADAS), 202

Quality of screening services. See also Mammogram interpretation;

Sensitivity of technologies;

Specificity

access to services and, 4, 5, 75-79

accreditation and certification of facilities, 82-83

best practices, 74-75, 253

breast density and, 85, 86

case variation and, 85-87

compliance costs, 101-102

and deployment of new technologies, 264-266

enforcement, 64-65, 83

financial issues, 4-5, 74, 75

history of breast cancer and, 86

integrated health services and, 5, 6, 74, 87

international models, 5-6, 64-73, 74-75, 86, 90, 114, 270-271

legislation, 5, 74, 79-83, 115;

see also Mammography Quality Standards Act

organizational factors, 5-6, 67, 75, 86, 89, 114, 115, 264-266

performance measures, 75, 85-87

physician extenders and, 7, 112, 271

practice guidelines, 73, 109

practice variation and, 86

QUADAS checklist, 202

recommendations, 4, 6-7, 270-273

and screening outcomes, 72-79

self-assessment programs, 6, 73, 74, 265

site visits, 64-65, 83

technology innovations and, 6-7, 92-100, 115, 264-266, 271

R

R2 Technology, Inc., 21, 94, 95, 222, 281

Race/ethnicity

and access to screening, 76

and breast density, 45, 128

and incidence of breast cancer, 76, 77

mortality rates and, 76, 77

risk assessment by, 140

Radiation exposure, hypersensitivity to, 48-49, 126, 130, 142-143

Radiation technologists, 111-112

Radioimmunoassay, 222

Radiolabeled probes, 173, 174, 175

Radiologic technologists, 5, 113, 272

Radiological associate, 110-111

Radiological imaging, 175-177

Radiological Society of North America, 107

Radiologists. See also Breast imagers

academic, 107, 108

clinical research by, 106-109

foreign, 109-110

interpretation of mammograms, 86, 89, 91, 103, 281

malpractice concerns, 104-106

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2005. Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis. Washington, DC: The National Academies Press. doi: 10.17226/11016.
×

moonlighters, 109

practice variation, 86

reimbursement policies, 103

retired, 109

and technology adoption, 108-109

training, 92, 107, 110, 242, 265, 272

workforce shortages, 4, 100, 101-102, 103-106

Radiology Diagnostic Oncology Group, 236

Radiology practitioner assistant, 110

Radiotherapy, 1, 54, 55

Recall rates. See Callback rates

Recommendations

leadership role in implementing, 270, 275

quality improvements in screening mammography, 4, 6-7, 270-273

research and development, 4, 10-11, 12-13, 14, 15, 276-277

risk modeling and communication, 4, 8, 10, 273-276

summary of, 16-17

technology adoption process, 4, 14-15, 278

Recurrence of breast cancer, 55, 225

Red-shifted fluorescent proteins, 178

Reliability and reproducibility, 94, 290, 338

Raloxifen, 140, 301

Reproductive factors, 8, 127

Research and development. See also Clinical trials;

Technology assessment

accelerating, 11, 226-227, 234

animal studies, 172-173

basic medical, 22, 188, 189-190, 195, 274-275

biomarkers, 9, 157, 161-164, 169, 204-205

challenges, 11, 14, 161-164, 170-172, 182-183

collaborative networks, 9-10, 11, 15, 162-163, 179, 180, 182, 211, 218, 230, 234-244, 274, 276

cost-effectiveness analysis, 197, 236

counseling for developers, 237-240

FDA review and approval process, 188, 218-227

funding and funders, 22, 189-191, 192-193, 209-210, 234

health care payers and, 227-234

HIPAA’s impact on, 215-218

medical device classification, 219-221

molecular imaging, 9, 172-173, 178-180

molecular profiling, 170-172

pathway from adoption to clinical practice, 188, 189

population measures of cancer status, 199-201

priorities, 10-11, 190-191

public support for, 209-210

quality of clinical trials and, 198-199

radiologists in, 106-109

reorganization plan, 237, 238-239

screening and diagnostic accuracy

improvements, 202-204

support for discovery, 189-197

translational, 238, 249, 275, 340

workforce training, 238-239, 275

Risk of breast cancer. See also Genetic risk factors;

Probability;

other specific risk factors

absolute (lifetime), 43, 123-124, 143, 326

age and, 8, 20, 30, 31, 124, 125, 126, 127, 130, 137, 143-144

assessment, 8, 22, 123, 132, 137, 139-141, 149, 157, 167, 236

and biopsies, 48

communication of, 10, 147-148, 149, 275-276

counseling, 148

DCIS, 140

and decision making, 145-148, 149-150

defined, 338

density of breasts and, 127, 128

double mastectomy and, 19

epidemiological studies, 123, 125, 131, 137, 211, 273

and frequency of screening, 141-142

Gail model, 8, 139-140, 141, 143, 273

individualized prediction, 7-8, 137-141

LIN and, 52

management, 4, 8, 10, 137-148

media portrayal of, 3, 29, 30-31

in men, 139

odds ratio, 336

perception, 3, 29, 143-145, 149, 276

physical exercise and, 130

reduction measures, 144

relative, 123, 124, 128, 143, 338

and screening technology, 92, 96, 97-98, 294

stratification, 48, 131-132, 137-139, 141-143, 146-147, 149, 199, 236, 273

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2005. Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis. Washington, DC: The National Academies Press. doi: 10.17226/11016.
×

study designs, 123, 124, 131, 199

uncertainty, 145-147

RNA. See also Messenger RNA

polymerase, 340

transcription, 340

ROC analysis

curves mapping decision thresholds, 315-319

decision thresholds on individual readers, 314-315

multiple-reader, multiple-case, 319-321

Rosenberg, Alan, 228, 230, 232

Rosenberg, R.N., 188

S

Sarcoma, defined, 327

Schwartz, Lisa, 31-32

Scintimammography

defined, 338

description, 26-27, 295, 297-298

EIS compared, 290

FDA approval, 223

tracers, 173

Screen-film (conventional x-ray) mammography

accuracy, 21, 92

defined, 338

description, 24-25, 280, 281

FDA approved systems, 223, 279

Screening for breast cancer

defined, 338

goals, 20, 38, 40, 85

integration of approaches, 23-24, 29, 74

key strategies for saving lives, 28-29

standard of care, 109, 273, 281

standards of evidence, 38-41

Screening mammography. See also Mammography interpretation;

Quality of screening services;

Sensitivity of technologies;

Specificity

adherence to guidelines, 143, 273, 276

adjunctive technologies, 6-7, 99, 155, 156, 157, 160-161, 219, 279, 284, 285, 287, 289-290, 292

benefits, 20, 37, 141, 145

contralateral, 98, 236

controversy over value of, 2, 3-4, 22, 41-44, 63

DCIS dilemma, 49-56

defined, 37

expert reviews of trials, 42-43

facility closures, 103-106

FDA-approved technologies, 21, 94, 96, 98, 279

frequency, 5, 51-52, 67, 69, 72, 141-142

funding for, 80

harms from, 43, 46-49, 141

international comparisons, 63-72

legislation, 79-84

as mammography complement, 155, 157, 160-161

media portrayal of benefits, 2, 29, 31-32, 41

menstrual cycle and, 45

pain and anxiety, 2, 43, 45, 46-47

perceptions of effectiveness, 143, 145, 146

radiation risk, 48-49

referrals, 64-65, 75

standard of care, 7, 40, 281

technologies, 24-27, 280-283

utilization rates, 20, 76, 147-148

views per breast, 64-65, 67

WHO guidelines, 38

Screening outcomes. See also Mortality rates;

Survival

abnormal, 67, 68, 70

international comparisons, 69-72

quality assurance and, 72-79

terminology, 39

volume of procedures and, 87-89

Screening personnel. See also Breast imagers;

Radiologists;

Workforce issues

and interpretation of mammograms, 91

moonlighters, 109

physician extenders, 7, 110-114, 272-273

recruitment, 80

shortages, 6-7, 80, 91, 101-106, 109-110

and technology adoption, 108-109

Second Look®, 21, 94, 222

Second opinions, 74, 103

Secondary cancer, 338

Self-examination. See Breast self-examination

Senographe 2000D, 222, 282, 283

Sensitivity of technologies, 314-315

age factors, 85, 87, 281

CAD, 94, 95

calculation, 38, 39

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2005. Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis. Washington, DC: The National Academies Press. doi: 10.17226/11016.
×

defined, 38, 39, 203, 281, 338

density of breast tissue and, 2, 44-45, 48, 49, 86, 96, 99-100, 105, 281, 282, 294, 297, 298

electrical-property-based technologies, 289, 290

false negatives, 2

false positives, 2, 21, 38-39, 43, 47-48, 87, 89, 94

international comparisons, 70

molecular profiling methods, 169, 170

MRI, 32, 45, 96-97

organizational efficiency and, 265

of radiation technologists, 111

screen-film vs. other technologies, 92, 94, 96-98, 156, 281

SensoScan FFDM, 222

Serum

estradiol, 142

proteomic profiling, 159, 164, 169-170, 171, 225, 261, 296, 301-302

Siemens Medical Systems, 223

Sigma-2 receptors, 174

Signal transduction, 173, 338

Single nucleotide polymorphism, 158, 167

Single-photon emission computer tomography (SPECT), 173, 174, 175-177, 333

Small Animal Imaging Resource Program, 180

Smith, Robert A., 115

Social factors, access to screening, 76, 78

Social injustice, 76, 78

Social Security Act

Amendments of 1965, 79

Native American Breast and Cervical Cancer Treatment Technical Amendment Act, 80

Society of Breast Imaging, 90, 101

Socioeconomic status, and access to screening, 5, 76

Soft copy, 94, 338

Sonography. See Ultrasound

Spain, 66

Specificity

calculation, 39

defined, 38, 39, 203, 281, 339

electrical-property-based technologies, 289, 290

international comparisons, 70

lesion margin visibility, 282

molecular profiling methods, 169, 170

of radiation technologists, 111

screen-film mammography, 156, 281

Specimen banks, 339

Spectroscopy. See also Magnetic resonance spectroscopy

defined, 339

electrical impedance, 290

Squamous cell carcinoma, 339

Staging of breast cancer, 66-67, 96, 99

Stamp Out Breast Cancer Act, 80-81

Standard of care, 7, 40, 161, 281

Standards for Reporting Diagnostic Accuracy, 202

State laws regulating mammography, 79

States as Certifiers program, 80

Statistical analysis, 314-321

Sullivan, Daniel, 98

Supervised analysis, 165

Surrogate endpoints, 100, 339

Surveillance, defined, 339

Surveillance Epidemiology and End Results (SEER, U.S.) data set, 66

Survival

benefit, 333

defined, 199, 339

early diagnosis and, 66-67, 69

as endpoint, 199, 201

incidence of cancer and, 199, 201

international comparisons, 66-67, 71

invasive breast cancer, 71

mastectomy and, 55

measuring, 199, 200

men, 138

overestimation, 333

race/ethnicity and, 76

Susan G. Komen Foundation, 190, 192, 213

Susan Love MD Breast Cancer Foundation, 193, 212

“Suspicious” findings, 48, 98

Sweden, 5-6, 65, 67, 72, 74, 90, 271

Systemic therapy, 339

T

T-Scan 2000, 219, 222, 255, 256, 289

Tamoxifen, 54, 55, 130, 301

Technetium-99m, 174, 297

Technologies

anatomical, 280-294

biological, 295-302

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2005. Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis. Washington, DC: The National Academies Press. doi: 10.17226/11016.
×

