Breast Cancer Screening Services Research Articles

Mammography Image Quality Assurance Using Deep Learning.

According to the European Reference Organization for Quality Assured Breast Cancer Screening and Diagnostic Services (EUREF) image quality in mammography is assessed by recording and analyzing a set of images of the CDMAM phantom. The EUREF procedure applies an automated analysis combining image registration, signal detection and nonlinear fitting. We present a proof of concept for an end-to-end deep learning framework that assesses image quality on the basis of single images as an alternative. Virtual mammography is used to generate a database with known ground truth for training a regression convolutional neural net (CNN). Training is carried out by continuously extending the training data and applying transfer learning. The trained net is shown to correctly predict the image quality of simulated and real images. Specifically, image quality predictions on the basis of single images are of similar quality as those obtained by applying the EUREF procedure with 16 images. Our results suggest that the trained CNN generalizes well. Mammography image quality assessment can benefit from the proposed deep learning approach. Deep learning avoids cumbersome pre-processing and allows mammography image quality to be estimated reliably using single images.

Are women satisfied with their experience with breast cancer screening? Systematic review of the literature.

The evaluation of participant experience is an essential part of monitoring the quality of breast cancer screening services. Satisfaction of services can lead to good adherence and hence affect health outcomes. We performed a systematic review to assess how satisfied women were with organized breast cancer screening programs. A literature search in Medline, CINAHL, Embase and PsycINFO from 1965 to October 2019 was performed. Articles reporting a quantitative measure of satisfaction collected via questionnaires in programs using mammography as a screening test were selected. We narratively synthesized the data and used tabulated summaries. Out of 4310 individual citations, 3099 abstracts were reviewed by two independent researchers, and 126 articles were selected for full-text reading. Finally, 48 studies, published between 1990 and 2018, were included in analysis, reporting 54 surveys in the context of an organized screening program, 37 on satisfaction with screening mammography, 14 on satisfaction with further assessments and 3 with counseling. Most studies reported a high level of satisfaction for both mammography and further assessments. Despite commonly reported temporary pain, discomfort and anxiety, the willingness to be re-screened was very high. Effective information transfer, the staff's interpersonal skills and quick delivery of results correlated with high satisfaction. Only 7 out of 54 surveys used recognized satisfaction instruments or their modifications. In general, satisfaction with breast cancer screening is high, but its evaluation is mainly performed using non-validated instruments. Emphasis should be put on effective communication, the staff´s interpersonal skills and quick delivery of results.

Breast and cervical cancer screening services in Malawi: a systematic review

BackgroundTo identify and to assess factors enhancing or hindering the delivery of breast and cervical cancer screening services in Malawi with regard to accessibility, uptake, acceptability and effectiveness.MethodsSystematic review of published scientific evidence. A search of six bibliographic databases and grey literature was executed to identify relevant studies conducted in Malawi in the English language, with no time or study design restrictions. Data extraction was conducted in Excel and evidence synthesis followed a thematic analysis approach to identify and compare emerging themes.ResultsOne hundred and one unique records were retrieved and 6 studies were selected for final inclusion in the review. Multiple factors affect breast and cervical cancer service delivery in Malawi, operating at three interlinked levels. At the patient level, lack of knowledge and awareness of the disease, location, poor screening environment and perceived quality of care may act as deterrent to participation in screening; at the health facility level, services are affected by the availability of resources and delivery modalities; and at the healthcare system level, inadequate funding and staffing (distribution, supervision, retention), and lack of appropriate monitoring and guidelines may have a negative impact on services. Convenience of screening, in terms of accessibility (location, opening times) and integration with other health services (e.g. reproductive or HIV services), was found to have a positive effect on service uptake. Building awareness of cancer and related services, and offering quality screening (dedicated room, privacy, staff professionalism etc.) are significant determinants of patient satisfaction.ConclusionsCapitalising on these lessons is essential to strengthen breast and cervical cancer service delivery in Malawi, to increase early detection and to improve survival of women affected by the disease.

