Breast Mammography Screening Research Articles

Trajectories in mammographic breast screening participation in middle-age overweight and obese women: A retrospective cohort study using linked data

ObjectivesDespite the established benefits and availability of mammographic breast screening, participation rates remain suboptimal. Women with higher BMIs may not screen regularly, despite being at increased risk of postmenopausal breast cancer and worse outcomes. This study investigated the association between prospective changes in BMI and longitudinal adherence to mammographic screening among women with overweight or obesity. MethodsRetrospective cohort study of women (N = 2822) participating in the Australian Longitudinal Study on Women's Health with an average follow-up of 20 years, with screening participation enumerated via BreastScreen NSW, Australia clinical records over the period 1996–2016. Association between BMI and subsequent adherence to screening was investigated in a series of marginal structural models, incorporating a time variant/invariant socio-demographic, clinical, and health behaviour confounders. Models were also stratified by a proxy measure of socio-economic status (education). ResultsParticipants with overweight/obesity were less adherent to mammography screening, compared to healthy/underweight participants (OR=1.29, 95 % CI=1.07, 1.55). The association between overweight/obesity and non-adherence was higher among those who ever had private health insurance (OR=1.30, 95 % CI=1.05, 1.61) compared to those who never had private health insurance and among those with lower educational background (OR=1.38, 95 % CI=1.08, 1.75) compared to those with higher educational background. ConclusionsLong-term impacts on screening participation exist among women with higher BMI, who are less likely to participate in routinely organised breast screening. Women with a higher BMI should be a focus of efforts to improve breast screening participation, particularly given their increased risk of breast cancer and association of higher BMI with worse breast cancer outcomes among older women.

Harnessing Opportunity: Pilot Intervention to Improve Lung Cancer Screening for Women Undergoing Breast Screening Mammography

IntroductionThe screening mammogram could be a “teachable moment” to improve lung cancer screening (LCS) uptake. The aim of our project was to combine patient self-referral with eligibility identification by providers as a two-pronged approach to increase rates of LCS among eligible women. MethodsLCS education materials were created to stimulate patient education and encourage self-referral. Chart review of patients scheduled for screening mammography was performed to identify patients who met LCS criteria. The primary outcome was rate of acceptance of targeted interventions as measured by qualitative survey material and rate of LCS uptake. ResultsBetween August 2022 and August 2023, 116 patients were identified by providers for potential eligibility for LCS and 34 patients (29.3%) deemed eligible based on the U.S. Preventative Services Task Force 2021 guidelines. There were 19 patients (56%) who completed LCS with three patients (16%) with screen-detected nodules that led to further workup. Post-implementation qualitative survey results reveal that 100% of the participants rated their shared decision-making visit experience as “very helpful” and 67% responded “very likely” to seek simultaneous breast and LCS in the future. Informational materials were rated as 80% favorable among all respondents; however, the rate of self-referral alone was 0%. The combined rates of eligible patients lost to follow-up or refusal was 24%. ConclusionThe self-referral aspect of the intervention revealed that patients are unlikely to self-refer for LCS. Nevertheless, patients undergoing screening mammograms individually identified for LCS were very responsive to learning more about dual screening.

Impact of Different Mammography Systems on Artificial Intelligence Performance in Breast Cancer Screening.

Artificial intelligence (AI) tools may assist breast screening mammography programs, but limited evidence supports their generalizability to new settings. This retrospective study used a 3-year dataset (April 1, 2016-March 31, 2019) from a U.K. regional screening program. The performance of a commercially available breast screening AI algorithm was assessed with a prespecified and site-specific decision threshold to evaluate whether its performance was transferable to a new clinical site. The dataset consisted of women (aged approximately 50-70 years) who attended routine screening, excluding self-referrals, those with complex physical requirements, those who had undergone a previous mastectomy, and those who underwent screening that had technical recalls or did not have the four standard image views. In total, 55 916 screening attendees (mean age, 60 years ± 6 [SD]) met the inclusion criteria. The prespecified threshold resulted in high recall rates (48.3%, 21 929 of 45 444), which reduced to 13.0% (5896 of 45 444) following threshold calibration, closer to the observed service level (5.0%, 2774 of 55 916). Recall rates also increased approximately threefold following a software upgrade on the mammography equipment, requiring per-software version thresholds. Using software-specific thresholds, the AI algorithm would have recalled 277 of 303 (91.4%) screen-detected cancers and 47 of 138 (34.1%) interval cancers. AI performance and thresholds should be validated for new clinical settings before deployment, while quality assurance systems should monitor AI performance for consistency. Keywords: Breast, Screening, Mammography, Computer Applications-Detection/Diagnosis, Neoplasms-Primary, Technology Assessment Supplemental material is available for this article. © RSNA, 2023.

