Breast Cancer Screening Program Research Articles

Random effects models of tumour growth for investigating interval breast cancer.

In Nordic countries and across Europe, breast cancer screening participation is high. However, a significant number of breast cancer cases are still diagnosed due to symptoms between screening rounds, termed "interval cancers". Radiologists use the interval cancer proportion as a proxy for the screening false negative rate (ie, 1-sensitivity). Our objective is to enhance our understanding of interval cancers by applying continuous tumour growth models to data from a study involving incident invasive breast cancer cases. Building upon previous findings regarding stationary distributions of tumour size and growth rate distributions in non-screened populations, we develop an analytical expression for the proportion of interval breast cancer cases among regularly screened women. Our approach avoids relying on estimated background cancer rates. We make specific parametric assumptions concerning tumour growth and detection processes (screening or symptoms), but our framework easily accommodates alternative assumptions. We also show how our developed analytical expression for the proportion of interval breast cancers within a screened population can be incorporated into an approach for fitting tumour growth models to incident case data. We fit a model on 3493 cases diagnosed in Sweden between 2001 and 2008. Our methodology allows us to estimate the distribution of tumour sizes at the most recent screening for interval cancers. Importantly, we find that our model-based expected incidence of interval breast cancers aligns closely with observed patterns in our study and in a large Nordic screening cohort. Finally, we evaluate the association between screening interval length and the interval cancer proportion. Our analytical expression represents a useful tool for gaining insights into the performance of population-based breast cancer screening programs.

Abstract PO1-10-09: The Performance Of Mobile Units Versus Hospital Units In National Breast Cancer Screening Program In Taiwan, 2010-2020

Abstract Purpose After the implementation of mobile units, the screened population increased from 3.9% to 40% of all women from 2004 to 2019 in Taiwan’s Breast Cancer Screening Program. There are limited studies comparing mobile units to hospital units. This study evaluated and compared the performance of the biennial mammography breast cancer screening in mobile units to hospital units in Taiwan over the past decade. Methods A cohort of 3 062 190 women aged 40 to 69 years who underwent biennial breast cancer mammography screenings from 2010 to 2020 was conducted, and data were obtained from the Health Promotion Administration, Ministry of Health and Welfare of Taiwan. Comparing participation of screened women mobile units and hospital units across national screening. Performance measures were determined as percentages and 95% confidence intervals (CIs) using the Wald asymptotic method. Results Among 3 062 190 women who underwent 7 444 450 examinations in the study population, the screened population by mobile units accounted for approximately 45.45 % of total examinations. The volume of screening mammograms performed in the mobile unit increased the number of people reached by this program. Since 2015, screenings performed in the mobile units have outnumbered those performed at brick-and-mortar hospitals: they comprised 480 456 of the 859 221 examinations (55.9%) performed in 2019. During the 10-year periods, the screen-detected cancers were 12 000 and 18 370 for mobile units and hospital units, respectively. Young women preferred screening in hospitals, resulting in a greater proportion of screen-detected cancers among those attending hospitals (49.4%) compared to the mobile unit (34.3%). The mean recall rate was higher in the hospitals at 8.95% (95% CI, 8.93%-8.99%) than in the mobile units at 7.27% (95% CI, 7.25%-7.32%). Conclusion Implementing mobile units increased the coverage of the screening program across the population. Hospital units had a younger patient population and higher recall rate than those mobile units. We can enhance mammography screening rates and follow-up among these groups by identifying these features, which can use to develop programs and materials fitting populations' specific requirements. Summary statement In Taiwan, the development of breast cancer screening has shown beneficial outcomes, especially with the deployment of mobile unit services to increase screened women. Our results could serve as an informative reference for other nations. Keywords: Breast cancer; screening; mobile units; hospital units. Table 1. Clinical Demographics for Mammographic Screening Examinations Table 2. Performance Measures of Digital Mammographic Screenings for Breast Cancer Citation Format: Vy Vu, Amy Ming-Fang Yen, Melissa Min-Szu Yao, Wing P. Chan. The Performance Of Mobile Units Versus Hospital Units In National Breast Cancer Screening Program In Taiwan, 2010-2020 [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-10-09.