Distribution and predictors associated with the use of breast cancer screening services among women in 14 low-resource countries

BackgroundBreast cancer is one of the leading public health problem globally, especially in low-resource countries (LRCs). Breast cancer screening (BCS) services are an effective strategy for early determining of breast cancer. Hence, it is imperative to understand the utilisation of BCS services and their correlated predictors in LRCs. This study aims to determine the distribution of predictors that significantly influence the utilisation of BCS services among women in LRCs.MethodsThe present study used data on 140,974 women aged 40 years or over from 14 LRCs. The data came from country Demographic and Health Surveys (DHS) between 2008 and 2016. Multivariate logistic regression analysis was employed to investigate the significant predictors that influence the use of BCS services.ResultsThe utilisation of BCS services was 15.41%, varying from 81.10% (95% CI: 76.85–84.73%) in one European country, to 18.61% (95% CI: 18.16 to 19.06%) in Asian countries, 14.30% (95% CI: 13.67–14.96%) in American countries, and 14.29% (95% CI: 13.87–14.74%). Factors that were significantly associated to increase the use of BCS services include a higher level of education (OR = 2.48), advanced age at first birth (> 25 years) (OR = 1.65), female-headed households (OR = 1.65), access to mass media communication (OR = 1.84), health insurance coverage (OR = 1.09), urban residence (OR = 1.20) and highest socio-economic status (OR = 2.01). However, obese women shown a significantly 11% (OR = 0.89) lower use of BSC services compared to health weight women.ConclusionThe utilisation of BCS services is low in many LRCs. The findings of this study will assist policymakers in identifying the factors that influence the use of BCS services. To increase the national BCS rate, more attention should be essential to under-represented clusters; in particular women who have a poor socioeconomic clusters, live in a rural community, have limited access to mass media communication, and are have a low level educational background. These factors highlight the necessity for a new country-specific emphasis of promotional campaigns, health education, and policy targeting these underrepresented groups in LRCs.

Availability Versus Utilization of Supplemental Breast Cancer Screening Post Passage of Breast Density Legislation.

Objective: Despite the lack of evidence that supplemental screening in women with dense breasts reduces breast cancer mortality, 38 states have passed breast density legislation, with some including recommendations for supplemental screening. The objective of this study is to compare the availability versus use of supplemental breast cancer screening modalities and determine factors driving use of supplemental screening in rural versus urban settings. Methods: A 50-item mailed survey using the Tailored Design Method was sent to American College of Radiology mammography-accredited facilities in North Carolina in 2017. Respondents included 94 facilities (48 rural and 46 urban locations). Survey questions focused on breast cancer and supplemental screening services, breast density, risk factors/assessment, and facility demographics. Results: The survey response rate was 60.3% (94/156). Among the 94 respondents, 64.0% (n = 60) reported availability of any type of supplemental screening (digital breast tomosynthesis [DBT], ultrasound, or magnetic resonance imaging [MRI]). In facilities where supplemental screening modalities were available, the most commonly utilized supplemental screening modality was DBT (96.4%), compared with ultrasound (35.7%) and MRI (46.7%). Facilities reported using supplemental screening based on patient breast density (48.3%), referring physician recommendation (63.3%), reading radiologist recommendation (63.3%), breast cancer risk factors (48.3%), and patient request (40.0%). Urban facilities were more likely than rural facilities to base supplemental screening on breast cancer risk factors (62.5% vs. 32.1%; p-value = 0.019), referring physician (75.0% vs. 50.0%; p-value = 0.045), and reading radiologist (78.1% vs. 46.4%; p-value = 0.011). Conclusion: In our study, supplemental screening modalities were widely available, with facilities more likely to use DBT for supplemental screening compared to other modalities.

