Publications by authors named "Åsne S Holen"

10 Publications

  • Page 1 of 1

Detection and significance of small and low proliferation breast cancer.

J Med Screen 2021 Jun 22:9691413211023970. Epub 2021 Jun 22.

Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway.

Objectives: To determine the frequency and discuss possible implications of early breast cancer with particularly good prognosis and defined by tumor diameter and cell proliferation.

Setting: Detection of small and slowly growing tumors presents a challenge in breast cancer management, due to the risk of over-treatment. Here, we attempted to define a group of such tumors by combining small diameter (≤10 mm, T1ab tumors) with low tumor cell proliferation (≤10% Ki67 expression rate). These tumors were termed small low proliferation cancers (SLPC).

Methods: Two population-based cohorts were studied: a small research series ( = 534), and a nation-wide registry-based series of prospectively collected routine data ( = 8433). In the latter, we stratified by detection mode; screen-detected, interval, and breast cancers detected outside of screening. Patients were treated according to national guidelines at time of their diagnosis. For both cohorts, we compared tumor histopathology and risk of breast cancer death using a log-rank test for cases with SLPC versus non-SLPC.

Results: In the research series (median follow-up 151 months), the frequency of SLPC was 10% (54/534), with one breast cancer death compared with 78 among the remaining 480 cases of non-SLPC ( = 0.008). In the registry series (median follow-up 42 months), the frequency of SLPC was 10% (854/8433), with five deaths compared to 187 among the remaining 7579 cases ( = 0.0004).

Conclusions: SLPC was associated with very low risk of breast cancer death. Prospective randomized trials are needed to clarify whether less aggressive treatment could be a safe option for women with such early breast cancers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/09691413211023970DOI Listing
June 2021

Interval and Subsequent Round Breast Cancer in a Randomized Controlled Trial Comparing Digital Breast Tomosynthesis and Digital Mammography Screening.

Radiology 2021 07 11;300(1):66-76. Epub 2021 May 11.

From the Cancer Registry of Norway, PO 5313, Maiorstuen, 0304 Oslo, Norway (S.H., N.M., Å.S.H., A.S.D.); Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway (S.H.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (C.I.L.); Department of Health Services, University of Washington School of Public Health, Seattle, Wash (C.I.L.); Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia (N.H.); Department of Radiology (H.S.A., I.S.H.), Department of Pathology (L.A.A.), and Mohn Medical Imaging and Visualization Centre (I.S.H.), Haukeland University Hospital, Bergen, Norway; and Department of Clinical Medicine (H.S.A., I.S.H.), Section for Pathology (L.A.A.), and Centre for Cancer Biomarkers CCBIO (L.A.A.), University of Bergen, Bergen, Norway.

Background Prevalent digital breast tomosynthesis (DBT) has shown higher cancer detection rates and lower recall rates compared with those of digital mammography (DM). However, data are limited on rates and histopathologic tumor characteristics of interval and subsequent round screen-detected cancers for DBT. Purpose To follow women randomized to screening with DBT or DM and to investigate rates and tumor characteristics of interval and subsequent round screen-detected cancers. Materials and Methods To-Be is a randomized controlled trial comparing the outcome of DBT and DM in organized breast cancer screening. The trial included 28 749 women, with 22 306 women returning for subsequent DBT screening 2 years later (11 201 and 11 105 originally screened with DBT and DM, respectively). Differences in rates, means, and distribution of histopathologic tumor characteristics between women prevalently screened with DBT versus DM were evaluated with Z tests, tests, and χ tests. Relative risk (RR) with 95% CIs was calculated for the cancer rates. Results Interval cancer rates were 1.4 per 1000 screens (20 of 14 380; 95% CI: 0.9, 2.1) for DBT versus 2.0 per 1000 screens (29 of 14 369; 95% CI: 1.4, 2.9; = .20) for DM. The rates of subsequent round screen-detected cancer were 8.1 per 1000 (95% CI: 6.6, 10.0) for women originally screened with DBT and 9.1 per 1000 (95% CI: 7.4, 11.0; = .43) for women screened with DM. The distribution of tumor characteristics did not differ between groups for either interval or subsequent screen-detected cancer. The RR of interval cancer was 0.69 (95% CI: 0.39, 1.22; = .20) for DBT versus DM, whereas RR of subsequent screen-detected cancer for women prevalently screened with DBT versus DM was 0.89 (95% CI: 0.67, 1.19; = .43). Conclusion Rates of interval or subsequent round screen-detected cancers and their tumor characteristics did not differ between women originally screened with digital breast tomosynthesis (DBT) versus digital mammography. The analysis suggests that the benefits of prevalent DBT screening did not come at the expense of worse downstream screening performance measures in a population-based screening program. © RSNA, 2021 See also the editorial by Taourel in this issue.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1148/radiol.2021203936DOI Listing
July 2021