Abstract PO2-29-03: Factors Affecting the Mammography Sensitivity and the Quality of the Breast Cancer Screening Program in the State of São Paulo, Brazil

Abstract Background: Previous researches found that false-positive mammogram results during breast cancer screening are related to age, family history of breast cancer, body mass index, and breast density. In Brazil, there is limited data available on possible factors that may influence the sensitivity of mammography and, consequently, the overall quality of the breast cancer screening program. Aims: This study aims to conduct a sensitivity analysis comparing the results of screening mammograms with diagnosis of breast cancer, taking into account factors that could impact this sensitivity. Methods: All mammogram and biopsy results in the state of São Paulo in 2013 were obtained from the Brazilian Breast Cancer Information System (SISMAMA) database. We obtained information on age (< 50, 50-59, 60-69, or 70+ years), type of lesion (solid, cyst, or calcifications), lesion size (< 10mm, 11-20mm, 21-50mm, or >50mm), lesion boundaries (defined or undefined), lesion characteristics (regular or irregular), and breast density (fatty/predominant fatty or dense/predominant dense). In addition, we evaluated the hormonal therapy usage (yes or no), radiotherapy treatment (yes or no), ethnicity (caucasian, asian, or black), education (illiterate, completed elementary school, completed high school, or completed higher education), skin type (retracted, thickened, or normal), and type of mammogram (simple or computerized). Our analysis focused on mammograms classified as BI-RADS 4, BI-RADS 5, and those with inconclusive results, which subsequently led to a biopsy for diagnosis. We conduct statistical analysis using SPSS v.29 software. To assess the agreement between mammograms and biopsy results (sensitivity), we calculated the proportion of true positive results. We compared the sensitivity across different strata of variables using the Chi-Square test and the V-Cramer measure. Results: A total of 6,064 women with BI-RADS 4, BI-RADS 5, or inconclusive mammogram results underwent biopsy procedures for breast cancer diagnosis. Among these cases, 3,414 (56.3%) were false positives, 1,765 (29.1%) were true positives, and 885 (14.6%) were inconclusive results. The sensitivity of mammographic screening was not significantly associated with ethnicity, education, type of mammogram, skin type, or previous radiotherapy. However, a higher proportion of false positive results was linked to high breast density (71.2%), irregular lesions with defined boundaries (87.5%), particularly calcifications (68.7%) smaller than 10 mm (67.5 %). True positive results, on the other hand, were associated with solid (87.1%) and irregular lesions with undefined boundaries (82.1 %), often larger than 50 mm (57.2%) in fatty breasts (82.7%). A notable proportion of inconclusive results was associated with the presence of dense/predominant dense breasts (88.4%) and irregular lesions with undefined boundaries (87%), particularly solid lesions (89.8%) ranging from 21 to 50 mm in size (60.8%). False positive and inconclusive results were more prevalent among women under 50 years old (79.8%) and those using hormonal therapy (54.8%) compared to true positives. This study has certain limitations, including the availability of data related to lesion density and morphology, as well as body mass index in the SISMAMA database, all of which can potentially impact mammography sensitivity. Furthermore, a notable limitation was a substantial number of missing values for ethnicity and education in the SISMAMA dataset. Conclusion: We identified associations between false-positive and inconclusive results on screening mammograms and factors such as age, breast density, lesion size, lesion types, and hormonal therapy. These results provide valuable information about potential factors that may affect the accuracy of mammography interpretations. Therefore, they must be taken into consideration when planning a breast cancer screening program. Citation Format: Alice Câmara, Lise Cury, Victor Filho. Factors Affecting the Mammography Sensitivity and the Quality of the Breast Cancer Screening Program in the State of São Paulo, Brazil [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-29-03.

Abstract PO3-10-08: Long-term uptake rate of a breast cancer screening program in Fukushima, Japan, following the 2011 Triple Disaster: a retrospective observational study

Abstract Introduction There has been a growing concern over the past few years about the effects of disasters and crises on breast cancer screening, an argument that has been further enhanced by the novel coronavirus disease 2019 (COVID-19) pandemic. However, little is known about how crises might affect the long-term uptake of breast cancer screening programs. This study aimed to clarify the long-term trend of breast cancer screening program uptake in Minamisoma City following the 2011 Triple Disaster in Fukushima, Japan (earthquake, tsunami, and nuclear disaster), and to evaluate the factors associated with this uptake. Material and Methods This study retrospectively analyzed data from the Basic Resident Registry and Breast Cancer Screening Program in Minamisoma City following the Triple Disaster. We calculated the annual breast cancer screening uptake rate for women aged 40–74 years who were of an even-numbered age at the end of each fiscal year and the incidence of at least one instance of uptake of the breast cancer screening initiative during the biennial intervals. We further performed cross-sectional and longitudinal regression analyses for the biannual screening uptake and investigated its associated factors. Results Breast cancer screening participation rates were 19.8% and 18.2% in 2009 and 2010, respectively. They decreased to 4.2% in 2011, and gradually increased thereafter, reaching the pre-disaster level of 20.0% in 2016. Similar but longer decrease of the uptake was observed in the biannual screening uptake rate. No pre-disaster screening uptake between 2009 and 2010, those living alone, or those who were evacuated, were factors that were found to be associated with non-uptake of the breast cancer screening program following the 2011 disaster. Conclusion This study showed a long-term decline in breast cancer screening uptake in the area affected by the Triple Disaster, which was the most severe among those under evacuation, those who were isolated, and those without previous uptake. The insights emerging from this study could be used to increase awareness of this issue and establish potential countermeasures. Nonetheless, we lack a complete understanding of the effects and variations of disasters on cancer screening in the affected areas. Therefore, global efforts should be intensified to conduct further studies on this topic. Citation Format: Kenji Gonda, Akihiko Ozaki, Kazunoshin Tachibana, Masahiro Wada, Hiroaki Saito, Yudai Kaneda, Yoshitaka Nishikawa, Michio Murakami, Kei Hirai, Hiromichi Ohira, Toyoaki Sawano, Tomohiro Kurokawa, Masaharu Tsubokura, Koji Kono, Thoru Ohtake, Seiichi Takenoshita. Long-term uptake rate of a breast cancer screening program in Fukushima, Japan, following the 2011 Triple Disaster: a retrospective observational study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-10-08.