Abstract A23: Using Internet-platform technology to train community-based researchers in developing countries: Lessons Learned from a Caribbean study

Abstract As cancer increases as a global health challenge, the use of available technological platforms for communication is required. To develop a collaborative program of cancer prevention research between the U.S. and the Caribbean, we relied on several mobile phone and Internet-based communication platforms. In 2016-2017, a two-phase advocacy-engaged research study was initiated to determine 1) women’s perceptions of breast and cervical cancer screening and 2) gatekeepers’ perceptions of the quality and availability of breast and cervical cancer screening and treatment services in the four countries of the English-speaking Windward Islands. Our results revealed that mobile communication and Internet-platform technologies successfully trained Caribbean community researchers on qualitative data collection and analysis methods as well as dissemination strategies. In particular, mobile platforms including GoToTraining, WhatsApp, YouTube, Dedoose, Google Drive, and email were used to deliver interactive training modules to community researchers in the Caribbean. The Internet-based technology enhanced training, communication, and social interactions. Additionally, it facilitated the collaborative development of recruitment materials and data collection instruments, data management, reports, manuscripts, and results dissemination. Community and academic researchers agreed that use of technology fostered a cost-effective and efficient collaborative process. The availability and use of communication technology are especially critical for researchers addressing the raising global cancer burden, particularly in resource-poor countries. Advocacy-engaged, technology-facilitated cancer research has the potential to cultivate and sustain community capacity and infrastructure for international research partnerships by building bridges via the use of mobile and Internet-based technology. Citation Format: Kamilah B. Thomas-Purcell, Marva Primus-Joseph, Christine Richards, Ann Marie McBurnie James, Julie Blaze, Lydia Atkins, Patsy Wiley, Kimlin Tam Ashing. Using Internet-platform technology to train community-based researchers in developing countries: Lessons Learned from a Caribbean study [abstract]. In: Proceedings of the AACR Special Conference on Modernizing Population Sciences in the Digital Age; 2019 Feb 19-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(9 Suppl):Abstract nr A23.

Wealth stratified inequalities in service utilisation of breast cancer screening across the geographical regions: a pooled decomposition analysis

BackgroundBreast cancer is the most commonly occurring cancer among women in low-resourced countries. Reduction of its impacts is achievable with regular screening and early detection. The main aim of the study was to examine the role of wealth stratified inequality in the utilisation breast cancer screening (BCS) services and identified potential factors contribute to the observed inequalities.MethodsA population-based cross-sectional multi-country analysis was used to study the utilisation of BCS services. Regression-based decomposition analyses were applied to examine the magnitude of the impact of inequalities on the utilisation of BCS services and to identify potential factors contributing to these outcomes. Observations from 140,974 women aged greater than or equal to 40 years were used in the analysis from 14 low-resource countries from the latest available national-level Demographic and Health Surveys (2008–09 to 2016).ResultsThe population-weighted mean utilisation of BCS services was low at 15.41% (95% CI: 15.22, 15.60), varying from 80.82% in European countries to 25.26% in South American countries, 16.95% in North American countries, 15.06% in Asia and 13.84% in African countries. Women with higher socioeconomic status (SES) had higher utilisation of BCS services (15%) than those with lower SES (9%). A high degree of inequality in accessing and the use of BCS services existed in all study countries across geographical areas. Older women, access to limited mass media communication, being insured, rurality and low wealth score were found to be significantly associated with lower utilisation of BCS services. Together they explained approximately 60% in the total inequality in utilisation of BCS services.ConclusionsThe level of wealth relates to the inequality in accessing BCS amongst reproductive women in these 14 low-resource countries. The findings may assist policymakers to develop risk-pooling financial mechanisms and design strategies to increase community awareness of BCS services. These strategies may contribute to reducing inequalities associated with achieving higher rates of the utilisation of BCS services.