Digital breast tomosynthesis in a population based mammographic screening program: Breast compression and early performance measures.

Eur J Radiol 2021 Jun 19;139:109665. Epub 2021 Mar 19.

Cancer Registry of Norway, Oslo, Norway; Faculty of Health Sciences Oslo Metropolitan University, Oslo, Norway. Electronic address:

Purpose: We aimed to determine if compression force or pressure could be associated with early performance measures for women screened with digital breast tomosynthesis (DBT) in BreastScreen Norway. Early performance measures included rates of consensus, recall, and screen-detected breast cancer.

Method: Data on compression force and pressure, compressed breast thickness and breast characteristics were extracted from an automated software for density assessment of DBT screening examinations for 25,286 women. For descriptive analyses, force (Newton, N) and pressure (kilopascal, kPa) were categorized into quartiles. Analyses were stratified by mammographic view, craniocaudal (CC) and mediolateral oblique (MLO). Logistic regression with restricted cubic splines was used to investigate the association between force and pressure as continuous exposures and early performance measures adjusted for age, compressed breast thickness and fibroglandular volume.

Results: Mean age of the screened women was 60.7 (SD = 5.2) years. Mean compression force was 90.8 (SD = 14.2) N for CC and 106.3 (SD = 20.6) N for MLO, and pressure was 11.3 (SD = 3.6) kPa for CC and 8.7 (SD = 2.0) kPa for MLO. The highest rates of screen-detected cancer were observed for low force (1.04 % for <82.5 N for CC and 1.07 % for <92.0 N for MLO) and low pressure (1.07 % for <7.2 kPa for MLO). No association was found between force or pressure as continuous exposures and early performance measures in adjusted regression analyses.

Conclusions: We found the highest rates of screen-detected cancer for low force and pressure, but no significant association between continuous values of force or pressure and early performance measures in DBT. The findings might indicate that the levels of force and pressure in DBT are of lower significance for screening performance than reported in standard digital mammography.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejrad.2021.109665DOI Listing
June 2021

Assessment of breast positioning criteria in mammographic screening: Agreement between artificial intelligence software and radiographers.

J Med Screen 2021 12 9;28(4):448-455. Epub 2021 Mar 9.

Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway.

Objectives: To determine the agreement between artificial intelligence software (AI) and radiographers in assessing breast positioning criteria for mammograms from standard digital mammography and digital breast tomosynthesis.

Methods: Assessment of breast positioning was performed by AI and by four radiographers in pairs of two on 156 examinations of women screened in Bergen, April to September 2019, as part of BreastScreen Norway. Ten criteria were used; three for craniocaudal and seven for mediolateral-oblique view. The criteria evaluated the appearance of the nipple, breast rotation, pectoral muscle, inframammary fold and pectoral nipple line. Intraclass correlation and Cohen's kappa coefficient (κ) were used to investigate the correlation and agreement between the radiographer's assessments and AI.

Results: The intraclass correlation for the pectoral nipple line between the radiographers and AI was >0.92. A substantial to almost perfect agreement (κ > 0.69) was observed between the radiographers and AI on the nipple in profile criterion. We observed a slight to moderate agreement for the other criteria (κ = 0.06-0.52) and generally a higher agreement between the two pairs of radiographers (mean κ = 0.70) than between the radiographers and AI (mean κ = 0.41).