Abstract PS13-02: Clinical Outcome and Patients’ Characteristics of Breast Cancer Diagnosed During Pregnancy: A Retrospective Single Institutional Study

Abstract Background: Breast cancer (BC) is considered the second most common malignancy affecting pregnant women. Treatment of this condition is complex due to the potential risks it poses to both the fetus and mother. In this study, we report on the incidence, clinicopathological characteristics, management, and the outcomes of patients diagnosed with breast cancer during pregnancy in a tertiary care institution in Saudi Arabia. Patients and methods: This is a single-institution retrospective cohort analysis. We reviewed the medical records of all breast cancer cases in pregnant women that were diagnosed and treated at a a tertiary care center in Saudi Arabia, during the period from 2001 to 2017. We used Fisher’s exact test, chi-square, and Kaplan-Meier (KM) method for various analyses. Demographic data, treatment received, response, and prognostic factors were analyzed. The study was approved by the institutional review board at our center. Results: One hundred seventy-three patients met the search criteria. Median age at diagnosis was 34 (IQR: 30 – 38) years. Of these patients, 100 (58%) had invasive ductal carcinoma (IDC), 42 (24%) had IDC with ductal carcinoma in situ (DCIS), and 15 (20%) had other types. One hundred forty-two (82%) had pathological grades 2 and 3. Hormone receptors were positive in 90 (52%) patients, negative in 79 (45.7) patients and unknown in 4 (2.3%) patients. Her2/neu receptor status was positive in 67 (38.7%) patients and negative in 96(55.5%) patients. Forty five (26%) patients had triple negative disease.Stages I, II,III and IV were identified in 7(4%), 47 (27.2%), 54 (31.3%) and 51 (29.5%) patients respectively. Ninety (52%) and 75 (43%) patients received neoadjuvant and adjuvant anthracycline, platinum or taxane based chemotherapy. After being implemented in different international and our institutional guidelines, anti-Her2/neu therapies were given in 35 (20.2%) patients. The median overall survival (OS) was 127 months. Univariate analysis had shown statistically significant correlation between clinical stage, hormonal status, and overall survival. Conclusion: Breast cancer diagnosed during pregnancy is associated with poor outcomes. Breast cancer awareness and screening programs are essential for early detection and proper management thereby leading to better outcomes. Citation Format: Mahmoud A Elshenawy, Emaan Haque, Ahmed Badran, Adhar AlSayed, Taher Twegieri, Dahish Ajarim, Wafa Khayal, Osama Al Malik, Amal Al Hefdhi, Tusneem El Hassan, Syed Saad Akhtar, Meshari Al Zahrani, Saba Al Aklabi, Kausar Suleman. Clinical Outcome and Patients’ Characteristics of Breast Cancer Diagnosed During Pregnancy: A Retrospective Single Institutional Study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PS13-02.