Abstract B108: Using patient navigation to inform determinants of breast cancer disparities among under-resourced women in Chicago

Abstract Background: Under-resourced women are subject to many factors that increase their risk of morbidity and mortality from breast cancer, such as being uninsured or underinsured and not having a medical home or primary care provider. They may also lack additional resources to access care such as transportation. Due to variance in mammography recommendations among health organizations, lack of knowledge or confusion about when to receive screening also poses a challenge to both women and providers. Objective: A partnership between University of Illinois (UI) Cancer Center, UI Hospital & Health System, and Chicago Department of Public Health was developed to initiate an implementation science program that aims to mitigate these barriers by providing free breast cancer screening services and patient navigation to under-resourced women at our Mile Square Federally Qualified Health Centers (FQHCs). The program also aims to increase community partnerships to extend community outreach and identify factors that facilitate or challenge women's access to breast care services. Methods: Breast health screening and navigation services are offered at 5 Mile Square FQHC clinics and through “mammography party” events with community partners. Navigators facilitate women's care through screening and any follow-up services, link patients to additional resources, and provide breast health education. Data obtained through electronic medical records and direct correspondence with women and providers are managed securely in REDCap and analyzed with SPSS software. A program evaluation will be implemented in September 2018. Program activities are ongoing. Results: Four hundred ten women completed a screening mammogram from August 1, 2017 to June 30, 2018. Ninety-seven percent of women were racial minorities, most of whom were Latina (60.2%), African American (31.5%) and uninsured (67.8%). Among this cohort of women, the recall rate (24.6%) and cancer detection rate (17 per 1000) exceeded Breast Cancer Surveillance Consortium 2013 recall and cancer detection rate benchmarks (11.5% and 4.8 per 1000, respectively). Ages of women diagnosed (n=7) ranged from 40 to 68 years. The majority of diagnosed women were uninsured (n=6), 4 of whom were not eligible for health insurance. Conclusion: Patient navigation has proven to be effective in increasing breast cancer screening rates, access to care and resources, and disseminating breast health education; however, systematic barriers to care still persist. Although the Affordable Care Act has been instrumental in increasing the number of insured Americans, health care costs still pose a significant challenge for those who are underinsured or not eligible to be insured. Additionally, our data imply that some recommended guidelines for mammography may not address the screening needs for women who are at higher risk for breast cancer, and more personalized screening based on a woman's individual risk factors may be instrumental in ameliorating breast cancer disparities. Citation Format: Vida Henderson, Karriem Watson, Kathy Tossas-Milligan, Erica Martinez, Mariela Rodriguez, Barbara Williams, Paola Torres, Lisa Aponte-Soto, Robert Winn. Using patient navigation to inform determinants of breast cancer disparities among under-resourced women in Chicago [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B108.

The pink vans: Bringing cancer screening closer to home.

e14021 Background: A global survey reported that among 15 Asian countries, the Philippines has the highest breast cancer mortality rate and the lowest mortality-to-incidence ratio. This may be due to the fact that majority of breast cancers are diagnosed in locally advanced or metastatic stages among low- and middle-income countries. Studies show that in the Philippines more than half (53%) of patients with breast cancer were diagnosed at stages III and IV, while only 2-3% of cases were treated at Stage I. This translates to a dismal 58.6 % 5-year survival rate. Furthermore, socioeconomic factors were identified as one of the major causes for the lack of access to early detection and treatment. These include lower educational level, higher poverty rates, inadequate or no health insurance, lack of transportation, and/or the unavailability of health services in far-flung areas. These findings are currently of urgent national concern since the improvements in breast cancer survival rates brought by advances in treatments are mainly dependent on early detection, screening and timely treatment. Methods: In response to this gap in the delivery of services to promote early cancer detection, the University of the Philippines – Philippine General Hospital (UP-PGH) Cancer Institute established the Mobile Breast Cancer Diagnostic Clinic Program, a first in the country where two fully equipped “pink” vans are sent out to far flung areas and provide breast cancer screening and diagnostic services (eg. Mammogram, breast ultrasound, biopsies of suspicious masses, etc). These vans are manned by medical and surgical oncologists, and various paramedical professionals. Results: In the first 6 months of the program, the “pink” vans were able to visit 3 strategically identified areas in the country. These three tours have served a total of 189 women who all underwent screening mammography. 18 had their suspicious lesions biopsied, and two-thirds of which were found to be malignant. These patients were then referred to our institution for further work-up and management. Conclusions: As the Philippine health department continues to emphasize clinical and self-breast exam as part of its breast cancer control program, efforts like the UP-PGH “Pink Vans” may eventually help supplement the gap in the country’s breast cancer screening endeavors with the goal of improving survival by identifying the disease at its earliest stage.