biopsy, 302-306

“breakthrough,” 4, 26, 30, 31-32, 191, 279

FDA-approved, 21, 24-27, 92, 94, 96, 98, 161, 173, 222-223, 279, 281, 282, 284, 286, 287, 289, 295, 297

high-throughput, 164, 169, 332

inappropriate, 109

“promising,” 279

reviewed in Mammography and Beyond report, 24-27

Technology adoption

in clinical practice, 3, 100

complexity and, 254-255

consumer demand and, 259-260

cost-effectiveness considerations, 14, 197

deployment, 14, 249-250, 252, 253, 261-266

drivers of, 100, 254-261

FDA approval and, 13, 14, 198, 255-257

information management and, 262, 263

insurance coverage and, 13, 14, 95, 188, 227-228, 229, 257-259

integration into practice, 3, 14, 250, 232, 253, 261-266

minimally invasive cardiac surgery, 263, 264

monitoring, 249, 250, 252, 253, 265

and organizational change, 261-266, 276

patents and, 256-257

patients’ willingness to pay and, 259

perceptions of benefits and, 254

practitioners and, 108-109

process, 251-254, 278

time lapse between R&D and, 23

typology of adopters, 254

void-filling technologies, 260-261

volume-outcome hypothesis, 264

Technology assessment. See also Clinical trials

assessors, 193, 194-195

centers, 194, 243-244, 276

in clinical settings, 251-252

defined, 191, 193

by health care delivery organizations, 250, 252-253

by health care payers, 227-234

history of federal involvement in, 196

integration and coordination of, 11, 195-196, 250, 252-253, 276, 278

scope of, 253-254

Telemammography, 109-110, 217, 240, 282, 339

Telomerase expression, 173

Texas Department of Health, 82

TGFBR16a, 134

Thermoacoustic computed tomography, 26-27

Thermography, 26-27, 255, 285, 286-287, 339

Thermorhythmometry, 285, 287

Thermotherapy, 339

Tissue array, 340

Tissue samples, handling, 163

TNF-alpha gene, 132, 136

Tomography. See also Computed tomography

defined, 340

fluorescence-mediated, 178

Tomosynthesis. See also Digital tomosynthesis mammography

defined, 340

Tp53 gene, 133

TranScan Medical, Inc., 222

Transcription.

See also RNA mutations, 134, 135, 137

Transcriptome, 340

Transforming growth factor, 134

Treatment. See also individual treatment modalities

clinical trials, 210

combinatorial, 168

DCIS, 54-55

decision aids, 146, 161

gene therapy, 172, 175

high-dose chemotherapy with bone marrow transplantation, 210, 260

image-guided, 172

individualized case management, 9, 182

international comparisons, 67

legislation related to, 80

molecular targeting, 9, 168-169, 172, 175, 182

monitoring response to, 161, 169, 172, 175, 177, 182, 228, 236, 279

predicting response to, 167

staging and follow-up, 96

unnecessary, 1, 21-22, 54-56

Trex Medical Corp., 223

Truquant® BR™ RIA, 222

Tumor suppressor genes, 137, 166, 299-300, 336, 340

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2005. Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis. Washington, DC: The National Academies Press. doi: 10.17226/11016.
×