Abstract PO1-07-10: Blood Based Early Cancer Detection Assay

Abstract Background: Breast cancer screening programs utilizing mammography have been shown to be highly effective in identifying breast cancer in women over the age of 40. High breast density is an independent risk factor for breast cancer and makes mammograms more difficult to interpret, decreasing their sensitivity. In the spring of 2023, the FDA, who certifies all mammography facilities under the Mammography Quality Standards Act, updated its regulations to require that breast density status be reported to all individuals receiving a mammogram. The new guidelines now require individuals with dense breast tissue be notified of this status. The guidelines also recommend these women discuss additional screening options with their healthcare providers1. These additional screening options may include breast tomosynthesis, breast MRI, breast ultrasound, and/or molecular breast imaging. Many of these options require additional exposure to radiation, are expensive, and are not equitably available across the country. In addition, they all require a follow-up appointment. Compliance can be challenging given the top barriers to mammography cited include the need for transportation, child-care, and the ability to take time off from work2. Genece Health is developing a simpler and less expensive screening solution that identifies the presence of early to late-stage breast cancer using cfDNA from a single blood draw. The Genece Health assay utilizes an algorithm that leverages Artificial Intelligence and Machine Learning to analyze fragment size and end motif patterns in cfDNA as well as regional mutational density to detect presence of ctDNA originating from breast cancer. This algorithm provides highly sensitive and specific results in a preliminary data set. Methods: The preliminary data set, presented herein, is a cohort of over 50 retrospective breast cancer plasma samples and over 100 presumed normal samples. The breast cancer samples were collected at all stages of progression, from stage 0, or ductal carcinoma in situ (DCIS), through stage IV. The majority ( >50%) were from stage I breast cancer. 400 µL of double spun plasma, collected in Streck BCT devices, was processed to purify and isolate cfDNA. cfDNA was used to create WGS libraries that were sequenced on a NovaSeq 6000. Sequence data were analyzed using a bioinformatics pipeline that yields an ensemble probability that correlates to the presence or absence of ctDNA from breast cancer. Results: The Genece Health assay and algorithm performed with a specificity greater than 85%. With this specificity, the assay had a sensitivity greater than 85% in samples from stages II to IV and a slightly lower sensitivity in stage 0 and I samples. Follow-up analyses were conducted to stratify performance based on breast cancer type (e.g. invasive ductal carcinoma vs invasive lobular carcinoma) and HR, PR, and HER2 status (e.g. HER2-negatives vs HER2-positives). Conclusions: The presented preliminary data indicate that the Genece Health technology can be leveraged as a complement to mammography in indications, such as dense breast tissue, where there is an unmet need for an easy and cost-effective way to monitor for breast cancer. The ability to have a blood-based test to complement mammography could reduce the access barriers most cited by females in the United States. Follow-up studies with greater numbers of samples and additional training and optimizations of the algorithm will yield performance improvements that allow the assay to detect all types and stages of breast cancer.

The association of demographic and socioeconomic variables with cancer screening participation: a national cross-sectional study of three cancer screening programs in Denmark

ObjectiveTo analyze the demographic and socioeconomic determinants of non-participation in cervical, colorectal and breast cancer screening programs in Denmark. Study design and settingWe conducted a cross-sectional study involving all women aged 53-65 years residing in Denmark on 31 March 2018, utilizing comprehensive individual data from population registries. Logistic regression models were employed to assess associations between demographic and socioeconomic factors and complete non-participation (participating in zero out of three cancer screening programs) compared with complete participation (participating in all three cancer screening programs), presenting odds ratios (ORs) with 95% confidence intervals (CIs). Both an unadjusted and two adjusted models were applied. ResultsSignificant associations with non-participation in the three cancer screening programs were observed across all demographic and socioeconomic covariates considered. A higher likelihood of complete non-participation was found among women in the oldest age group (OR: 1.46, 95% CI: 1.32-1.62), women living alone (OR: 1.97, 95% CI: 1.78-2.19), women with ≤10 years of education (OR: 1.75, 95% CI: 1.56-1.97), women outside the labor force (OR: 1.51, 95% CI: 1.34-1.70), and women with lower income (low tertile OR: 4.05, 95% CI: 3.59-5.56, middle tertile OR: 1.72, 95% CI: 1.55-1.91). Further, compared with being an ethnic Dane, both Western immigrants (OR:3.06, 95% CI: 2.53-3.71) and non-Western immigrants (OR: 3.03, 95% CI: 2.46-3.73) demonstrated a strong association with non-participation. ConclusionsDemographic and socioeconomic variables are significantly associated with non-participation in all three Danish cancer screening programs, particularly affecting women from vulnerable demographic and socioeconomic backgrounds. Future research should prioritize strategies to enhance participation within this subgroup, aiming to alleviate social inequities in cancer screening.

Factors affecting the participation and utilization of breast cancer screening services among health care workers Kolar: a qualitative study

Background: India is going through epidemiologic transition with a shift of disease burden from communicable to non-communicable diseases. There is no organized screening programme for breast cancer in the country. Hence, a large proportion of women with cancer of the breast present in advanced stages of cancer. The integrated cancer control programme calls for early detection of cancer, opportunistic screening and cancer outreach camps that are to be promoted and carried out by health care providers. The objective of this study was thus designed to understand the various factors preventing the participation and utilisation of breast cancer screening.   Methods: It was a qualitative method with two groups. The study was conducted between two taluks out of 6, Kolar and Bangarpete. All Angawadi workers and helpers aged more than 30 years were invited and those who have history of breast cancer and family history of breast cancer were excluded from the study. All the subjects who did not attend the screening were included to elicit the reasons for non-attendance.   Results: The theme ‘barriers to screening uptake’ were broadly divided into three main categories- namely ‘worry’, ‘transport’ and ‘work commitment’.  The sub-category ‘anxiety’ (31.9%) was reported to be the highest barrier and least was in the sub-category ‘no replacement’ (4.3%). The frequency of response categorized into different sub-categories.   Conclusions: The reasons were identified by using ‘single question’ interview guide, and were categorized into ‘worry’, ‘transport’ and ‘work-commitment’. Barrier in ‘worry’ category was found to be highest.

Re-attendance in supplemental breast MRI screening rounds of the DENSE trial for women with extremely dense breasts.

Supplemental MRI screening improves early breast cancer detection and reduces interval cancers in women with extremely dense breasts in a cost-effective way. Recently, the European Society of Breast Imaging recommended offering MRI screening to women with extremely dense breasts, but the debate on whether to implement it in breast cancer screening programs is ongoing. Insight into the participant experience and willingness to re-attend is important for this discussion. We calculated the re-attendance rates of the second and third MRI screening rounds of the DENSE trial. Moreover, we calculated age-adjusted odds ratios (ORs) to study the association between characteristics and re-attendance. Women who discontinued MRI screening were asked to provide one or more reasons for this. The re-attendance rates were 81.3% (3458/4252) and 85.2% (2693/3160) in the second and third MRI screening round, respectively. A high age (> 65years), a very low BMI, lower education, not being employed, smoking, and no alcohol consumption were correlated with lower re-attendance rates. Moderate or high levels of pain, discomfort, or anxiety experienced during the previous MRI screening round were correlated with lower re-attendance rates. Finally, a plurality of women mentioned an examination-related inconvenience as a reason to discontinue screening (39.1% and 34.8% in the second and third screening round, respectively). The willingness of women with dense breasts to re-attend an ongoing MRI screening study is high. However, emphasis should be placed on improving the MRI experience to increase the re-attendance rate if widespread supplemental MRI screening is implemented. For many women, MRI is an acceptable screening method, as re-attendance rates were high - even for screening in a clinical trial setting. To further enhance the (re-)attendance rate, one possible approach could be improving the overall MRI experience. • The willingness to re-attend in an ongoing MRI screening study is high. • Pain, discomfort, and anxiety in the previous MRI screening round were related to lower re-attendance rates. • Emphasis should be placed on improving MRI experience to increase the re-attendance rate in supplemental MRI screening.

Impact of different age ranges on the benefits and harms of the breast cancer screening programme by the EU-TOPIA tool.

The recommendation for the implementation of mammography screening in women aged 45-49 and 70-74 is conditional with moderate certainty of the evidence. The aim of this study is to simulate the long-term outcomes (2020-50) of using different age range scenarios in the breast cancer screening programme of the Valencia Region (Spain), considering different programme participation rates. Three age range scenarios (S) were simulated with the EU-TOPIA tool, considering a biennial screening interval: S1, 45-69 years old (y); S2, 50-69 y and S3, 45-74 y. Simulations were performed for four participation rates: A = current participation (72.7%), B = +5%, C = +10% and D = +20%. Considered benefits: number (N°) of in situ and invasive breast cancers (BC) (screen vs. clinically detected), N° of BC deaths and % BC mortality reduction. Considered harms: N° of false positives (FP) and % overdiagnosis. The results showed that BC mortality decreased in all scenarios, being higher in S3A (32.2%) than S1A (30.6%) and S2A (27.9%). Harms decreased in S2A vs. S1A (N° FP: 236 vs. 423, overdiagnosis: 4.9% vs. 5.0%) but also benefits (BC mortality reduction: 27.9% vs. 30.6%, N° screen-detected invasive BC 15/28 vs. 18/25). In S3A vs. S1A, an increase in benefits was observed (BC mortality reduction: 32.2% vs. 30.6%), N° screen-detected in situ B: 5/2 vs. 4/3), but also in harms (N° FP: 460 vs. 423, overdiagnosis: 5.8% vs. 5.0%). Similar trends were observed with increased participation. As the age range increases, so does not only the reduction in BC mortality, but also the probability of FP and overdiagnosis.