The eligibility and reach of the national breast and cervical cancer early detection program after implementation of the affordable care act.

The uninsured rate declined following passage of the Affordable Care Act in 2010. It is unclear how this decrease affected the size of the population eligible for existing safety net programs. We evaluated trends in the number of women eligible for breast and cervical cancer screening and diagnostic services under the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and the reach of the program. Using the Census Bureau's Small Area Health Insurance Estimates data, we calculated the number of women who met the NBCCEDP eligibility criteria based on age, income, and insurance status. We used these data in conjunction with program to estimate the proportion of eligible women served by the NBCCEDP. The number of women eligible for breast cancer screening and diagnostic services under the program declined from 5.4 (90% CI 5.2-5.6) to 2.8 (90% CI 2.6-3.0) million from 2011 to 2017. The number of women eligible for cervical cancer screening and diagnostic services declined from 10.3 (90% CI 10.0-10.6) to 5.3 (90% CI 5.1-5.6) million. The share of eligible women served by the program was 15.0% (90% CI 14.8-15.1%) for breast services in 2016-2017 and 6.8% (90% CI 6.7-6.8%) for cervical services in 2015-2017. Insurance coverage expansions may have contributed to a decrease in the number of program-eligible women. There are many more women eligible for the program than are served.

Socioeconomic Inequalities in Uptake of Breast Cancer Screening among Saudi Women: A Cross-Sectional Analysis of a National Survey.

Timely and adequate screening for breast cancer could improve health outcomes and reduce health costs. However, the utilization of free breast cancer screening services among Saudi women is very low. This study aims to investigate socioeconomic inequalities in breast cancer screening among Saudi women. The data of this study were extracted from the nationally representative Saudi Health Interview Survey, conducted in 2013; the study included 2786 Saudi women. Multivariate logistic regression, the concentration curve, and the concentration index were used to examine, illustrate, and quantify income- and education-related inequalities in three outcomes: Knowledge about self-breast examination (SBE), clinical breast examination (CBE) received in the last year, and mammography, that has ever been previously carried out. Results showed a marked socioeconomic gradient in breast cancer screening services. The concentration index by income was 0.229 (SBE), 0.171 (CBE), and 0.163 (mammography). The concentration index by education was 0.292 (SBE), 0.149 (CBE), and 0.138 (mammography). Therefore, knowledge about breast cancer screening, and the utilization of screening services, were more concentrated among richer and better-educated women. Poorer and less educated women had less knowledge about self-breast examination, and had considerably less adherence to clinical breast examination and mammography. The findings are helpful for policy makers to devise and implement strategies to promote equity in breast cancer screening among Saudi women.

Inter- and intra-provincial variation in screen-detected breast cancer across five Canadian provinces: a CanIMPACT study

Breast cancer screening aims to identify cancers in early stages when prognosis is better and treatments less invasive. We describe inter- and intra-provincial variation in the percentage of screen-detected cases under publicly funded healthcare systems and factors related to having screen- vs non-screen-detected breast cancer across five Canadian provinces. Women aged 40+ diagnosed with incident breast cancer from 2007 to 2012 in five Canadian provinces were identified from their respective provincial cancer registries. Standardized provincial datasets were created linking screening, health administrative, and claims data. Province-specific logistic regression models were used to evaluate the association of demographic and healthcare utilization factors in each province with the odds of screen-detected cancer. There was significant inter- and intra-provincial variation by age. Screen detection ranged from 42% to 52% in ages 50-69 but women aged 50-59 had approximately 4-8% lower screen detection than those aged 60-69 in all provinces. Screening associations with income quintile and rurality varied across provinces. Those least likely to be screen-detected within a province were consistently in the lowest income quintile; OR ranged from 0.62-0.89 relative to highest income quintile/urban patients aged 50-69. Lack of visits to primary care 30months prior to diagnosis was also consistently associated with lower odds of screen detection (OR range, 0.37-0.76). Breast cancer screen detection rates in the Canadian provinces examined are relatively high. Associations with income-rurality indicate a need for greater attention and/or targeted outreach to specific communities and/or provincial regions to improve access to breast cancer screening services intra-provincially.

