Background
Several studies have demonstrated that mammographic dense breast is related to the risk of breast cancer and is associated with decreased mammographic sensitivity and specificity. In contrast, studies concerning women with dense breast are virtually non-existent. This study was conducted to evaluate the relationship between mammographic dense breast and other risk factors of breast cancer, and to make a plan for individualized strategies in high risk populations. Methods: The study subjects were 565 women, aged 20∼70 years, who had a screening mammogram from April 2005 to August 2005 at a health promotion center. Data of demographic factors, breast caner risk factors and menstrual status were collected by the self-administered questionnaire. Mammographic breast density was classified according to the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) fours categories, as measured by the proportion of glandular tissues within the total breast tissue. Results: By BI-RADS categories, 'entirely fat' were 46, 'scattered fibroglandular' were 96, 'heterogenous dense' were 332 and 'extremely dense' were 91 (16.1%). Univariate analysis showed that age, occupation, education level, body mass index, age at menarche, parity, breast feeding, menopausal status and triglyceride had significantly related to dense breast (P＜0.05). In the multivariate logistic analysis, only low body mass index (P＜0.001), low parity (P=0.009, 0.038) and premenopausal status (P=0.001) were significantly associated with dense breast. Conclusion: In Korean women, dense breast was significantly associated with low body mass index, low parity and premenopausal status. Therefore, if women with dense breast have these risk factors, they need to be managed more intensively with regular screening, breast sonogram, and lifestyle modification. (J Korean Acad Fam Med 2007;28:937-942)

Background
: Density patterns on mammography have been related to the risk factors for breast cancer in the western countries. High mammographic density appears to confer a 4-fold risk of breast cancer. While the proportion of high-density mammography is higher in Korean women than in Caucasian women, the incidence of breast cancer in Korean women is considerably lower. Therefore, we examined if the mammographic breast density pattern correlates with the risk factors for breast cancer in Korean women.

Methods : In a cross-sectional design, we recruited 1,758 pre- and post-menopause women without prior history of breast cancer and breast surgery who underwent screening mammogram and completed a self-administered questionnaire in 6 general hospitals. On the basis of ACR BI RADS breast composition, four density patterns were classified in caudocranial and mediolateral mammography by a designated radiologist in each hospital. Multiple linear logistic regression was used for statistical analyses.

Results : Inter-rater reliability between the initial report and the report made by another blinded radiologist was high (Pearson's co-efficient=0.81). Overall, the age, body mass index, family history of breast cancer, and duration of hormone replacement therapy correlated with the mammographic density patterns. In pre-menopausal women, the high body mass index and parity (=2) were associated with low mammographic density. In post- menopausal women, older age, high body mass index, negative family history of breast cancer, and duration of hormone replacement therapy were associated with low mammographic density.

Conclusion : Our data showed that the mammographic breast density patterns correlated with risk factors for breast cancer in Korean women. While the proportion of high-density mammography is higher in Korean women, the incidence of breast cancer is lower than in the western population. This maybe dependent on other unknown factors.

Background
: Because the sensitivity of mammography (MAM) is lower in young women than in old and in women with dense breast than those without, many physicians utilize breast ultrasonography (US) with MAM. But the addictive value of US is unclear. This study compared the diagnostic value between MAM and MAM+US.

Methods : Between September, 2002, and February, 2003, there were 89 cases of breast disease confirmed by surgery, that had both MAM and US results. The results of MAM and US were classifed by Breast Imaging Reporting and Data System (BI-RADS) and were categorized as positive or negative. Among the positive results, BI-RADS Category 0 and Category 3 with recommendation of other test were regarded as an intermediate result.

Results : Among all 89 cases, 38 cases were malignancies. The receiver operating characteristic curves showed non-significant increase in diagnostic value by adding US to MAM. The sensitivity of MAM was non-significantly higher in above-50-years women than in below- 49-years women and in women with dense breast than in women with non-dense breast. Among positive results of MAM, 21 cases were 'intermediate results'. US correctly regraded 8 benign lesions from 19 cases of false-positive MAM and 1 extra malignancy with palpable lump from 4 false-negative MAM.