IJCM_229A: A Community-based screening programme for oral, breast, and cervical cancer in the rural area of Dakshin Kannada

Background: Karnataka recorded 87304 new cancer cases in the year 2021. Breast, lip and oral cavity, cervix were the top cancer sites amongst all sexes and are preventable. Despite the nation-wide launch of Population-based screening (PBS) in 2016, the reported coverage of individuals who were screened for these three cancers in Dakshin Kannada was 0.4% (NFHS-5). The study introduces on-site screening for oral and breast cancer in the community. Objectives: To estimate the proportion of pre-cancerous lesions of oral, breast, and cervical cancer, through community-based screening in adults aged 18 to 65 years, in the catchment area of a medical college in Dakshina Kannada Methodology: This observational study was conducted among all persons aged 18 to 65years, residing in the rural catchment area of a medical college in Mangalore taluk of Dakshina Kannada and consenting for the study. Pregnant women and persons with prior diagnosis of oral, breast or cervical cancer were excluded. Two-stage cluster sampling was used to enrol an estimated sample of 1120 beneficiaries. The study comprised of house-to-house survey, cancer awareness sessions, and community-based screening. Screening tests included Oral visual examination, clinical breast examination, iBreast examination (iBE; electronic palpation by ibreast device), and Pap smear tests. Participants who screened positive were referred for diagnostic tests and management. Results: The study was completed with survey of 556 households, 3 cancer awareness sessions, and screening of 525 beneficiaries (325 females and 200 males) for oral, breast, and cervical cancer. Three participants screened positive for oral cancer, and one participant for breast cancer, who were referred for management to tertiary care hospital attached to the medical college. 25% of female participants underwent cervical cancer screening, with no one detected with pre-cancerous lesions. Conclusion: A combination of house-to-house and camp-based approaches along with awareness sessions results in improved coverage of PBS in the community.

Breast Cancer Screening and Prophylactic Mastectomy for High-Risk Women in Romania.

Breast cancer remains a significant contributor to morbidity and mortality within oncology. Risk factors, encompassing genetic and environmental influences, significantly contribute to its prevalence. While germline mutations, notably within the BRCA genes, are commonly associated with heightened breast cancer risk, a spectrum of other variants exists among affected individuals. Diagnosis relies on imaging techniques, biopsies, biomarkers, and genetic testing, facilitating personalised risk assessment through specific scoring systems. Breast cancer screening programs employing mammography and other imaging modalities play a crucial role in early detection and management, leading to improved outcomes for affected individuals. Regular screening enables the identification of suspicious lesions or abnormalities at earlier stages, facilitating timely intervention and potentially reducing mortality rates associated with breast cancer. Genetic mutations guide screening protocols, prophylactic interventions, treatment modalities, and patient prognosis. Prophylactic measures encompass a range of interventions, including chemoprevention, hormonal inhibition, oophorectomy, and mastectomy. Despite their efficacy in mitigating breast cancer incidence, these interventions carry potential side effects and psychological implications, necessitating comprehensive counselling tailored to individual cases.

The Prognostic Quality of Risk Prediction Models to Assess the Individual Breast Cancer Risk in Women: An Overview of Reviews

Purpose. Breast cancer is the most common cancer among women globally, with an incidence of approximately two million cases in 2018. Organised age-based breast cancer screening programs were established worldwide to detect breast cancer earlier and to reduce mortality. Currently, there is substantial anticipation regarding risk-adjusted screening programs, considering various risk factors in addition to age. The present study investigated the discriminatory accuracy of breast cancer risk prediction models and whether they suit risk-based screening programs. Methods. Following the PICO scheme, we conducted an overview of reviews and systematically searched four databases. All methodological steps, including the literature selection, data extraction and synthesis, and the quality appraisal were conducted following the 4-eyes principle. For the quality assessment, the AMSTAR 2 tool was used. Results. We included eight systematic reviews out of 833 hits based on the prespecified inclusion criteria. The eight systematic reviews comprised ninety-nine primary studies that were also considered for the data analysis. Three systematic reviews were assessed as having a high risk of bias, while the others were rated with a moderate or low risk of bias. Most identified breast cancer risk prediction models showed a low prognostic quality. Adding breast density and genetic information as risk factors only moderately improved the models’ discriminatory accuracy. Conclusion. All breast cancer risk prediction models published to date show a limited ability to predict the individual breast cancer risk in women. Hence, it is too early to implement them in national breast cancer screening programs. Relevant randomised controlled trials about the benefit-harm ratio of risk-adjusted breast cancer screening programs compared to conventional age-based programs need to be awaited.

What Breast Cancer Screening Program do Rural Women Prefer? A Discrete Choice Experiment in Jiangsu, China.

