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
socioeconomic status and, 5, 76
and survival rates, 66-67
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
clinical trials of, 202-204
defined, 326
molecular profiling, 170
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
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
Agency for Healthcare Research and Quality, 11, 194, 195, 196, 199, 234, 276, 278
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
Angiogenesis, 159, 165, 172, 173, 287, 326
Annas, George, 215
Anti-angiogenesis drugs, 172
Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), 205, 206-207, 208-209, 210, 253
APC gene, 137
AR gene, 136
Arkansas Department of Health, 82
Artificial intelligence systems, 169
Ashkenazi Jewish women, 129, 130, 131
Association of American Medical Colleges, 12, 218
AstraZeneca, 206
Ataxia telangiectasia, 133
ATM gene, 133
Atypical hyperplasia, 52, 126, 326
Austin, Melissa, 130
Axillary node dissection, 67
B
Balanced Budget Refinement Act of 1999, 233
Benign lesions, 52, 97, 98, 170, 294
Berlin, Leonard, 89
Beta-galactosidase, 177
Bias, 99
in clinical trials, 326-327
defined, 323-324
interpretation, 315
systematic or measurement errors, 163, 324
Biologically based technologies. See also Biomarkers and biomarker assays;
Molecular imaging;
Molecular profiling;
specific technologies
clinical applications, 155, 156-157, 181-182, 274
Bioluminate, Inc., 306
Bioluminescent probes, 175, 176, 178
Biomarkers and biomarker assays. See also Genetic markers;
individual biomarkers
discovery and development, 9, 157, 161-164, 169, 204-205
for DNA stability, 335
handling of tissue samples, 163
limitations, 157, 158-159, 160
as mammography complement, 155, 157, 160-161
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
density of breast tissue and, 53
fine needle aspiration, 126, 299, 301, 304-305, 331
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
risk factors for, 48
specimen handling, 166
supplemental technologies, 170, 305
surgical, 53, 69, 71, 302, 303-304, 306
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
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
and biopsy method, 53
mapping, 286
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
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
Case-control studies, 124, 125, 132, 204-205, 327-328
Case reports, 328
Catecholamine transmitters, 136
Cathepsin B, 175
Catheter, 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
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
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
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
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
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)
defined, 329
FDA-approved systems, 21, 94, 222, 279, 281
image archive and, 240-241
and interpretation of mammograms, 6-7, 93-96, 271-272
risk of breast cancer and use of, 92
COMT gene, 136
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
financial losses from, 103
interpretation of mammograms, 85, 112
Diagnostic testing, 330
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
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
Dopamine, 136
Dose-response relationship, 49, 330
Dosimetry, 330
Drug-eluting stents, 259
DucPrep™ Breast, 222
Ductal carcinoma in situ (DCIS)
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
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
measure of, 40-41
of national programs, 42
technology assessment, 249, 251
Efficacy of screening
age and, 42
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
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
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
MRI, 98
psychological effects, 47
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
Fibrocystic breast disease, 52, 204
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
Friends…you can count on, 193
Frost & Sullivan, 258
Full-field digital mammography
CAD use with, 94
clinical trials, 93, 202, 203, 282
defined, 332
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
Gene. See also specific genes
amplification, 166, 167, 168, 326
copying alterations, 168
defined, 332
positional cloning, 337
in susceptibility to breast cancer, 126, 129-137, 327
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
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
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
and telemammography, 217
and tissue and data repositories, 215, 242
Health maintenance organizations, 332
Heterogeneous characteristics, 159, 161, 332
Heterozygosity
defined, 332
HFE/HH gene, 136
HGF/SF60, 174
High-dose chemotherapy with bone marrow transplantation, 210, 260
Hispanics, 76
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
Hyperplasia
defined, 332
lobular, 52
I
IBM, 242
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
defined, 333
as endpoint, 199
rates, 1, 31, 43, 50, 51, 76, 77, 142
screens, 67
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
defined, 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
J
Japan, 242
Johns Hopkins University, 166
K
Kaiser Permanente, 194
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
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
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
deceptive marketing of, 30, 31-32, 98, 279
defined, 334
elastographic, 286
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
and workforce shortages, 91-92, 104-106
MAMM, 212
Mammogram
defined, 281
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
double readings, 64-65, 67, 75, 86, 94, 95, 111, 112, 113, 271
first screens vs. subsequent screens, 85, 87
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
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