Conclusions: AI has great potential in evaluating breast position criteria in mammography by reducing subjectivity. However, varying agreement between radiographers and AI was observed. Standardized and evidence-based criteria for definitions, understandings and assessment methods are needed to reach optimal image quality in mammography.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0969141321998718DOI Listing
December 2021

Interval and Consecutive Round Breast Cancer after Digital Breast Tomosynthesis and Synthetic 2D Mammography versus Standard 2D Digital Mammography in BreastScreen Norway.

Radiology 2020 02 10;294(2):256-264. Epub 2019 Dec 10.

From the Departments of Radiology (T.H., H.B.) and Research (K.K.S.), Vestre Viken Hospital Trust, Drammen, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway (T.H.); Cancer Registry of Norway, Oslo, Norway (Å.S.H., S.H.); Department of Diagnostic Radiology, Department of Translational Medicine, Lund University, Malmö, Sweden (K.L.); Institute for Biomedical Engineering, Zurich, Switzerland (K.L.); Departments of Radiology (J.L.A.) and Pathology (P. Suhrke), Vestfold Hospital Trust, Tønsberg, Norway; Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway (S.H.B.B., P. Skaane); and Department of Life Sciences and Health, Faculty of Health Science, Oslo Metropolitan University, PO 5313 Majorstuen, 0304, Oslo, Norway (S.H.).

Background Screening that includes digital breast tomosynthesis (DBT) with two-dimensional (2D) synthetic mammography (SM) or standard 2D digital mammography (DM) results in detection of more breast cancers than does screening with DM alone. A decrease in interval breast cancer rates is anticipated but is not reported. Purpose To compare rates and characteristics of interval breast cancer in women screened with DBT and SM versus those screened with DM alone and screen-detected breast cancer at consecutive screenings with DM. Materials and Methods This prospective cohort study from BreastScreen Norway included women screened with DBT and SM (study group) or DM alone (control group) between February 2014 and December 2015 (baseline). All women, except nonattendees, women with breast cancer, and those who exceeded the upper age limit, were consecutively screened with DM after 2 years. Interval breast cancer, sensitivity, and specificity were estimated for women screened at baseline. Recall, screen-detected breast cancer, and positive predictive value were analyzed for consecutively screened women. A χ test, test ( < .001 after Bonferroni correction indicated a significant difference), and binomial regression model were used to analyze differences across groups. Results A total of 92 404 women who underwent baseline screening (mean age, 59 years ± 6 [standard deviation]) were evaluated; 34 641 women in the study group (mean age, 59 years ± 6) were screened with DBT and SM and 57 763 women in the control group (mean age, 59 years ± 6) were screened with DM. A total of 26 474 women in the study group (mean age, 60 years ± 5) and 45 543 women in the control group (mean age, 60 years ± 5) were consecutively screened with DM. Rates of interval breast cancer were 2.0 per 1000 screened women in the study group and 1.5 per 1000 screened women in the control group ( = .12). No differences in histopathologic characteristics of interval breast cancer were observed. In the consecutive screening round, rates of screen-detected breast cancer were 3.9 per 1000 screened women (study group) and 5.6 per 1000 screened women (control group) ( = .001). Rates of histologic grade 1 invasive cancer were 0.5 per 1000 screened women (study group) and 1.3 per 1000 screened women (control group) ( = .001). Conclusion No differences in interval breast cancer rates or tumor characteristics were observed in women screened with DBT and SM compared with women screened with DM. Higher rates of low-grade screen-detected tumors were observed in the control group at consecutive screening. © RSNA, 2019
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1148/radiol.2019191337DOI Listing
February 2020

Screening outcome for consecutive examinations with digital breast tomosynthesis versus standard digital mammography in a population-based screening program.

Eur Radiol 2019 Dec 11;29(12):6991-6999. Epub 2019 Jun 11.

Cancer Registry of Norway, P.O 5313, Majorstuen, 0304, Oslo, Norway.

Objectives: To retrospectively investigate early performance measures of digital breast tomosynthesis (DBT) versus standard digital mammography (DM) for consecutive screening rounds.

