Breast Cancer Screening Research Articles

BackgroundSocioeconomic inequalities in cancer screening participation remain a public health issue worldwide. We assessed trends in cancer screening participation according to socioeconomic status in Japan between 2013 and 2022, considering the potential impact of the coronavirus disease 2019 (COVID-19) pandemic.MethodsData from the nationally representative Comprehensive Survey of Living Conditions (2013–2022: approximately 500,000 persons per survey) were analyzed for age-standardized self-reported cancer screening rates for stomach, lung, colon, breast (aged 40–69 years), and cervical (aged 20–69 years) cancers, stratified by education levels. An age-adjusted Poisson model was used to assess the statistical significance of changes between the survey years.ResultsA clear socioeconomic gradient was observed, particularly in stomach cancer screening, where the 2022 rates ranged from 28.3% (low education) to 58.2% (high education) for men and 20.2% to 43.2% for women, depending on education level. Between 2019 and 2022, screening rates for stomach, lung, and colorectal cancers changed by −1.2%, −0.9%, and +0.6% for men and −1.0%, +0.1%, and +1.4% for women, respectively. Breast and cervical cancer screening rates declined by 0.5% and 0.4%, respectively. The COVID-19 pandemic worsened inequalities, with a 3.1% decline in breast cancer screening among individuals with low education level, compared to a 1.0% decline among those with higher education level.ConclusionThe COVID-19 pandemic had a minor impact on screening rates (counteracting increasing trends of screening rates), except for colorectal cancer screening rates; however, the impact was relatively severe for individuals with lower socioeconomic status, especially for women.

Awareness, Knowledge and Utilisation of Breast Cancer Screening among Women of Reproductive Age in Keffi, Nigeria

Introduction Transgender and non-binary (TNB) individuals often experience barriers accessing breast and cervical cancer screening, resulting in lower attendance rates compared to cisgender individuals. This study aims to explore and compare the preferences and perspectives of TNB individuals and healthcare professionals regarding cancer screening. Methods We conducted eight semi-structured focus group interviews and three individual interviews with TNB individuals (N = 8), mammographers (N = 10), General Practitioners (GPs) (N = 12), and GPs assistants (N = 7), each in separate groups. The data were analyzed thematically using both inductive and deductive coding approaches. Results Two major themes were: 1) Lack of awareness among TNB individuals and healthcare professionals about eligibility for breast and cervical cancer screening, particularly after a legal gender change. This is mainly due to a lack of education and limited interaction with TNB individuals in daily healthcare practice. As a result, healthcare professionals often fail to inform TNB individuals about available screenings, leaving them unaware. 2) TNB individuals and healthcare professionals appeared to have different views on issues like disclosure of gender identity. TNB individuals were unsure when to share it, while healthcare professionals stressed the importance of proactive disclosure before or during consultations, especially if there has been a gender change in the registry. Conclusion This study reveals different preferences between TNB individuals and healthcare professionals regarding interactions during cancer screening. The lack of knowledge on both sides underscores the need for better training for healthcare providers and more accessible, tailored information for TNB individuals.

Breast cancer is the most commonly diagnosed cancer among women worldwide, and concerns regarding radiation exposure from mammography screening remain a potential barrier to participation. This scoping review explores existing models estimating long-term radiation risks associated with repeated mammography screening. A structured search across five databases (Medline, Embase, Scopus, Web of Science and CINAHL) along with manual searching identified 24 studies published between 2014 and 2024. These were categorised into three themes: (1) models estimating dose-risk profiles, (2) factors affecting radiation dose and (3) the use of artificial intelligence (AI) in dose estimation and mammographic breast density (MBD) estimation. Studies showed that breast density, compressed breast thickness (CBT) and technical imaging parameters significantly influence mean glandular dose (MGD). Modelling studies highlighted the low risk of radiation-induced cancer, inconsistencies in protocols and vendor-specific limitations. AI applications are emerging as promising tools for improving individualised dose-risk assessments but require further development for compatibility across different imaging platforms.