Best practice models recommended by Bhutanese refugee women for cervical and breast cancer screening in Australia: A qualitative study

The purpose of this paper was to explore what a refugee women's health screening program would look like if the views of Bhutanese refugee women were incorporated into service design and the approaches to targeting access to cervical and breast cancer screening. Qualitative study, used in-depth interviews with 30 Bhutanese refugee women resettled in Melbourne, Australia. Two practice models were identified by refugee women: a doctor-initiated model involving opportunistic screening during consultations for other purposes; and a group screening model. Participants emphasised the need for a supportive environment with culturally appropriate services, community education and peer networks to encourage and facilitate their participation in cervical and breast cancer screening services. General practitioners can provide guidance, opportunistic screening that includes education, and advice about follow-up. The need for the routine use of professional interpreter services was reinforced. Available cervical and breast cancers screening services are not attuned to refugee women's views where this study focuses attention on the roles and practices of doctors in preventive health care for refugee women. Merging their perspectives with those of providers and policymaker's can fill the existing gaps and support to formulate the new interventions that will improve women's access to such preventative services. SO WHAT?: Refugee women resettled in high income countries are less likely to attend preventive cancer screening programs than other women, so we need to understand how to motivate them to seek regular check-ups. In this study Bhutanese refugee women resettled in Melbourne, Australia said that group screening or doctor-led care would be appealing to them.

Socioeconomic determinants of cancer screening utilisation in Latin America: A systematic review.

Cancer incidence and mortality in Latin America are rising. While effective cancer screening services, accessible to the whole population and enabling early cancer detection are needed, existing research shows the existence of disparities in screening uptake in the region. We conducted a systematic review to investigate the socioeconomic determinants for the disparities in the use of breast, cervical and colorectal cancer screening services in Latin America. We searched for studies reporting on socioeconomic determinants impacting on access to breast, cervical and colorectal cancer screening, published from 2009 through 2018. The studies that qualified for inclusion contained original analyses on utilisation of breast, cervical and colorectal cancer screening across socioeconomic levels in Latin America. For each study, paired reviewers performed a quality analysis followed by detailed review and data extraction. Twenty-four articles that met the eligibility criteria and were of sufficient quality were included in this review. Thirteen of the included articles were written in English, eight in Portuguese and three in Spanish, and they reported on the use of breast or cervical cancer screening. No studies were found on the socioeconomic determinants regarding the utilisation of colorectal cancer screening in Latin America. Low income, low education level, lack of health insurance and single marital status were all found to be determinants of underuse of breast and cervical cancer screening services. Cancer screening programs in the region must prioritize reaching those populations that underuse cancer screening services to ensure equitable access to preventive services. It is important to develop national screening programmes that are accessible to all (including uninsured people) through, for example, the use of mobile units for mammography and self-screening methods.

Financial barriers related to breast cancer screening and treatment: A cross-sectional survey of women in Kenya

BackgroundBreast cancer is a leading cause of cancer mortality among women in Kenya. Regular screening and optimal treatments can reduce the burden from this disease, but the cost of health care is a barrier to accessing these services. The objective of this study is to assess barriers to breast cancer screening and treatment services, with special emphasis on economic aspects. MethodsWe recruited 400 women with and 400 women without a diagnosis of breast cancer and conducted face-to-face interviews. We developed tailored instruments to capture demographics, socioeconomic factors, employment status, insurance coverage, barriers to seeking care, and treatment cost. Qualitative feedback was also sought from the participants. ResultsAmong women without breast cancer, the most commonly cited impediments to receiving medical care were cost (46.3 %) and transportation (23.3 %). For women with breast cancer, 53.8 % reported that they had to forego care because of cost and 91.2 % reported that their diagnosis impacted household financial wellbeing. Additionally, about half the women (44.9 %) with insurance coverage indicated that the reimbursement received for medical costs was less than they expected to receive. ConclusionFor women both with and without diagnosed breast cancer, cost was a major concern in seeking medical services. Affordability and access to breast cancer screening and treatment need to be improved. Providing more comprehensive insurance coverage is a key solution.

Mammography Dose Survey Using International Quality Standards

Digital mammography is the current standard for breast cancer screening. The absence of any dosimetric data, the quality standards, and the fear of radiation detriment, sometimes, hampers the smooth introduction of this technology and the launch of breast cancer screening programmes. As the breast cancer screening programmes are in development in Morocco, quality standards have been set in this study, so that any new breast cancer screening service could get started with their first analysis. The purpose of this study was to report the first Moroccan breast dose and to test quality standards compared with European guidelines. A dosimetric study is conducted by calculating mean glandular dose (MGD) for patients' breasts and polymethyl methacrylate (PMMA) for each thickness from recorded radiographic factors and X-ray tube (output and half-value layer) measurements using Dance's model for a digital mammography system. This is carried out to determine the correlation between phantom and patient measurements.The mean MGD for patient data was 1.02 ± 0.5 mGy and the compressed breast thickness was 55 ± 14 mm. For compressed breast thickness range of 50–60 mm, the MGD was 0.94 ± 0.3 mGy and the dose calculated with PMMA phantom for the same range thickness was 1.33 mGy. The results of MGD as a function of PMMA thickness is lower than the achievable limit curve proposed in the European guidelines. The average doses, which depend on the technical parameters of the mammography equipment, are in line with values obtained in European guidelines. In addition, an investigation is needed throughout the Moroccan territory, in the sense of optimization of radiological practices and techniques in mammographic centres aligning with the international recommendations.

Didactic and narrative methods of communicating breast cancer screening: a systematic review

There is limited studies that have sought to understanding the processes and mechanisms through which stories influence health-related decisions and actions is critical to maximizing their effectiveness and developing appropriate applications for use in practice settings, more also studies that seek to interrogate the available evidence on the effectiveness of narratives in on seven correlates of behaviour change hence the current review. The main aim of this review was to conduct a comparative evaluation on effectiveness of didactic and narrative methods of cancer communication. Studies were included if they the study used empirical data whether the data was quantitative or qualitative discussing the use of narrative or didactic forms communication on cancer screening, if the study reported outcome of the intervention, if the study was on cancer screening, if the article was written in English language, and the article appeared in a peer-reviewed journal that was published before July 2017. The current systematic review evaluated evidence supporting narrative intervention in cancer communication in an attempt to increase the uptake of breast cancer screening as well as comparing narrative mode of communication with statistical mode of passing the information. Over all it was observed that there exist some evidence that narrative is efficacious in increasing breast cancer screening services. However there were a lot of inconsistences in the evidence adduced in these studies, a fact that warrant that more studies be done in this area of study.

Factors Associated with Initial Mode of Breast Cancer Detection among Black Women in the Women's Circle of Health Study.