Tumorigenesis

changes common in, 165

defined, 340

ionic imbalances, 288, 289

metabolism, 173

vascular activity, 173, 287, 291, 292

Tumors

cell surface receptors, 173, 175, 177

defined, 340

electrical conducting properties, 290

high-grade, 54-55

immune response to, 136

marker, 340

occult, 96, 97, 160, 336

palpable, 98-99, 305, 336

staging, 66-67

Tunis, Sean, 228, 230, 232

U

UGT1A1 gene, 136

Ultramark 9 HDI Ultrasound System, 222

Ultrasound

clinical applications, 54, 98-99, 173, 284, 285-286, 303

clinical trials, 236

combined with screening mammography, 99

contrast agents, 332

cost-effectiveness, 100

defined, 339, 340

density of breast tissue and, 45, 99-100

description, 24-25, 284, 285-286

FDA approval, 98, 222, 284

image storage, 242

molecular imaging, 173, 176

novel techniques, 26-27, 54, 173, 286

quality for screening, 96, 98-100

United HealthCare, 195

United Kingdom

data archives, 242

intervals for screening, 5

organization of screening services, 5

perceptions of benefits of mammography, 145

quality assurance program, 65, 66, 74, 92, 271

radiographers, 111, 112

risk perception by women in, 143

malpractice environment, 69, 89, 111

National Health Service Breast Screening Programme, 5, 72-73

screening outcomes, 70-71

volume standards, 90

workforce issues, 111, 112

United States Preventive Services Task Force, 43, 194, 232

University of California at Los Angeles, 177

University of California at San Francisco, 306

University of Chicago, 240

University of Kentucky, 110

University of Medicine and Dentistry, 111

University of North Carolina, 111, 240, 283

University of Pennsylvania, 240

University of Texas Health Science Center, 42

University of Toronto, 240

University of Virginia, 292

Unsupervised analysis, 165, 169

Urokinase plasminogen activator, 159

U.S. Air Force, 109

U.S. Army, 109

U.S. Navy, 109

U.S. Postal Service, 80

Utilization of mammography age and, 20, 64

false positive results and, 47-48

increasing, 269

insurance coverage and, 76, 78-79, 149

rates, 20, 76, 147-148

risk perception and, 143, 273, 276

V

Validity. See Clinical validity

Van Nuys Prognostic Index, 53

Vasoactive intestinal peptide receptors, 174

VDR gene, 137

Venipuncture, defined, 340

Veterans’ Benefits Act of 1997, 80

Veterans Health Administration, 80

Visual Analog Scale and Brief Pain Inventory, 46

W

Weber State University, 110

Weissleder, Ralph, 178

WellPoint Health Networks, 195, 228, 229, 230, 232

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2005. Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis. Washington, DC: The National Academies Press. doi: 10.17226/11016.
×

Whites, 76, 128, 133, 208

Windy Hill Technology, Inc. Aspirator, 222

Workforce issues. See also Breast imagers;

Radiologists

access to screening services, 4, 7, 21, 100, 101-102, 103-106, 115

capacity building strategies, 7, 109-114

malpractice litigation, 91-92, 104-106, 112-113

physician extenders, 7, 110-114, 272-273

recommendations, 7

research and development, 106-109

technology adoption, 108-109

World Health Organization, 42.

See also International Agency for Research on Cancer

principles of effective screening, 38

X

X-rays

defined, 340

monoenergetic, 335

synchrotron-based machine, 260, 283

Y

Y-Me National Breast Cancer Organization, 212

Z

Zerhouni, Elias, 195, 237

Zheng, Bin, 94

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2005. Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis. Washington, DC: The National Academies Press. doi: 10.17226/11016.
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Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis Get This Book
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The outlook for women with breast cancer has improved in recent years. Due to the combination of improved treatments and the benefits of mammography screening, breast cancer mortality has decreased steadily since 1989. Yet breast cancer remains a major problem, second only to lung cancer as a leading cause of death from cancer for women. To date, no means to prevent breast cancer has been discovered and experience has shown that treatments are most effective when a cancer is detected early, before it has spread to other tissues. These two facts suggest that the most effective way to continue reducing the death toll from breast cancer is improved early detection and diagnosis.

Building on the 2001 report Mammography and Beyond, this new book not only examines ways to improve implementation and use of new and current breast cancer detection technologies but also evaluates the need to develop tools that identify women who would benefit most from early detection screening. Saving Women’s Lives: Strategies for Improving Breast Cancer Detection and Diagnosis encourages more research that integrates the development, validation, and analysis of the types of technologies in clinical practice that promote improved risk identification techniques. In this way, methods and technologies that improve detection and diagnosis can be more effectively developed and implemented.

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