Mammography screening is essential for the early detection of breast cancer; however, delayed detection among screen-detected breast cancers (SDBCs) is rarely studied. To investigate whether women diagnosed with SDBC who missed the screening round immediately before the diagnostic round experience clinically significant delays in detection and whether tumor characteristics vary. This prospective register-based cohort study included all women diagnosed with SDBC in Stockholm, Sweden, between January 1, 1995, and February 28, 2020, with a follow-up until December 31, 2022. Data were analyzed from November 5, 2023, to May 27, 2024. Nonparticipation in the screening immediately prior to the diagnostic round. Tumor characteristics and breast cancer-specific survival. Among 8602 women with SDBC (median age at diagnosis, 61 [IQR, 55-66] years), 1482 (17.2%) did not attend the immediate past screening. Nonparticipants in the past screening were more likely to have larger tumors (adjusted odds ratio [AOR], 1.55 [95% CI, 1.37-1.76] for a tumor size ≥20 mm), lymph node involvement (AOR, 1.28 [95% CI, 1.12-1.45), and distant metastasis (AOR, 4.64 [95% CI, 2.10-10.29]) and less likely to have estrogen receptor-negative breast cancer (AOR, 0.74 [95% CI, 0.60-0.92]); however, there were no differences in progesterone receptor status (AOR, 0.96 [95% CI, 0.83-1.11]) or ERBB2 (formerly HER2 or HER2/neu) status (AOR, 1.00 [95% CI, 0.81-1.24]). In addition, these women experienced poorer breast cancer-specific survival, with an adjusted hazard ratio (AHR) of 1.33 (95% CI, 1.08-1.65). There was no association after adjusting for tumor characteristics (AHR, 1.11 [95% CI, 0.89-1.38]). Additionally, no association was found between nonparticipation in the second-to-last screening and tumor characteristics among those with screen-detected breast cancers (AHR, 0.98 [95% CI, 0.80-1.19] for stage II tumors or higher). The findings of this cohort study suggest that some women with SDBC experience delayed detection and have clinically relevant worse outcomes. Future research is needed to investigate whether advancing the next mammography screening invitation date could enhance early detection and improve breast cancer outcomes in this population.

Breast cancer is one of the main causes of cancer-related death for women worldwide, and enhancing patient outcomes still depends on early detection. The most common imaging technique for diagnosing and screening for breast cancer is mammography, which has a high potential for early lesion detection. With an emphasis on the incorporation of deep learning (DL) techniques, this review examines the changing role of mammography in early breast cancer detection. We examine recent advancements in DL-based approaches for mammogram analysis, including tasks such as classification, segmentation, and lesion detection. Additionally, we assess the limitations of traditional mammographic methods and highlight how DL can enhance diagnostic accuracy, reduce false positives and negatives, and support clinical decision-making. The review emphasizes the potential of DL to assist radiologists in clinical decision-making, as well as increases in diagnostic accuracy and decreases in false positives and negatives. We also discuss issues like interpretability, generalization across populations, and data scarcity. This review summarizes the available data to highlight the revolutionary potential of DL-enhanced mammography in breast cancer screening and to suggest future research avenues for more reliable, transparent, and clinically useful AI-driven solutions.

BackgroundDespite the World Health Organization’s recommendation of clinical breast examination (CBE) in resource-limited settings where mammography services are unavailable, the participation rate among women in Ghana remains low. This study examined multilevel factors associated with CBE uptake among women in the Northern Region of Ghana.MethodsA multi-stage cluster sampling technique was employed to recruit women aged 25 years and older from 30 communities in the Tamale metropolis, Northern Region of Ghana. To determine the factors associated with CBE uptake, multilevel logistic regression models were fitted. The outcome of the fixed effects analysis was presented using adjusted odds ratios (aOR), with a 95% confidence interval (CI) and a p-value of less than 0.05.ResultsApproximately 1,543 women were recruited from 30 communities with 48 clusters. The prevalence of CBE uptake was 23%. From the fixed effects results, women with tertiary education (aOR = 2.53, 95%CI = 1.49–4.29) were more likely to have CBE compared to those with no formal education. Women with increased knowledge of breast cancer (BC) were more likely to undergo CBE (aOR = 1.04, 95%CI = 1.00-1.07). The higher the perceived susceptibility to BC, the higher the likelihood of undergoing CBE (aOR = 1.25, 95%CI = 1.06–1.47). Women with increased perceived barriers to BC screening (aOR = 0.54, 95%CI = 0.41–0.73) and higher perceived fear of BC (aOR = 0.72, 95%CI = 0.57–0.91) were less likely to undergo CBE. Women who received recommendations from friends (aOR = 1.99, 95%CI = 1.25–3.18) and healthcare providers (aOR = 1.55, 95%CI = 1.00-2.39) were more likely to utilize CBE compared to their counterparts. Women in communities with health facilities (aOR = 2.14, 95%CI = 1.43–3.21) and those who resided in urban areas (aOR = 1.72, 95%CI = 1.10–2.69) were more likely to utilize CBE than their counterparts.ConclusionThe findings signify that a multifactorial systematic approach is required to increase CBE uptake among Ghanaian women. We recommend a comprehensive community-based education program about BC, targeted at raising awareness of breast health and improving the knowledge of the disease, together with the benefits of CBE uptake. Concurrently, improving access to health facilities and CBE services is needed.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12885-025-14550-w.