Methods: We included information about 35,736 women screened in BreastScreen Norway, 2008-2016, with at least two consecutive screening examinations. The pair of two consecutive screening examinations was the unit of analysis, and results from the subsequent examination were the measure of interest. Screening technique changed during the study period, resulting in four study groups: DM after DM, DBT after DM, DM after DBT, and DBT after DBT. We compared selected early performance measures between the study groups.

Results: Recall for DM after DM was 3.6% and lower for all other study groups (p < 0.001). The rate of screen-detected breast cancer was 4.6/1000 for DM after DM; for DBT after DM and DBT after DBT, it was 9.9/1000 and 8.3/1000, respectively (p < 0.001 relative to DM after DM), and for DM after DBT 4.3/1000. The rate of tubular carcinoma was higher for DBT after DBT or after DM compared with DM after DM (p < 0.01). The rate of histologic grade 1 tumors was higher for DBT after DM compared with DM after DM (p < 0.001). We did not observe any statistical difference in the interval cancer rates.

Conclusions: Lower recall and higher cancer detection rates for screening with DBT were sustainable over two consecutive screening rounds. Positive predictive values were higher for DBT than DM. There were no differences in the interval cancer rates between the study groups.

Key Points: • There is limited knowledge about early performance measures for screening with digital breast tomosynthesis beyond one screening round. • A decline in recall rate and an incline in the rate of screen-detected breast cancer were observed for women screened with DBT compared with DM, irrespective of prior screening technique. The interval breast cancer rate did not differ statistically for women screened with DBT versus DM. • Tumor characteristics tended to be prognostic favorable for DBT compared with DM with no differences in rates of more advanced cancers. The clinical significance of increased cancer detection and the potential for future mortality reduction remain unknown.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00330-019-06264-yDOI Listing
December 2019

Two-view digital breast tomosynthesis versus digital mammography in a population-based breast cancer screening programme (To-Be): a randomised, controlled trial.

Lancet Oncol 2019 06 8;20(6):795-805. Epub 2019 May 8.

Department of Pathology, Haukeland University Hospital, Bergen, Norway; Centre for Cancer Biomarkers, Haukeland University Hospital, Bergen, Norway; Deparment of Clinical Medicine, University of Bergen, Bergen, Norway.

Background: Digital breast tomosynthesis is an advancement of mammography, and has the potential to overcome limitations of standard digital mammography. This study aimed to compare first-generation digital breast tomo-synthesis including two-dimensional (2D) synthetic mammograms versus digital mammography in a population-based screening programme.

Methods: BreastScreen Norway offers all women aged 50-69 years two-view (craniocaudal and mediolateral oblique) mammographic screening every 2 years and does independent double reading with consensus. We asked all 32 976 women who attended the programme in Bergen in 2016-17, to participate in this randomised, controlled trial with a parallel group design. A study-specific software was developed to allocate women to either digital breast tomosynthesis or digital mammography using a 1:1 simple randomisation method based on participants' unique national identity numbers. The interviewing radiographer did the randomisation by entering the number into the software. Randomisation was done after consent and was therefore concealed from both the women and the radiographer at the time of consent; the algorithm was not disclosed to radiographers during the recruitment period. All data needed for analyses were complete 12 months after the recruitment period ended. The primary outcome measure was screen-detected breast cancer, stratified by screening technique (ie, digital breast tomosynthesis and digital mammography). A log-binomial regression model was used to estimate the efficacy of digital breast tomosynthesis versus digital mammography, defined as the crude risk ratios (RRs) with 95% CIs for screen-detected breast cancer for women screened during the recruitment period. A per-protocol approach was used in the analyses. This trial is registered at ClinicalTrials.gov, number NCT02835625, and is closed to accrual.