Conclusion : MAM is a valuable test in diagnosing breast cancer. US is a valuable complementary test to MAM in evaluating palpable lump with negative MAM and intermediate result of MAM.

Background
: Lymphedema is a common condition occurring in over 50% of breast and cervix cancer patients. The pneumatic pump as used in the past is still utilized for the treatment. A complex lymphatic therapy was developed by Dr. Michael Foeldi of Germany in the 1980s, and was widely practiced with good effects. This study was to observe the practical effectiveness in patients receiving such treatment.

Methods : Twenty two patients diagnosed with lymphedema and treated in department of Family Medicine of National Health Insurance Corporation Ilsan Hospital from August 1,2000 to September 30, 2001. They were observed with respect to the frequency of demographic characteristics, and were compared to assess the improvement of clinical symptoms before and after complex lymphatic therapy by independent samples T-test and the degree of edema reduction before and after complex lymphatic therapy by paired samples T-test (P-value<0.05).

Results : Among the 22 subjects I was a male and 21 were females and their mean age was 49.9±9.3. Cervix and breast cancer patients comprised 86.4% among the total. Twenty one cancer patients developed lymphedema after the operation or radiotherapy. Most were in stage 2 or 3 of edema with 81.8%. Relative to the edema onset time, there were 7(33.3%) of less than 1 year, 5(23.8%) from 1 to 3 years and 9 (42.9%) over 3 years. They came to see a lymphedema specialist in 2.9±3.9 years after edema progressed. The degree of lymphedema with 968.4±545.3 ml before the treatment was improved to 337.3±326.8 ml after the of lymphedema with 968.4±545.3 ml before the treatment was improved to 337.3±326.8 ml after the treatment which showed a statistically remarkable 65.0±33.2% effectiveness.

Conclusion : complex lymphatic therapy for the patients of lymphedema presented with a 65% edema reduction in our study. Thus, the therapy for such patients is considered the most effective method up to present.

Background
: Breast cancer is increasing cause of cancer-related mortality among Korean women. Early detection and treatment are the most important strategy for reducing breast cancer mortality. Despite of its importance as an early detection method, a low percentage of women practice breast self-examination(BSE) regularly. The aim of this study was to describe the effectiveness of patient education on performing BSE regularly and to identify predisposing factors associated with these activities.

Methods : Sixty-six women who did not have experience in BSE in the past were randomly assigned to the experimental group and the control group. We taught BSE knowledge and skill about BSE using breast models and audiovisual equipment for experimental group in patient education class. Women in control group, however, were simply educated by their physician about BSE knowledge and skill with only educational booklet during their outpatient visits. We observed the difference in regular BSE performance proportion between two groups 6, 12 months later and analyzed the predisposing factors affecting on the education effect. Direct and telephone interview methods were used to gather the information. Data were analyzed with t-test, x²-analysis and logistic regression using SAS 6.10, EGRET program.

Results : There were no differences in sociodemographic characteristics between study groups. They were followed for 12 months. At follow-up after 6 months 44.1% of women performed BSE regularly among experimental group and 18.8% of women did it among control group(OR= 3.4, 95% CI 1.1-10.4, p<0.05). At follow-up after 12 months proportion of women performed BSE regularly in experimental group(28.6%) was slightly higher than that of control group(22.2%), but that difference was not statistically significant. The prevalence of performing BSE regularly was higher among women who had experience in periodic health examination(OR=6.0, 95% CI 1.9-18.8, p<0.01), who had experience in mammography(OR=4.0, 95% CI 1.0-15.6, p<0.05). And the prevalence of performing BSE regularly also was higher among women who were older than 40 years old, married, had experience in cervical Pap smear, had knowledge about BSE before education, have done exercise regularly, had less number of health risk factors, but without statistical significance.

Conclusion : These results showed that effectiveness of patient education on BSE, if we determine the effectiveness of BSE education with regular performance of BSE, is relatively low among Korean women. We could see, however, that if we use breast models for demonstration in addition to usual educational material, the effectiveness of BSE education can be more effective. We also recognized that effectiveness of BSE education will not be continued for long time without any maintenance strategy. There were lots of predisposing factors which could affect the effectiveness of BSE education positively or negatively. So, family physicians who plan BSE patient education at their clinics must consider these factors.