163 Background: Cancer screening programs are critical for early detection and improved oncologic outcomes, yet significant disparities in screening adherence persist across regions, racial/ethnic groups, and socioeconomic statuses in the U.S. We sought to use national data to evaluate public awareness, adherence rates, and barriers to cancer screening programs in the U.S. Methods: We used data from the National Health Interview Survey (NHIS), Behavioral Risk Factor Surveillance System (BRFSS), and the Health Information National Trends Survey (HINTS) from 2015-2023 to assess cancer screening adherence, awareness, and barriers. We included adults eligible for breast, colorectal, cervical, and lung cancer screening to determine screening adherence and associations among patient-reported barriers (financial, informational, access, psychological, time, cultural/language, prior negative experiences). Results: Among 100,000 patients (mean age 52.3 years, 51% female), the racial/ethnic composition was 65% White, 15% Hispanic, 13% Black, 5% Asian, and 2% Other. Screening adherence rates were 73% for cervical, 72% for breast, 65% for colorectal, and 60% for lung cancer. Screening adherence rates varied by race/ethnicity, with White individuals at 72.5%, Hispanic 64.5%, Other 63.5%, Asian 62.5%, and Black individuals 59.5% (p < 0.001). Regionally, breast cancer screening was highest in the Northeast (72%) and lowest in the rural South (58%) (p < 0.001), while cervical cancer screening was higher in metropolitan (77%) than non-metropolitan areas (65%), and colorectal and lung cancer screening rates were greater in urban (69% and 63%) than rural areas (57% and 52%). The most common patient-reported barriers to cancer screening were financial (30%), lack of awareness (22%), and transportation/access issues (20%). Additional barriers included fear/anxiety (15%), time constraints (15%), cultural/language barriers (10%), and prior negative experiences (7%). Conclusions: In this study, we identified racial, regional, and socioeconomic disparities in U.S. cancer screening adherence. We also demonstrated that financial, informational, and access barriers remain prevalent. Findings underscore the importance of addressing barriers to screening through targeted interventions.

Abstract Background Breast cancer screenings decrease mortality from the disease. In Finland, women aged 50-69 receive biennial invitations to the screening. Attendance varies between population groups, but factors related to non-attendance are insufficiently understood. More comprehensive information is needed to improve participation across population groups. This study aimed to determine lifestyle and wellbeing-related factors associated with non-attendance in the screening. Methods Data from the national Healthy Finland 2022-2023 survey were linked to breast cancer screening data from the Finnish Cancer Registry. A total of 5220 women aged 50-72 who participated in the survey and received a screening invitation within five years were included. Non-attendance was defined as not attending the latest screening. Results were presented as population-weighted prevalences (%) and 95% confidence intervals (CI) of non-attendance. Results Of the study sample, 8.8% did not attend the latest screening. Non-attendance was more common in women with low consumption of vegetables and fruit (15.2% (95% CI 8.8-21.5)) vs. high consumption (7.3 (6.0-8.7)), low physical activity (PA) (14.1 (9.7-18.4)) vs. high PA (7.8 (6.2-9.3)), current smokers (15.8 (12.2-19.4)) vs. non-smokers (7.6 (6.6-8.6)), very low social inclusion (Experiences of Social Inclusion Scale (ESIS)<50) (14.4 (10.2-18.6)) vs. ESIS≥50 (8.3 (7.2-9.3)). Conclusions Breast cancer screening attendance is generally high in Finland. As a novelty, this study linked national registry-based screening data to population-based survey data enabling the study of diverse determinants of non-attendance. Unhealthy lifestyle habits and low social inclusion are associated with non-attendance. Understanding the factors associated with it may help to identify and target non-attenders, ultimately improving attendance and early detection, and thus decrease breast cancer mortality. Key messages • Poor lifestyle habits and low social inclusion are associated with lower breast cancer screening attendance. Screening participation should be addressed as part of broader public health strategies. • Identifying factors that are associated with poor breast cancer screening attendance aids in tailoring strategies to promote attendance and decrease cancer mortality.