Chinese rural women aged 35-64 years are encouraged to complete breast cancer screening (BCS) free of charge. However, it is challenging to reach a satisfying BCS uptake rate. In this study, rural women's preferences and preferences heterogeneity were measured for the development of strategies to enhance participation in BCS. A cross-sectional survey with a discrete choice experiment (DCE) was conducted via convenience sampling via face-to-face interviews in Jiangsu, China. Six DCE attributes were identified through a systematic literature review; our previous study of Chinese rural women's BCS intentions; a qualitative work involving in-depth interviews with rural women (n = 13), medical staff (n = 4), and health care managers (n = 2); and knowledge of realistic and actionable policy. The D-efficient design was generated using Ngene 1.3.0. A mixed logit model (MXL) in Stata 18.0 was used to estimate the main effect of attribute levels on rural women's preferences. The relative importance and willingness to utilize BCS services (WTU) were also estimated. The heterogeneous preferences were analyzed by a latent class model (LCM). Sociodemographic status was used to predict the characteristics of class membership. The WTU for different classes was also calculated. A total of 451 rural women, aged 35-64 years, were recruited. The MXL results revealed that the screening interval (SI) was the most important attribute for rural women with regard to utilizing BCS services, followed by the level of screening, the attitude of medical staff, ways to get knowledge and information, people who recommend screening, and time spent on screening (TSS). Rural women preferred a BCS service with a shorter TSS; access to knowledge and information through multiple approaches; a shorter SI; a recommendation from medical staff or workers from the village or community, and others; the enthusiasm of medical staff; and medical staff with longer tenures in the field. Two classes named "process driven" and "efficiency driven" were identified by the preference heterogeneity analysis of the LCM. There is a higher uptake of breast cancer screening when servicesare tailored to women's preferences. The screening interval was the most important attribute for rural women in China with a preference for a yearly screening interval versus longer intervals.

Long-term trends in incidence, characteristics and prognosis of screen-detected and interval cancers in women participating in the Dutch breast cancerscreening programme.

No studies are available in which changes over time in characteristics and prognosis of patients with interval breast cancers (ICs) and screen-detected breast cancers (SDCs) have been compared. The aim was to study these trends between 1995 and 2018. All women with invasive SDCs (N = 4290) and ICs (N = 1352), diagnosed in a southern mammography screening region in the Netherlands, were included and followed until date of death or 31 December 2022. The 5-year overall survival rate of women with SDCs increased from 91.4% for those diagnosed in 1995-1999 to 95.0% for those diagnosed in 2013-2018 (P < 0.001), and from 74.8 to 91.6% (P < 0.001) in the same periods for those with ICs. A similar trend was observed for the 10-year survival rates. After adjustment for changes in tumour characteristics, the hazard ratio (HR) for overall survival was 0.47 (95% confidence interval (CI): 0.38-0.59) for women with SDCs diagnosed in the period 2013-2018, compared to the women diagnosed in the period 1995-1999. For the women with ICs this HR was 0.27 (95% CI: 0.19-0.40). The prognosis of women with ICs has improved rapidly since 1995 and is now almost similar to that of women with SDCs.

Approach to the care process by nurse case managers in a breast unit

ObjectiveBreast units led by nurse case managers are being implemented to provide comprehensive care in the detection and treatment of breast cancer. However, their implementation is heterogeneous and the results of the care process with this professional have not been studied. The aim of the study is to describe the management in time and the approach of the process by a nurse case manager in the breast unit of women with suspected breast cancer pathology, derived from the breast cancer screening program. MethodsDescriptive, cross-sectional, retrospective study carried out in 2021. Women treated in a breast unit managed by a nurse case manager in a hospital in southern Spain were included. Sociodemographic, clinical and care process characteristics were analysed ResultsA total of 118 women of Spanish nationality (92%) participated, with a mean age of 59 years. The diagnosis of malignancy was made in 74.6% of them. Seventy-nine percent of the women had their first visit within 3 days. The mean time to diagnosis was 3.98 days (SD: ±3.93), 4.2 weeks (SD: ±1.84) to initiate treatment and a total in-hospital time of 33 days (SD: ±13.45). ConclusionsThe management of nurse case managers in breast units contributes to improving or speeding up times, in accordance with international guidelines, helping this approach in the continuity of the care process for women referred after screening for breast cancer detection.

Optimizing the Patient Experience for Women With Disabilities in the Breast Imaging Clinic.

While there are varying opinions on what age to begin and at what interval to perform breast cancer screening, screening mammography is recommended for all women irrespective of disability. Unfortunately, women with disabilities are more likely to present with later-stage disease and higher mortality owing to the barriers for more widespread screening in this population. Women with disabilities may experience challenges accessing breast imaging services, and imaging centers may have suboptimal facilities and staff who are inexperienced in caring for this population. Efforts to increase accessibility by employing universal design to increase ease of access and provide training to improve the patient experience will go far to improve outcomes for patients with disabilities. To date, there exists no comprehensive guidance on how to improve breast cancer screening programs for women with disabilities. The purpose of this paper is to review barriers to screening faced by patients with disabilities, describe strategies to overcome these barriers, and provide guidance for radiologists and referring providers in selecting the best exam for the individual patient.

Diagnostic capabilities of artificial intelligence as an additional reader in a breast cancer screening program.

We aimed to evaluate the early-detection capabilities of AI in a screening program over its duration, with a specific focus on the detection of interval cancers, the early detection of cancers with the assistance of AI from prior visits, and its impact on workload for various reading scenarios. The study included 22,621 mammograms of 8825 women within a 10-year biennial two-reader screening program. The statistical analysis focused on 5136 mammograms from 4282 women due to data retrieval issues, among whom 105 were diagnosed with breast cancer. The AI software assigned scores from 1 to 100. Histopathology results determined the ground truth, and Youden's index was used to establish a threshold. Tumor characteristics were analyzed with ANOVA and chi-squared test, and different workflow scenarios were evaluated using bootstrapping. The AI software achieved an AUC of 89.6% (86.1-93.2%, 95% CI). The optimal threshold was 30.44, yielding 72.38% sensitivity and 92.86% specificity. Initially, AI identified 57 screening-detected cancers (83.82%), 15 interval cancers (51.72%), and 4 missed cancers (50%). AI as a second reader could have led to earlier diagnosis in 24 patients (average 29.92 ± 19.67months earlier). No significant differences were found in cancer-characteristics groups. A hybrid triage workflow scenario showed a potential 69.5% reduction in workload and a 30.5% increase in accuracy. This AI system exhibits high sensitivity and specificity in screening mammograms, effectively identifying interval and missed cancers and identifying 23% of cancers earlier in prior mammograms. Adopting AI as a triage mechanism has the potential to reduce workload by nearly 70%. The study proposes a more efficient method for screening programs, both in terms of workload and accuracy. • Incorporating AI as a triage tool in screening workflow improves sensitivity (72.38%) and specificity (92.86%), enhancing detection rates for interval and missed cancers. • AI-assisted triaging is effective in differentiating low and high-risk cases, reduces radiologist workload, and potentially enables broader screening coverage. • AI has the potential to facilitate early diagnosis compared to human reading.

Expanding Outcomes in Cancer Screening Safety Net Programs: Promoting Sustainability and Policy Reform.

Community-engaged patient navigation safety net programs are established as an evidence-based approach to address cancer prevention and early detection efforts, but barriers to expand and sustain such programs persist. In addition, few studies describe how these programs impact buy-in among communities and policy change within health care systems and government. We describe how we used the Capacity for Sustainability Framework to guide efforts for program sustainability and community, institutional, and policy level change in a breast cancer screening and patient navigation safety net program. The nine domains of the Capacity for Sustainability Framework were used to develop program logic models, to inform program implementation and quality improvement agendas, and to guide multi-level partner and stakeholder engagement, outreach, and dissemination of outcomes. The program is currently in its seventh year and continues to be annually funded by a city public health department. In 2021, additional 5-year renewable funding from a state public health department was secured. In addition, institutional program support was expanded for patients diagnosed with breast cancer. Program leaders worked with policymakers to draft legislation to support training certification and third-payor reimbursement for patient navigators and community health workers. The program is well-known and trusted among community members, community-based organizations, and providers. Community, organizational, and policy-level outcomes demonstrate that community-engaged patient navigation safety net programs can influence more than individual and interpersonal outcomes and can be sustained over time.

Mammography with deep learning for breast cancer detection.

X-ray mammography is currently considered the golden standard method for breast cancer screening, however, it has limitations in terms of sensitivity and specificity. With the rapid advancements in deep learning techniques, it is possible to customize mammography for each patient, providing more accurate information for risk assessment, prognosis, and treatment planning. This paper aims to study the recent achievements of deep learning-based mammography for breast cancer detection and classification. This review paper highlights the potential of deep learning-assisted X-ray mammography in improving the accuracy of breast cancer screening. While the potential benefits are clear, it is essential to address the challenges associated with implementing this technology in clinical settings. Future research should focus on refining deep learning algorithms, ensuring data privacy, improving model interpretability, and establishing generalizability to successfully integrate deep learning-assisted mammography into routine breast cancer screening programs. It is hoped that the research findings will assist investigators, engineers, and clinicians in developing more effective breast imaging tools that provide accurate diagnosis, sensitivity, and specificity for breast cancer.