Findings: Between, Jan 14, 2016, and Dec 31, 2017, 44 266 women were invited to the screening programme in Bergen, and 32 976 (74·5%) attended. After excluding women with breast implants and women who did not consent to participate, 29 453 (89·3%) were eligible for electronic randomisation. 14 734 women were allocated to digital breast tomosynthesis and 14 719 to digital mammography. After randomisation, women with a previous breast cancer were excluded (digital breast tomosynthesis group n=314, digital mammography group n=316), women with metastases from melanoma (digital breast tomosynthesis group n=1), and women who informed the radiographer about breast symptoms after providing consent (digital breast tomosynthesis group n=39, digital mammography group n=34). After exclusions, information from 28 749 women were included in the analyses (digital breast tomosynthesis group n=14 380, digital mammography group n=14 369). The proportion of screen-detected breast cancer among the screened women did not differ between the two groups (95 [0·66%, 0·53-0·79] of 14 380 vs 87 [0·61%, 0·48-0·73] of 14 369; RR 1·09, 95% CI 0·82-1·46; p=0·56).

Interpretation: This study indicated that digital breast tomosynthesis including synthetic 2D mammograms was not significantly different from standard digital mammography as a screening tool for the detection of breast cancer in a population-based screening programme. Economic analyses and follow-up studies on interval and consecutive round screen-detected breast cancers are needed to better understand the effect of digital breast tomosynthesis in population-based breast cancer screening.

Funding: Cancer Registry of Norway, Department of Radiology at Haukeland University Hospital, University of Oslo, and Research Council of Norway.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S1470-2045(19)30161-5DOI Listing
June 2019

A randomized controlled trial of digital breast tomosynthesis versus digital mammography in population-based screening in Bergen: interim analysis of performance indicators from the To-Be trial.

Eur Radiol 2019 Mar 29;29(3):1175-1186. Epub 2018 Aug 29.

Cancer Registry of Norway, P.O. 5313, 0304, Majorstuen, Oslo, Norway.

Objectives: To describe a randomized controlled trial (RCT) of digital breast tomosynthesis including synthesized two-dimensional mammograms (DBT) versus digital mammography (DM) in a population-based screening program for breast cancer and to compare selected secondary screening outcomes for the two techniques.

Methods: This RCT, performed in Bergen as part of BreastScreen Norway, was approved by the Regional Committees for Medical Health Research Ethics. All screening attendees in Bergen were invited to participate, of which 89% (14,274/15,976) concented during the first year, and were randomized to DBT (n = 7155) or DM (n = 7119). Secondary screening outcomes were stratified by mammographic density and compared using two-sample t-tests, chi-square tests, ANOVA, negative binomial regression and tests of proportions (z tests).

Results: Mean reading time was 1 min 11 s for DBT and 41 s for DM (p < 0.01). Mean time spent at consensus was 3 min 12 s for DBT and 2 min 12 s for DM (p < 0.01), while the rate of cases discussed at consensus was 6.4% and 7.4%, respectively for DBT and DM (p = 0.03). The recall rate was 3.0% for DBT and 3.6% for DM (p = 0.03). For women with non-dense breasts, recall rate was 2.2% for DBT versus 3.4% for DM (p = 0.04). The rate did not differ for women with dense breasts (3.6% for both). Mean glandular dose per examination was 2.96 mGy for DBT and 2.95 mGy for DM (p = 0.433).

Conclusions: Interim analysis of a screening RCT showed that DBT took longer to read than DM, but had significantly lower recall rate than DM. We found no differences in radiation dose between the two techniques.

Key Points: • In this RCT, DBT was associated with longer interpretation time than DM • Recall rates were lower for DBT than for DM • Mean glandular radiation dose did not differ between DBT and DM.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00330-018-5690-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6510877PMC
March 2019

Digital Breast Tomosynthesis and Synthetic 2D Mammography versus Digital Mammography: Evaluation in a Population-based Screening Program.

Radiology 2018 Jun 1;287(3):787-794. Epub 2018 Mar 1.