Health equity is greatly impacted by the systems and processes with which health systems deliver care. Given the minimal guidance on measurement and reporting of health inequities specific to key population health outcomes, a solution for measurement of health equity is proposed.The concept of a lens of equity was adopted to disaggregate common measures such as breast cancer screening rates to expose inequities across neighborhoods and races in populations served. Two measures were introduced into the corporate measurement systems, race/ethnicity as measured in the electronic health record, and a surrogate measure of family income.An equity category was added to system scorecards and counted toward corporate goals along with data insights and discovery tools to support the efforts of the breast cancer screening improvement teams. Over a 1-year timeframe, Endeavor Health not only met but exceeded its breast cancer screening equity goal, increasing mammography adherence from 73 to 82.6% among residents in the lowest-income neighborhoods served.The analytics and data systems that support complex health care measurement tools require diligent and thoughtful design to meet external reporting requirements and support the internal teams who aim to improve the care of populations served. The analytic approach presented may be readily extended to populations with other potentially impactful differences in social determinants and health status. A "lens-of-equity" tool may be established along similar lines, allowing policy and strategy initiatives to be appropriately targeted and successfully implemented.

Independent double reading of mammograms plays a key role in improving the effectiveness of breast cancer screening by providing more accurate diagnosis. This diagnostic procedure should be carried out in a short time, but its performance is associated with the necessity of significant amount of time and human resources, that complicates its use within the existing regulatory standards. A simple and clear process model is necessary for effective organization of mammographic screening with double reading. Objective. To develop an optimal organizational and functional model of X-rays double reading in performing mammographic screening of breast cancer in women as a part of medical check-up. Materials and methods. Content-analysis of current regulatory documents (orders of Ministry of Healthcare of the Russian Federation, methodological recommendations), in which the process of breast cancer screening organization as a part of medical check-ups is regulated, was carried out. Regulatory framework governing the organization of mammography offices’ work was the basis of content-analysis. Results. It has been found that the descriptions of X-rays double reading procedure are fragmented and controversial in regulatory documents. The model of mammography double reading organization in an outpatient clinic was proposed. Parallel double reading with automatic synchronization of results can facilitate procedure performing in established periods. It is necessary to improve regulatory documents in order to increase the effectiveness of mammography screening including the use of artificial intelligence technologies. Conclusion. The importance of improving regulatory documents governing mammographic screening in outpatient clinic was justified. The proposed organizational and functional model provides the possibility of organizing double reading in the current conditions of regulatory framework. The development of digital technologies is crucial for widespread implementation of X-rays double reading in mammographic screening.

Abstract Background Polygenic risk scores (PRS) have the potential to personalize breast cancer screening by refining starting ages and intervals. Yet, evidence remains fragmented and largely based on modeling. The EU4Health Can.Heal project aimed to develop evidence-based recommendations to guide integration of PRS into screening programs across Europe. Methods Using the GRADE approach, we developed an Evidence to Decision (EtD) framework and systematically reviewed literature across relevant domains. In the absence of randomized controlled trials, the project synthesized four decision-analytic models to evaluate benefits & harms. Two systematic reviews informed analysis of feasibility, acceptability, equity and Cost-effectiveness. Evidence quality was appraised using ISPOR and GRADE standards. A multidisciplinary panel of nine experts-including clinicians, public health specialists and a patient representative-reviewed findings and formulated recommendations. Results All estimates came from modeling studies, with overall certainty rated as low to very low due to indirectness, imprecision, and variability. Models predicted modest reductions in breast cancer mortality and gains in quality-adjusted life years with PRS-enhanced screening, but also highlighted increased risk of overdiagnosis and false positives. Cost-effectiveness results varied widely and were sensitive to assumptions about PRS cost and protocol design. Key implementation challenges include limited preparedness, infrastructure gaps, and reduced predictive accuracy in non-European populations. Conclusions We conditionally recommend pilot and prospective implementation of PRS-enhanced screening in the EU, with real-time monitoring of outcomes, acceptability, and equity. Broader adoption should await stronger trial evidence (e.g., WISDOM, MyPeBS, BREATHE). National programs should prioritize local learning, risk communication, public engagement, and supportive infrastructures like genetic counseling and data protection. Key messages • Pilot PRS-based breast cancer screening via well-designed studies and phased programs, with real-time monitoring of benefits, harms, and costs due to low-certainty modeling evidence. • Uncertain, context-specific evidence on PRS screening calls for transparent, cautious stakeholder engagement, research investment, and strong support systems like counseling and data governance.

A Survey Study of Patients' Reported Preferences for Episode-Based Cost-Sharing Models.

BackgroundMost intervention areas for improving cancer screening uptake are in deprived neighbourhoods. However, in recent years, determinants and attitudes to screening have evolved, and new perspectives are needed in understanding cancer screening practices. It is therefore necessary to develop simple, effective and reproducible strategies for identifying intervention areas.Using one map, the aim is to investigate spatially and temporally breast and colorectal cancer screening in France from 2015-2016 to 2021-2022.MethodsUptake in breast (BS) and colorectal (CS) cancer screening at the census block level was generated by the regional cancer screening centre for women aged 50 to 74, residing in the Rhône department (mostly rural but including the urban Lyon metropolitan area). We used spatial analysis to create a map highlighting groups of hotspots, identifying their direction of propagation between 2015-2019 and 2020-2022.ResultsThe results reveal interesting areas for intervention with differences and similarities in uptake of the two screenings. For CS, there was a 5-pt increase in uptake between the two periods (2015-2019: 33% and 2020-2022: 38%), whereas for BS the uptake remained stagnant around 49% on average in the metropolitan area. The map highlights 49 urban census blocks with consistently lower uptake rates in both screenings (39.2% for BS, 23.7% for CS) than the overall average. Conversely, some census blocks have consistently lower uptake rates on one screening but not on the other (CS or BS).ConclusionsThis work may inform the breast and colorectal locally screening trend and inform policymakers to develop tailored prevention strategies. These analyses are easily reproducible at different times and spaces, and they have the potential for evaluation and comparison of screening uptake.Key messages• Maps may inform policymakers to develop tailored prevention strategies.• Investigate spatially and temporally breast and colorectal cancer screening reveal interesting areas for interventions.

Cancer screening, prevalence, and mortality vary across US counties; the broad set of community factors associated with these differences are not well understood. To assess the relative importance of diverse community measures for explaining county-level variance in cancer screening, prevalence, and mortality rates for breast, colorectal, lung, and prostate cancers. This geospatial cross-sectional analysis across all US counties used random forest algorithms to estimate the relative importance of 24 community measures-including health behaviors and lifestyle, socioeconomic, and environment factors-as explanatory factors for cancer screening, prevalence, and mortality. For each cancer, county-level cancer screening and prevalence rates were based on a nationally representative 5% sample of Medicare fee-for-service beneficiaries (2020). The 5-year (2016-2020) mean mortality rates were from the National Cancer Institute's State Cancer Profiles. Neiman Cancer disparity maps geospatially display significant community-factor to cancer-outcome associations via county-level choropleth maps. Data were analyzed from September 2024 through February 2025. Residence in the 50 states, Puerto Rico, and the District of Columbia. Outcomes were county-level rates of cancer screening, prevalence, and mortality for breast, colorectal, lung, and prostate cancers. Separate random forest algorithms estimated the relative importance of 24 community measures for each outcome-cancer type combination, and maps display county-level associations. Among a nationally representative 5% of 2020 Medicare Fee-For-Service beneficiaries, 87% were aged 65 years or older. The top ranking explanatory community factors (100% relative importance) for mortality were smoking rate for both lung and colorectal cancers, and the non-Hispanic Black population share for both breast and prostate cancers. For prevalence and screening rates, the top factors were unique for each cancer type. Uninsured rate, unemployment, limited access to health foods, and poor physical health were the top ranked factors for breast, colorectal, lung, and prostate cancer prevalence, respectively. Hispanic population, poverty, air pollution, and Air Toxics Cancer Risk were ranked highest for screening rates, respectively, for each cancer. Two of only 3 environmental factors, Environmental Justice Index and Air Toxics Cancer Risk, had the most top-5 associations for mortality and screening, respectively. Uninsured rates for prevalence and poverty rates for screening were also important across cancer types. In this cross-sectional study of the relative explanatory importance of community measures on cancer screening, prevalence, and mortality rate we found that the ranking of factors varied for each specific cancer and outcome, which can inform targeted population health efforts. Factors that ranked high across cancer types for a given outcome, such as uninsured rates for cancer prevalence, represent opportune targets for future study and broader policy change.

