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Title: The screening of well women for breast cancer
Author: Stark, Agnes Macfarlane
Awarding Body: University of Glasgow
Current Institution: University of Glasgow
Date of Award: 1972
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This thesis is based on work done in screening Well Women for the detection of early breast cancer during the period September, 1967, to June, 1971. The work was undertaken because of the high incidence of breast cancer, and the fact that there has been little improvement in survival rates for breast cancer in the past fifty years - in spite of developments in treatment. It has been shown by others that the smaller the neoplasm at the time of initial treatment the greater the chance of cure. The aim of the project is to diagnose breast cancer before there is a palpable mass. The methods used are (1) history (2) clinical examination (3) cytology of nipple discharge, if relevant (4) thermography using an Aga Thermovision (5) soft tissue X-ray (a) at first by conventional X-ray equipment (mammography) and (b) from December, I969, by the Senograph (senography). Medical thermography and its application to breast lesions is described with appropriate references to the literature. The technique of breast thermography used is detailed. The interpretation of the thermograms, and the factors infltiencing this, is discussed and illustrated. The history of mammography is reviewed. The X-ray signs of malignancy are enumerated, and described at length. Illustrations of the technique of using the Senograph and a series of representative films of senograms are presented, with comments. Particular reference is made to difficulties in interpretation of senograms, in spite of the latter being superior to films taken by conventional equipment. A description is given of the Unit, designed for this work, and the organisation of the clinics. The work falls into three phases: [Phase I] consisted of seven hundred women, aged forty to sixty-three, who were examined clinically. On account of palpable findings, fifteen per cent were referred for mammography. [Phase II] comprised 3,684 unselected women, examined clinically and by thermography. Of these, 10.9% were referred for mammography on account of palpable findings and/or abnormal thermograms. [Phase III] consisted of 1,017 highly selected women, considered to be at high risk of breast cancer. The high risk factors are enumerated and discussed in depth. During Phase III, all women were examined by all three methods clinical examination, thermography and sonography. [The Biopsy] The importance of ensuring that, in the absence of a palpable mass, the correct area has been removed at biopsy is stressed and the technique is described. Detailed results are given in tabular form. The following points are discussed (1) The accuracy of thermography and mammography (including senography) with the advantages and disadvantages of these investigations (2) The Question of false positive and false negative results with suggestions for improvement 50 (3) The histology of the biopsy with special attention to that present in positive results (4) The frequency of breast screening with particular reference to irradiation (5) The value of well women screening for breast cancer, especially when restricted to women in a high-risk group (6) The cost in time of trained personnel, and capital outlay. The thesis ends by listing thirteen conclusions evolved during the course of this work and which indicate the merits of clinical, thermographic and senographic examination in the screening of well women for breast cancer.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available