From the Cancer Registry of Norway, PO Box 5313, Majorstuen, Oslo 0304, Norway (S.H., Å.S.H.); Oslo and Akershus University College of Applied Sciences, Oslo, Norway (S.H.); Departments of Radiology (T.H., H.B., L.R.) and Pathology (D.P.), Vestre Viken Hospital, Drammen, Norway; University of Washington School of Medicine, Seattle, Wash (C.I.L.); University of Washington School of Public Health, Seattle, Wash (C.I.L.); Hutchinson Institute for Cancer Outcomes Research, Seattle, Wash (C.I.L.); Departments of Radiology (J.A., E.V.) and Pathology (P. Suhrke), Vestfold Hospital, Tønsberg, Norway; and Departments of Radiology and Nuclear Medicine (S.H.B.B., R.G., P. Skaane) and Pathology (J.L.), Oslo University Hospital, Oslo, Norway.

Purpose To compare the performance of digital breast tomosynthesis (DBT) and two-dimensional synthetic mammography (SM) with that of digital mammography (DM) in a population-based mammographic screening program. Materials and Methods In this prospective cohort study, data from 37 185 women screened with DBT and SM and from 61 742 women screened with DM as part of a population-based screening program in 2014 and 2015 were included. Early performance measures, including recall rate due to abnormal mammographic findings, rate of screen-detected breast cancer, positive predictive value of recall, positive predictive value of needle biopsy, histopathologic type, tumor size, tumor grade, lymph node involvement, hormonal status, Ki-67 level, and human epidermal growth factor receptor 2 status were compared in women who underwent DBT and SM screening and in those who underwent DM screening by using χ tests, two-sample unpaired t tests, and tests of proportions. Results Recall rates were 3.4% for DBT and SM screening and 3.3% for DM screening (P = .563). DBT and SM screening showed a significantly higher rate of screen-detected cancer compared with DM screening (9.4 vs 6.1 cancers per 1000 patients screened, respectively; P < .001). The rate of detection of tumors 10 mm or smaller was 3.2 per 1000 patients screened with DBT and SM and 1.8 per 1000 patients screened with DM (P < .001), and the rate of grade 1 tumors was 3.3 per 1000 patients screened with DBT and SM versus 1.4 per 1000 patients screened with DM (P < .001). On the basis of immunohistochemical analyses, rates of lymph node involvement and tumor subtypes did not differ between women who underwent DBT and SM screening and those who underwent DM screening. Conclusion DBT and SM screening increased the detection rate of histologically favorable tumors compared with that attained with DM screening. RSNA, 2018 Online supplemental material is available for this article.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1148/radiol.2018171361DOI Listing
June 2018

The impact of compression force and pressure at prevalent screening on subsequent re-attendance in a national screening program.

Prev Med 2018 03 11;108:129-136. Epub 2018 Jan 11.

Cancer Registry of Norway, P.O. 5313, Majorstuen, 0304 Oslo, Norway; Oslo and Akershus University College of Applied Sciences, P.O. 4, St. Olavs plass, 0130 Oslo, Norway. Electronic address:

Adherence to screening may indirectly help assess whether a prior screening examination deters women from returning for a subsequent examination. We investigated whether compression force and pressure in mammography were associated with re-attendance among prevalently screened women in the organized breast cancer screening program in Norway. Data on compression force (kg) and pressure (kPa) from women's first screening examination in the program (prevalent screening) and subsequent re-attendance were available for 31,225 women aged 50-68, screened during 2007-2013. Crude re-attendance rates and log-binomial regression models estimating the prevalence ratio of re-attendance were used to identify the association between compression force or pressure and re-attendance two-years later. Age and year at prevalent screening, county of residence, screening result (negative or false positive), breast volume, and breast density were included in analyses. Overall, 27,197 (87.1%) women re-attended the program. Re-attendance was highest for women who received a compression force of 10.0-13.9 kg (87.5%) or pressure of 9.0-17.9 kPa (87.8%) and lowest for those who received a compression force of <10.0 kg (85.0%) or pressure of <9.0 kPa (84.7%). The adjusted prevalence of re-attendance was 3% lower for women who received low compression force (<10.0 kg) and 2% lower for women who received low compression pressure (<9.0 kPa) relative to the reference groups (10.0-13.9 kg and 9.0-17.9 kPa, respectively). Future research related to re-attendance should also include information about women's experience of pain, anxiety and stress, as well as image quality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ypmed.2018.01.008DOI Listing
March 2018
-->