154 Background: Cervical (CC), breast (BC), and colorectal (CRC) cancer screening rates lag for US Latinas compared to non-Latina white women. Obesity/overweight, a known cancer risk factor, is prevalent among Latinas, making cancer screening a pressing priority in this population. This study investigates determinants of CC, BC, and CRC screening adherence at baseline and screening uptake at study completion among overweight/obese Latinas in SANOS (Health and Nutrition for All), a 6-month culturally tailored lifestyle program with navigation to insurance, primary care, and screening. Methods: We enrolled 412 Spanish-speaking Latinas with BMI ≥25 kg/m 2 (2019-2024). Surveys conducted at baseline and study completion captured participants’ time in the US, English proficiency, primary care physician (PCP) access, health insurance status, and cancer screening adherence per USPSTF guidelines. Logistic regression assessed determinants of screening adherence, and Fisher’s exact tests compared screening uptake at study completion, with significance at p < 0.05. Results: Of 412 participants (mean age 43.4 ± 9.7), 77.5% had limited English proficiency, and 39.9% were insured, mainly through Medicaid (73.0%). Baseline adherence was high for CC (75.7%; 311/411 eligible) and BC (66.5%; 165/248), while only 45.9% (68/148) for CRC. Logistic regression showed that more time living in the US (CRC: OR = 1.06, p = 0.001; BC: OR = 1.06, p < 0.001), having insurance (CRC: OR = 2.97, p = 0.002; BC: OR = 2.26, p = 0.006), and more recent PCP access (CRC: OR = 0.08, p < 0.001; BC: OR = 0.24, p < 0.001) predicted CRC and BC adherence. Having insurance (OR = 1.76, p = 0.026) and more recent PCP access (OR = 0.24, p < 0.001) predicted CC adherence. Participants reporting CC adherence were 13.3 (CI .95 = 5.38, 37.87) and 7.76 (CI .95 = 2.05, 50.87) times more likely to report BC and CRC adherence, respectively. At study completion, among those non-adherent at baseline, CRC uptake (13.6%, 9/66) was significantly lower than BC uptake (44.8%, 30/67; p < 0.001) and CC uptake (35.8%, 24/67; p < 0.018). Conclusions: High CC and BC screening adherence among overweight/obese Latinas demonstrates regular engagement with the healthcare system; however, disproportionately low CRC screening reflects a critical missed opportunity for prevention. Interventions to promote CRC screening adherence in this population should include both provider education and culturally tailored patient education on CRC risk and screening. Further research is needed on Latinas' perceived barriers to CRC screening and their awareness of screening options.

BackgroundAn organized breast cancer screening program has been introduced by the local government in Ordos City since 2010. Women between 35 and 64 years are eligible to be screened freely at local maternal and child healthcare hospitals. The screening coverage rate in Ordos City is relatively higher than the national average level. However, the overall breast cancer detection rate remains low. This study aims to identify contextual influencing factors of this program from local maternal and child healthcare hospitals’ perspectives and provide suggestions for screening service improvement in Ordos City.MethodsWe conducted a qualitative study to evaluate the implementation of the organized breast cancer screening program from maternal and child healthcare hospitals’ perspectives in Ordos City. Four domains (outer setting, inner setting, individuals, and process) and nine constructs were selected for evaluation under the instruction of the Consolidated Framework for Implementation Research (CFIR). CIFR constructs were rated in both valence and strength factors. The interview scripts were coded and themes were generated by using content analysis. Data obtained were interpreted and described by tables and charts.ResultsA total of 28 individuals participated in our study. We found that the implementation of the organized breast cancer screening in Ordos City went well. Policies & laws, partnerships & connections, performance-measurement pressure, implementation leads, teaming, and engaging constructs holistically facilitated the implementation performance. Available resources varied and this construct chiefly displayed a neutral impact. Access to knowledge & information and doing constructs were considered to negatively influence the implementation performance. Political commitment to cervical cancer elimination, multisectoral collaboration, specialized leadership, and structured screening teams were the main factors promoting the screening progress. Inconsistent referrals, underqualified professional competence of primary health workers, and non-interoperable electronic systems were the main barriers to screening performance.ConclusionsWe recommend that Ordos City further facilitates the prompt referral for imaging and biopsy, promotes the capacity building of primary health workers, and strengthens the construction of electronic systems. Future quantitative studies are necessary to comprehend the knowledge and attitudes of caregivers and target population toward breast cancer screening. Interviews with other stakeholders, such as policymakers and target population, are also needed.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13289-1.

The expert eye - Navigating ambiguity in clinical breast radiology.

BackgroundBreast cancer has a high health and economic burden in Europe. Screening is an effective intervention, enabling cancer prevention. Trend analysis provides insights for public health planning, particularly for understanding the impact of disruptive events such as the COVID-19 pandemic and then adopting strategies to increase adherence.MethodsData on breast cancer screening adherence from EU and EFTA countries were collected from Eurostat. Seventeen countries with ≥15 years of data between 2000 and 2022 (last data available) were included. Joinpoint regression was used to identify the Annual Percent Change (APC) and Average Annual Percent Change (AAPC) over time.ResultsOverall, 12 countries had declining screening adherence; 10 had significant reductions (Finland, Germany, Hungary, Iceland, Ireland, Italy, Luxembourg, Netherlands, Norway, Slovakia; AAPC -0.25 to -0.97). Considering the pandemic years, all but two countries (Iceland and Ireland) reported a decrease (between -1.35% and -15.98%). Three trend patterns emerged. Group 1 (Finland, Norway) showed a decline in 2020 (APC -1.3, -12.29) followed by an increase in 2021-2022. Group 2 (Cyprus, Hungary, Netherlands) exhibited accelerated negative trends during the pandemic period. Group 3 (Belgium, Croatia, Czech Republic, Estonia, France, Germany, Iceland, Ireland, Italy, Lithuania, Luxembourg, Slovakia) displayed no statistically significant trend changes.ConclusionsOverall, most of the countries reported a decrease in screening adherence. The COVID-19 pandemic coincided with abrupt disruptions in uptake in 5 European countries, while in others it aligned with pre-existing patterns. These heterogeneous impacts highlight the need for research into the factors influencing different healthcare system responses. Strengthening monitoring and adaptability of preventive programs will be critical to sustain equitable access during future health crises.Key messages• Analyzing trends in breast screening uptake provides crucial insights for public health planning, particularly in understanding the impact of major disruptive events.• COVID-19 caused varying impacts on breast cancer screening trends across European countries; understanding health system responses is key to strengthening resilience of screening programs.

Abstract Background With the advent of personalised medicine, risk prediction models that incorporate personal and genetic factors now enable individualised breast cancer risk assessment. These innovations have sparked global interest in risk-stratified screening, which may improve early detection in high-risk women, reduce overdiagnosis in low-risk women, and enhance the cost-effectiveness of screening programmes. The aim of this study was to assess the acceptability and perceptions of personalised, risk-based breast cancer screening among Cypriot women. Methods A cross-sectional survey was conducted between November 2024 and March 2025 across all 5 mammography centers operating in Cyprus. Women attending routine screening appointments were invited to complete a structured five-question questionnaire. Descriptive statistics were performed using Stata 18. Results A total of 503 Cypriot women aged 45-74 years participated in the study (98.2% participation rate). Only 31% of respondents were aware of personalised, risk-stratified breast cancer screening. However, 90% expressed interest in knowing their personal breast cancer risk, and 78% were willing to participate in a risk-based screening programme. Hesitancy was primarily attributed to anxiety, fear of results, time constraints, and satisfaction with the current screening system. While 62% of women reported feeling anxious about being categorised as “high-risk” for breast cancer, only 51% felt reassured by a potential “low-risk” classification. Conclusions Cypriot women appear broadly supportive of personalised, risk-based breast cancer screening, although overall awareness is limited. Addressing this gap will require a coordinated approach involving public education, effective communication strategies, and collaboration with healthcare professionals to improve understanding and facilitate future implementation. Key messages • Most Cypriot women support personalised, risk-based breast cancer screening. • Public awareness is essential for the successful implementation of risk-stratified breast screening.