title: Increased mammographic screening and use of percutaneous image-guided core biopsy in non-palpable breast cancer: impact on surgical treatment.
abstract: BACKGROUND
  Major efforts are being directed at the early diagnosis of breast cancer. The diagnosis rate of non-palpable tumors is steadily growing as a result of increased screening by mammography. In most patients with non-palpable lesions, percutaneous image-guided biopsies have replaced wire localization with surgical excision for obtaining tissue diagnosis. In recent years the Israel Ministry of Health initiated a mammograpy screening program. Percutaneous image-guided biopsies have also become widely available.
  
  
  OBJECTIVE
  To assess the impact of these changes on breast cancer surgical treatment in our hospital.
  
  
  METHODS
  The charts of 483 patients operated on in our department for primary breast carcinoma during the years 1997 to mid-2001 were reviewed. Data on the mode of diagnosis, tumor stage, resection margins, and number and types of operations were recorded and analyzed. The term non-palpable tumors relates to tumors necessitating wire localization for surgical excision.
  
  
  RESULTS
  The percentage of patients diagnosed with non-palpable tumors rose from 16.2% in 1997 to 47.4% in 2001, with an average size of 2.6 cm for palpable and 1.7 cm for non-palpable tumors. The rate of preoperative diagnosis for non-palpable tumors rose from 6.2% in 1997 to 96.4% in 2001. The rate of involved or very close margins was reduced by 73% in the patient group diagnosed preoperatively as compared to those without a preoperative diagnosis (10.6% vs. 39.4%). Finally, the percentage of patients who had two operations fell from 56.2% in 1997 to 11.1% in 2001.
  
  
  CONCLUSIONS
  The mammography screening program in Jerusalem in 1997-2001 was effective in increasing the relative percentage of non-palpable breast cancers with reduced tumor size at diagnosis. The improved availability of preoperative tissue diagnosis in these patients reduced the number of surgical procedures needed.
authors.affiliation: Department of General Surgery, Shaare Zedek Medical Center, Jerusalem, Israel. mcarmon@szmc.org.il
authors.forename: Moshe
authors.initials: M
authors.lastname: Carmon
authors.forename: Louis
authors.initials: L
authors.lastname: Rivkin
authors.forename: Ribhi
authors.initials: R
authors.lastname: Abu-Dalo
authors.forename: Meir
authors.initials: M
authors.lastname: Goldberg
authors.forename: Oded
authors.initials: O
authors.lastname: Olsha
authors.forename: Irit
authors.initials: I
authors.lastname: Hadas
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Zagal
authors.forename: Shalom
authors.initials: S
authors.lastname: Strano
authors.forename: Alex
authors.initials: A
authors.lastname: Fisher
authors.forename: Omri
authors.initials: O
authors.lastname: Lernau
mesh_terms: D001707:Biopsy, Needle / Q000379:methods; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D007557:Israel; D008403:Mass Screening; D008408:Mastectomy; D010347:Patient Care Planning; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional