Women's screening preferences shift after being informed about the 2024 USPSTF breast cancer screening guideline.

Food insecurity affects nearly 1 in 5 US adults and is associated with barriers to preventive health care. Whether food insecurity is associated with lower national cancer screening adherence and whether Supplemental Nutrition Assistance Program (SNAP) participation is associated with attenuation of these disparities remain unclear. To evaluate the association between food insecurity and guideline-concordant colorectal, breast, and cervical cancer screening and to assess whether SNAP participation was associated with attenuation of screening disparities among food-insecure adults. This cross-sectional study used 2022 Behavioral Risk Factor Surveillance System data, a nationally representative survey of noninstitutionalized US adults. The study took place from May 22 to July 21, 2025. Data analyses were conducted from June 3 to July 7, 2025, and included respondents with complete food insecurity, SNAP participation, covariate, and age- and sex-eligible cancer screening data. Self-reported food insecurity during the past 12 months; SNAP participation served as the primary effect modifier. Guideline-concordant colorectal, breast, and cervical cancer screening based on US Preventive Services Task Force recommendations. Of 251 107 adults included in the analytic cohort, 47 453 (18.9%) reported food insecurity; food-insecure respondents were more often younger than 65 years (35 031 [73.8%] vs 118 063 [58.0%]) and female (27 690 [58.4%] vs 106 203 [52.2%]) compared with food-secure respondents. Screening adherence was lower among food-insecure than food-secure adults for colorectal (10 115 [51.6%] vs 59 825 [63.8%]), breast (1459 [61.2%] vs 7457 [72.5%]), and cervical cancer screening (1124 [39.8%] vs 4682 [50.3%]). In adjusted analyses stratified by SNAP participation, food insecurity was associated with lower odds of colorectal (adjusted odds ratio [aOR], 0.78; 95% CI, 0.74-0.83), breast (aOR, 0.69; 95% CI, 0.60-0.79), and cervical cancer screening (aOR, 0.63; 95% CI, 0.49-0.81) among respondents not enrolled in SNAP. Among food-insecure respondents, adjusted probabilities of being up to date with screening were higher among SNAP participants than nonparticipants for colorectal (48.2% [95% CI, 46.1%-50.2%] vs 46.3% [95% CI, 44.1%-48.4%]; difference, 1.9 [95% CI, 0.5-3.6] percentage points), breast (56.1% [95% CI, 54.0%-58.3%] vs 52.7% [95% CI, 49.7%-55.8%]; difference, 3.4 [95% CI, 1.3-5.6] percentage points), and cervical (51.3% [95% CI, 48.9%-53.8%] vs 45.2% [95% CI, 42.5%-47.4%]; difference, 6.1 [95% CI, 3.8-8.4] percentage points) cancer screening. In this cross-sectional study of 251 107 US adults, food insecurity was associated with lower likelihood of guideline-concordant colorectal, breast, and cervical cancer screening. Among food-insecure adults, SNAP participation was associated with higher adjusted screening probabilities than nonparticipation.

To evaluate the necessity of breast implant-inclusion (BII) views in breast cancer screening for women with breast implants. This retrospective study was conducted on patients who underwent full-field digital mammography, including four BII and four implant-displacement (BID) views, at three institutions in South Korea between January 2009 and December 2020. The true positive rate and radiologic findings were assessed and compared between BII and BID views. Factors associated with the change in suspicion level of malignancy and radiation dose were analyzed. Of the total 1470 patients (45.6 ± 8.4 years) evaluated, 215 were diagnosed with breast cancer (15%), and the cancer was not demonstrable in 37 cases in both BII and BID views. Thetrue positive rates of theBII and BID views were 54% (116/215) and 83% (178/215), respectively (p < 0.01). The suspicion level of malignancy increased in 72% (129/178) and remained unchanged in 28% (49/178) in BID view compared to BII view. The implant location and tumor size differed between the increased suspicion and unchanged groups (p = 0.01 and < 0.01, respectively). The radiation dose per breast was 1.2 ± 0.5 mGy and 1.1 ± 0.4 mGy in BII and BID views (p < 0.01), respectively. BID view alone may be sufficient for breast cancer screening in women with breast implants while minimizing radiation exposure, particularly in those with subpectoral implants. Question Does the implant-inclusion view provide additional diagnostic value over the implant-displacement view in breast cancer screening for women with breast implants? Findings Implant-displacement view demonstrated a higher true positive rate and lower radiation dose than implant-inclusion view, with no cancers detected exclusively by implant-inclusion view. Clinical relevance Screening with implant-displacement view alone in women with breast implants is sufficient for cancer detection while reducing radiation exposure-particularly in those with subpectoral implants, supporting a protocol that benefits patient safety and clinical efficiency.

In breast cancer screening, determining the optimal balance between the number of screen-detected cancer cases and false-positive recalls is essential. This study explored the relationship between these indicators for the Dutch Digital Mammography Screening Program and aimed to determine the optimal recall rate. From March to June 2019, 21 screening radiologists provided continuous Probability-of-Malignancy (PoM) scores during their standard reading sessions. Scores ranged from 'no suspicion' (PoM = -100) to 'highest suspicion' (PoM = 100). Follow-up data were obtained in June 2024 and included recall decisions after double reading, outcomes of further assessments (false positive or screen-detected cancer), and interval cancer diagnoses. Recall-detection and receiver operating characteristic (ROC) curves were constructed for each reader and averaged to obtain summary curves, with error bars computed from hierarchical bootstrapping of cases within readers (1000 resamples). The overall screening performance was quantified using the area under the ROC curve (AUC). The final dataset comprised 40,829 screening records with 315 cancer cases. The overall recall rate was 2.33%, and the cancer detection rate after double reading was 6.4 per 1000 screens. Radiologist performance was high (AUC = 0.91). Moving the operating point results in either substantially lower cancer detection or relatively little gain. This prospective study identified the trade-off between unconditional recall and detection rates, as well as conditional sensitivity and specificity. We found that Dutch screening radiologists perform at a high level and operate at a point that seems to optimize the false-positive recall and cancer detection rate trade-off. Question Breast cancer screening requires a good balance between detection and false-positive rate. However, the interrelationship between these rates, and thus the optimal recall, is unknown. Findings Overall, the Dutch screening radiologists performed with high accuracy, and the current operating point optimizes the trade-off between cancer detection and false-positive recalls. Clinical relevance ROCS provides an efficient method to evaluate performance and determine target values based on data from screening practice. This method applies to various screening programs. Screening evaluation is essential for achieving and maintaining a positive benefit-to-harm ratio for participants.

Economic Evaluation of Breast Cancer Screening in China: A Systematic Review of Costs and Cost-Effectiveness.

Early breast cancer detection is essential to reducing disproportionately high mortality among Black women. This study aimed to explore multilevel, place-based barriers to breast cancer screening among Black women living in a low-income community and examine how geo-social-cultural-ecological systems contribute to the barriers. This qualitative study used focus group approach and recruited Black women with and without breast cancer, health care providers, and community leaders (N = 22) from a low-income community in the United States. Bronfenbrenner's ecological framework guided an iterative and inductive method to analyze data. Eleven themes emerged across the individual, microsystem, macrosystem, exosystem, and mesosystem levels, illuminating barriers and interconnected pathways of barriers that limited breast cancer screening. Participants also identified facilitators that helped Black women manage multilevel system challenges to breast cancer screening. Findings support a geo-social-cultural-ecological approach to systematically identifying barriers and discerning the pathways of barriers across multilevel systems within a geolocation.

Breast cancer screening is vital for early detection and improved health outcomes but requires robust health economic evaluations to guide implementation. This systematic review examines the methodology, quality, and results of health economic evaluations of screening strategies to support decision making and future research. A literature search was performed in PubMed, Embase, Web of Science, EconLit, and the HTA database. Health economic evaluations of breast cancer screening strategies using imaging modalities were included and screened independently by two reviewers. Data on study design, screening strategies, and outcomes were extracted and synthesized. Quality was assessed using the ISPOR checklist for model-based studies and the Consensus on Health Economics criteria (CHEC-extended) checklist for empirical data-based studies. All results were made publicly accessible via an interactive platform and the Open Science Framework, providing an open resource that facilitates transparency, reuse, and future updates. The review included 128 studies, comprising 96 model-based studies, 14 empirical data-based studies, 15 studies combining empirical data with extrapolation using a modeling approach, and 3 studies with unclear methods. Microsimulation and cohort simulation were used in 47 and 53 studies, respectively. Incremental cost-effectiveness ratios varied widely across studies depending on the screening modality, risk factors, age range of screening, and screening interval. Most studies found mammography to be cost effective compared with no screening, while some studies showed it as being not cost effective, especially for women at average risk of breast cancer, in young screening ages (40-49years), or with an annual interval. Ultrasound-based screening programs were generally cost effective compared with no screening in the women with average risk of breast cancer. Supplementing magnetic resonance imaging (MRI) with mammography was generally cost effective in women with dense breasts and a family history of breast or ovarian cancer but not cost effective in women with previous treatment using radiation therapy. The median quality score was 55% for model-based studies, with microsimulations having higher quality than cohort simulations. Empirical data-based studies with and without extrapolation had a similar median quality score of 65%. Mammography was generally reported as cost effective compared with no screening. Supplementing mammography with ultrasound and/or MRI could be cost effective depending on comparator, risk factors, age range, and screening interval. Suboptimal quality was commonly observed across published health economic evaluations. Future studies should prioritize enhancing overall quality, particularly in data, validation, and reporting.

Bonus Finding: How breast cancer screening can predict heart disease risk.

Uptake of breast cancer screening varies between English regions despite adherence to similar screening protocols across regions and screening services. Poor uptake is thought to impair breast cancer outcomes, including the assumption of higher breast cancer mortality. There are known demographic differences between English regions, and there has been limited investigation into which characteristics are associated with behavior and outcomes in a single region compared with overall national performance. In this research letter, we outline the challenges we have faced when conducting this analysis using routinely collected data and provide recommendations to facilitate similar work in the future.

Artificial Intelligence as a Triage Partner in Breast Cancer Screening.

Breast cancer is the most prevalent cancer among UK women. Screening aims to detect cancer early, improving treatment options, and survival. However, participation varies across England with lower participation and cancer detection rates in London than other regions. We postulate that demographic factors (age, ethnicity, deprivation, and migration) might explain some regional differences. An ecological analysis of aggregated data compared English regions (April 2007-March 2020). Primary outcomes were breast cancer mortality, coverage rate, and rate of screen-detected invasive cancers. Linear regression analyses compared outcomes between London and other English regions, adjusting for age, ethnicity, deprivation, and migration. Data included 104 observations aggregated from 26 202 645 screenings, of which 11.9% were in London. Coverage was lower in London (67.8%) than other English regions (73.6%-79.8%). London had significantly lower rates of screen-detected invasive cancers (mean= 6.2 per 1000, SD = 0.2) compared to 6 of 7 regions (ranging from 6.3 to 6.9 per 1000) and lower breast cancer mortality rate (mean = 31.7, SD = 0.8) than 4 regions (ranging from 33.4 to 36.1). Differences in coverage were attenuated and non-significant after adjustment for demographic factors. Regional differences in screening participation are associated with demographic factors, but breast cancer outcomes in London are not worse than the rest of England. Targeted interventions to improve screening accessibility for underserved communities could reduce inequalities. We describe challenges associated with combining several sources of information when performing our analyses and further research using individual-level data is recommended to confirm results and explore additional predictors. This national ecological analysis demonstrates that lower breast screening coverage and invasive cancer detection rates in London are associated with demographic factors, particularly ethnicity, deprivation, and migration. Despite poorer participation, breast cancer mortality in London is not worse than in other English regions. The findings emphasize the importance of demographic factors in breast screening outcomes and improved data linkage to address regional inequalities in breast cancer screening and outcomes.

Exosomes are nanoscale extracellular vesicles (EVs) that carry molecular signatures reflective of their cells of origin, making them attractive biomarkers for liquid biopsy applications. In this study, we present a rapid and highly specific colorimetric aptasensor for the detection of Gremlin-1 (GREM1)-expressing exosomes in serum. The sensing strategy relies on the disaggregation of gold nanoparticle (AuNP) clusters, initially formed by NaCl-induced aggregation, upon selective binding of the target. AuNPs were functionalized with a thiolated Ex.50.T aptamer specifically recognizing exosomal GREM1, and the binding event triggers a measurable spectral shift in the plasmonic profile. A detection limit below 10 6 exosomes/mL was achieved using serial dilutions of purified exosomes isolated from breast cancer serum samples, demonstrating the method’s sensitivity and robustness under controlled conditions. Applied to 100 clinical serum samples, the assay demonstrated excellent diagnostic performance, with 84% sensitivity and 90% specificity—values comparable to those of mammography—without requiring extensive sample processing. Comparative analysis with commercial ELISA and Ex.50.T aptamer-based ELONA confirmed the superior discriminatory power of the method proposed here. Transmission electron microscopy further corroborated the mechanism by revealing exosomes physically disrupting AuNP aggregates. These results highlight the diagnostic potential of exosome-focused sensing strategies and establish this aptamer-based colorimetric platform as a promising candidate for non-invasive screening of breast cancer through liquid biopsy. • Colorimetric aptasensor discriminates breast cancer serum with 84% sensitivity, 90% specificity • Simple optical test matches mammography performance in liquid biopsy for breast cancer • Mix-and-measure detection of tumor-derived exosomes in 1:1 diluted serum • Anti-aggregation assay detects GREM-1-positive exosomes with high diagnostic accuracy • TEM imaging is consistent with exosome-induced disaggregation of gold nanoparticle clusters

Enhancing breast mass detection: Super-resolution multi-spectral transmission imaging with unstructured sinusoidal illumination.

Image quality assessment in digital breast tomosynthesis equipment in the cities of Belo Horizonte and Aracaju.

Biofilm surface proximity-induced branched hybridization chain reaction strategy based on microchip electrophoresis for distinguishing exosomes from different cancer cells.

In the French national breast cancer screening program, second reading is performed only for mammograms interpreted as negative (Breast Imaging and Reporting Data System [BI-RADS] 1-2) at first reading, representing a unique screening workflow in Europe. This retrospective study assessed whether artificial intelligence (AI) could identify a subgroup of negative screening mammograms that could safely bypass second reading. A total of 55 589 screening mammograms from 42 419 women aged 50-74 years (January 2015-December 2019) whose mammograms were initially classified as BI-RADS 1-2 were analyzed. Second reading outcomes were compared with those of a commercial AI system using a predefined binary threshold (≥5). Among these examinations, 183 of 55 589 (0.33%) were recalled at second reading, yielding 12 cancers (positive predictive value, 6.6%; cancer detection rate, 0.22 per 1000 examinations). AI classified 42 606 of 55 589 (76.6%) examinations as low risk (≤4) and 12 983 of 55 589 (23.3%) as nonlow risk (≥5). One cancer was detected in the AI-low group (one of 55 589 [0.002%]) compared with 11 in the AI-nonlow group (11 of 55 589 [0.020%]; P < .001). Interval cancer rates were higher in the AI-nonlow group than in the AI-low group (2.16 vs 0.47 per 1000 examinations). These findings suggest that excluding AI-low examinations from second reading could reduce workload by approximately 77% while focusing radiologist review on higher-risk cases; prospective validation is needed. Keywords: Mammography, Breast, Computer Aided Diagnosis (CAD) Supplemental material is available for this article. © RSNA, 2026 See also commentary by Yao and Chae in this issue.

Assessment of anatomical heterogeneity effects on X-ray breast dosimetry using MCNP.

Purpose To evaluate breast density changing trajectories in women age 60 years or older and identify their associated factors. Materials and Methods Data were obtained from the Korean National Health Insurance Service Database, which includes six biennial mammography screenings from January 2009 to December 2020. Women age 60 years or older who participated in screenings in 2009-2010 and 2019-2020 and at least two screenings in between were included. Breast density was classified using the Breast Imaging Reporting and Data System (BI-RADS). Group-based trajectory modeling was used to identify patterns of breast density changes across the six screening cycles. Logistic regression was used to examine breast cancer risk factors associated with the increasing or decreasing breast density trajectories. Results Among 674 993 women (mean age, 65.0 years ± 4.3 [SD]; 51% BI-RADS 1 at baseline), five distinct breast density change trajectories were identified: persistent fatty (20.5%), persistent BI-RADS 2 (36.1%), and persistent BI-RADS 3 (15.4%). Group 2 (17.2%) showed increased density, and group 3 (10.8%) demonstrated decreased density. Several breast cancer risk factors were associated with the breast density trajectories. For example, older women (adjusted odds ratio, 0.98; 95% CI: 0.97, 0.98; P < .001) and women with a higher baseline body mass index and a greater increase in body mass index over time were less likely to have increased breast density. Conclusion Five distinct breast density change trajectories were identified among Korean women who were age 60 years or older. Women with initially low breast density and more breast cancer risk factors were more likely to show increasing trajectory, whereas those with initially high density and fewer risk factors tended to show decreasing density. Keywords: Breast Density, Breast Density Change, Older Women, Reproductive Factors, Breast Cancer © RSNA, 2026.

Implementation of timely and targeted health screening programmes is strongly aligned with the United Nations Sustainable Development Goals (SDGs) in promoting prevention, early detection, and timely intervention across populations. However, participation in breast, cervical, and colorectal cancer screening remains suboptimal and inequitable, and is increasingly challenged. This review synthesised global evidence on implementation interventions aimed at increasing screening participation and reducing disparities, to identify gaps that must be addressed to achieve screening targets. This scoping review was conducted and reported in accordance with PRISMA-ScR and the Joanna Briggs Institute methodological guidance. The Consolidated Framework for Implementation Research (CFIR) was used to extract and synthesise barriers and facilitators, while the RE-AIM framework for the performance of interventions. We used descriptive quantitative methods and a hybrid (deductive-inductive) thematic analysis to summarise and interpret the evidence. One hundred ten studies were included and identified ten intervention categories: educational, reminders, self-sampling, outreach, peer education and counselling, quality improvement, promotional messages, patient navigation and tracking, mass media, and multicomponent interventions. Barriers and facilitators to screening participation were assessed using the CFIR framework, while intervention performance was synthesised using RE-AIM components. Although most interventions demonstrated promising effectiveness, multicomponent interventions showed the greatest impact. However, most interventions were implemented in highly controlled settings, limiting their real-world applicability and scalability. Findings revealed important gaps in culturally responsiveness and real-world intervention approaches for cancer screening. Future research should prioritise pragmatic, culturally appropriate, and multiple component interventions, supported by sufficiently long follow-up periods to assess sustainability and real-world effectiveness.

Young adult women are increasingly undergoing infertility treatment; however, evidence regarding breast cancer screening in this population remains limited. Given that most women in this age group have dense breast tissue, for which mammography has limited sensitivity, breast ultrasound (US) is often used as a screening modality. A diagnosis of breast cancer during infertility treatment may affect both oncologic management and reproductive planning. This study aimed to examine the clinical relevance of breast US in women in their 30s undergoing infertility treatment at an infertility clinic. We retrospectively analyzed 1,336 women aged 30-39 years who underwent screening breast US between November 1, 2018, and June 30, 2025. Analyses were performed on a per-woman basis, including only the first screening examination for each participant. Breast composition was categorized according to the BI-RADS 5th edition Atlas. Screening outcomes-including recall rate, positive predictive value (PPV), cancer detection rate, and US findings (mass and non-mass findings)-were assessed using medical records. The continuation of infertility treatment, defined as ongoing or resumed treatment during the diagnostic evaluation period, was descriptively evaluated as part of the clinical context. Of the 1,336 women, 1,277 (95.6%) were classified as having dense breasts. A total of 140 (10.5%) women were recalled for further evaluation. In these recalled cases, 147 findings were identified, comprising 113 mass lesions (76.8%) and 34 non-mass findings (23.1%). Four breast cancers were identified, corresponding to a cancer detection rate of 0.30% and a PPV of 2.86%. Histological diagnoses included one mucinous carcinoma, two invasive carcinomas of no special type (NST), and one ductal carcinoma in situ (DCIS). Following diagnostic evaluation, 124 recalled women (88.6%) continued infertility treatment. Breast US screening in women in their 30s undergoing infertility treatment provides descriptive findings within a specific clinical setting. The observed cancer detection rate appears to be within the range reported in previous studies; however, direct comparisons are limited due to differences in study populations and clinical contexts. The clinical course following recall was described as part of the screening pathway. Further prospective and multicenter studies are required to clarify the clinical significance of breast US screening in this population.