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
prophylactic bilateral, 19, 130, 144, 273, 301, 337
Maynard, C. Douglas, 107-108
MBF Sales LLC, 223
McGill Pain Questionnaire, 46
MDR1 Pgp, 174
See also Centers for Medicare and Medicaid Services
Medical physicist, 113
See also Centers for Medicare and Medicaid Services
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
Menopause, 45, 86, 127, 142, 335
Menstrual cycle, 45
Met tyrosine kinase, 174
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
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
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
DCIS and, 52, 53, 54, 55, 99, 285
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
defined, 172
FDA approval, 177
functional imaging technologies and, 173
MRI, 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
DCIS and, 50
defined, 336
early detection and, 67
international comparisons, 67, 69, 71, 72
quality of services and, 69, 72, 76
screening and, 1, 40-41, 43, 49, 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
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
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
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
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
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
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
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
Optical imaging
animal studies, 176
applications, 173, 174, 178, 291-292
defined, 336
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
Papanicolaou, George N., 336
Parity, 45
Patents
as barriers to technology adoption, 256-257
composition of matter, 257, 329
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
Phillips Medical Systems, Inc., 223
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
Positive predictive value
for biopsy, 67
calculation, 39-40
MRI, 98
prevalence of disease and, 39, 40, 98
Positron emission tomography (PET)
applications, 173, 228, 295, 298
defined, 337
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
positive predictive value and, 39, 40, 98
screens, 67
Prevention of breast cancer, 2, 19
clinical trials, 140
defined, 337
primary, 200
Pritzker, Kenneth, 161-162
Probability. See also Risk of breast cancer
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
post-translational processing, 168
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
case variation and, 85-87
compliance costs, 101-102
and deployment of new technologies, 264-266
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 variation and, 86
QUADAS checklist, 202
recommendations, 4, 6-7, 270-273
and screening outcomes, 72-79
self-assessment programs, 6, 73, 74, 265
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 incidence of breast cancer, 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
clinical research by, 106-109
foreign, 109-110
interpretation of mammograms, 86, 89, 91, 103, 281
malpractice concerns, 104-106
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
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
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
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
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
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
defined, 338
FDA approved systems, 223, 279
Screening for breast cancer
defined, 338
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
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
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
utilization rates, 20, 76, 147-148
WHO guidelines, 38
Screening outcomes. See also Mortality rates;
Survival
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
Secondary cancer, 338
Self-examination. See Breast self-examination
Senographe 2000D, 222, 282, 283
Sensitivity of technologies, 314-315
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
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
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 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
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
Surveillance, defined, 339
Surveillance Epidemiology and End Results (SEER, U.S.) data set, 66
Survival
benefit, 333
early diagnosis and, 66-67, 69
incidence of cancer and, 199, 201
international comparisons, 66-67, 71
invasive breast cancer, 71
mastectomy and, 55
men, 138
overestimation, 333
race/ethnicity and, 76
Susan G. Komen Foundation, 190, 192, 213
Susan Love MD Breast Cancer Foundation, 193, 212
Sweden, 5-6, 65, 67, 72, 74, 90, 271
Systemic therapy, 339
T
T-Scan 2000, 219, 222, 255, 256, 289
Technologies
anatomical, 280-294
biological, 295-302
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
complexity and, 254-255
consumer demand and, 259-260
cost-effectiveness considerations, 14, 197
deployment, 14, 249-250, 252, 253, 261-266
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
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
in clinical settings, 251-252
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
Thermotherapy, 339
Tissue array, 340
Tissue samples, handling, 163
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
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
Trex Medical Corp., 223
Truquant® BR™ RIA, 222
Tumorigenesis
changes common in, 165
defined, 340
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
staging, 66-67
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
density of breast tissue and, 45, 99-100
description, 24-25, 284, 285-286
image storage, 242
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
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
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
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
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
Zheng, Bin, 94