Mammogram-detected breast cancers have a better prognosis than those identified through clinical breast exam (CBE) or through self-detection, primarily because tumors detected by mammography are more likely to be smaller and do not involve regional nodes. In a sample of 1,322 Black women, aged 40-75 years, diagnosed with breast cancer between 2002 and 2016, we evaluated factors associated with CBE and self-detection versus screening mammogram as the initial mode of breast cancer detection, using multivariable logistic regression models. Compared with screening mammogram, history of routine screening mammogram (OR 0.20, 95% CI: 0.07, 0.54) and performance of breast self-examination (BSE) (OR 0.31, 95% CI: 0.13, 0.74) before diagnosis were associated with lower odds of CBE as the initial mode of detection, while performance of CBEs before diagnosis (OR 11.04, 95% CI: 2.24, 54.55) was positively associated. Lower body mass index (<25.0 kg/m2 vs. ≥35.0 kg/m2: OR 2.46, 95% CI: 1.52, 3.98), performance of BSEs before diagnosis (less than once per month: OR 4.08, 95% CI: 2.45, 6.78; at least monthly: OR 4.99, 95% CI: 3.13, 7.97), and larger tumor size (1.0-2.0 cm vs. <1.0 cm: OR 2.92, 95% CI: 1.84, 4.64; >2.0 cm vs. <1.0 cm: OR 6.41, 95% CI: 3.30, 12.46) were associated with increased odds of self-detection relative to screening mammogram. The odds of CBE and self-detection as initial modes of breast cancer detection among Black women are independently associated with breast care and breast cancer screening services before diagnosis and with larger tumors at diagnosis.

Abstract 1627: Using internet-platform technology to train community-based researchers in developing countries: Lessons learned from a Caribbean study

Abstract Cancer is increasing as a health crisis in the Caribbean region. In the U.S. advocate engagement and Community Based Participatory Research (CBPR) have been used successfully to partner with community members in each stage of the research process thereby utilizing the knowledge and experience of those individuals for improved community responsive research and greater societal benefit. We utilized advocate engagement and CBPR towards building a cancer prevention program of research between U.S. and Caribbean researchers. In 2016-2017, a two-phased CBPR research study was initiated to address breast and cervical cancer screening in the four countries of the English-speaking Windward Islands of the Caribbean. The aims were to determine 1) community member’s perceptions of breast and cervical cancer screening and 2) gatekeepers’ perceptions of the quality and availability of breast and cervical cancer screening and treatment services. Mobile communication and internet-platform technologies were used to successfully train Caribbean community researchers on qualitative data collection and analysis methods. Our results showed that the incorporation of internet-based technology facilitated training, communication, social interactions, and alleviated transportation challenges. In particular, mobile platforms including GoToTraining, WhatsApp, Dedoose, Google Drive, and email were to used to deliver interactive training modules to community researchers and facilitate the collaborative development of recruitment materials, data collection instruments, data management, reports, manuscripts and results dissemination. Participatory research studies of this nature not only shed light on the cancer burden in developing nations but also builds community trust and capacity to engage in future international research. Citation Format: Kamilah B. Thomas-Purcell, Marva Primus Primus-Jospeh, Christine Richards, Lydia S. Atkins, Julie Blaze, Patsy Wylie, Ann Marie Burnie James, Kimlin Ashing. Using internet-platform technology to train community-based researchers in developing countries: Lessons learned from a Caribbean study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1627.

Uptake of cancer screening services among middle and older ages in Ireland: the role of healthcare eligibility

ObjectivesThe aim of this analysis was to examine the association between public healthcare eligibility combined with private health insurance (PHI) status and the uptake of breast and prostate cancer screening services among middle and older age groups in Ireland. Study designThis is a cross-sectional analysis using The Irish Longitudinal Study on Ageing (TILDA). MethodsThe analysis included 6902 people aged 50 years and older who completed an in-house interview as part of TILDA. The interview collects information on a range of demographic, socio-economic, health and health service usage variables including the uptake of cancer screening services. An eligibility variable was created using information on public healthcare entitlement and PHI status. The association between eligibility and the uptake of two cancer screening services—mammogram and prostate-specific antigen (PSA) test—was examined using weighted multivariate logistic regression analysis. ResultsThe uptake of a mammogram and PSA testing was significantly higher in those with PHI. This relationship held after controlling for a range of confounders including health and socio-economic status. ConclusionsMore research is required to identify the reasons for the higher uptake of cancer screening services among those with PHI, given that insurance does not confer any advantages in accessing these services. It is possible that the higher uptake is explained by differential access to secondary care services between those with and without PHI. Consideration of the integrated nature of healthcare systems is essential when seeking to maximise the uptake of services (such as cancer screening) that potentially involve multiple parts of the healthcare system.