AI in breast screening mammography: breast screening readers' perspectives.

This study surveyed the views of breast screening readers in the UK on how to incorporate Artificial Intelligence (AI) technology into breast screening mammography. An online questionnaire was circulated to the UK breast screening readers. Questions included their degree of approval of four AI implementation scenarios: AI as triage, AI as a companion reader/reader aid, AI replacing one of the initial two readers, and AI replacing all readers. They were also asked to rank five AI representation options (discrete opinion; mammographic scoring; percentage score with 100% indicating malignancy; region of suspicion; heat map) and indicate which evidence they considered necessary to support the implementation of AI into their practice among six options offered. The survey had 87 nationally accredited respondents across the UK; 73 completed the survey in full. Respondents approved of AI replacing one of the initial two human readers and objected to AI replacing all human readers. Participants were divided on AI as triage and AI as a reader companion. A region of suspicion superimposed on the image was the preferred AI representation option. Most screen readers considered national guidelines (77%), studies using a nationally representative dataset (65%) and independent prospective studies (60%) as essential evidence. Participants' free-text comments highlighted concerns and the need for additional validation. Overall, screen readers supported the introduction of AI as a partial replacement of human readers and preferred a graphical indication of the suspected tumour area, with further evidence and national guidelines considered crucial prior to implementation.

Mammographic breast density status in women aged more than 40 years in Sulaimaniyah, Iraq: a cross-sectional study.

Mammography is the gold standard screening procedure for the early diagnosis of breast cancer. This study aimed to determine the distribution of breast density among women older than 40 years in Sulaimaniyah, Iraq, and to examine the correlations between breast density and various risk factors. This cross-sectional study included 750 women who received routine mammographic breast screening at Sulaimaniyah Breast Center. Bilateral standard two-view mammographic images (craniocaudal and mediolateral oblique projections) were acquired and reported using a picture archiving and communication system. American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BI-RADS) assessment categories C and D were considered as dense. A total of 54.3% of breasts were classified as dense, with ACR-BI-RADS categories C or D. Breast density was significantly associated with age, body mass index, a family history of breast cancer, and pre-menopause, and women with no history of breastfeeding were more likely to have dense breasts than those with partial or complete breastfeeding. This study revealed that women from Sulaimaniyah with a distinct breast-density profile at mammographic screening may have a significantly increased risk of breast cancer.

The Impact of Morbidity and Disability on Attendance at Organized Breast Cancer-Screening Programs: A Systematic Review and Meta-Analysis.

Individuals with morbidity experience worse breast cancer outcomes compared with those without. This meta-analysis assessed the impact of morbidity on breast cancer-screening attendance and subsequent early detection (PROSPERO pre-registration CRD42020204918). MEDLINE, PsychInfo, and CINAHL were searched. Included articles published from 1988 measured organized breast-screening mammography attendance using medical records by women with morbidity compared with those without. Morbidities were assigned to nine diagnostic clusters. Data were pooled using random-effects inverse meta-analyses to produce odds ratios (OR) for attendance. 25 study samples (28 articles) were included. Data were available from 17,755,075 individuals, including at least 1,408,246 participants with one or more conditions;16,250,556 had none. Individuals with any morbidity had lower odds of attending breast screening compared with controls [k = 25; OR, 0.76; 95% confidence interval (CI), 0.70-0.81; P = <0.001; I2 = 99%]. Six morbidity clusters had lower odds of attendance. The lowest were for neurological, psychiatric, and disability conditions; ORs ranged from 0.45 to 0.59 compared with those without. Morbidity presents a clear barrier for breast-screening attendance, exacerbating health inequalities and, includes a larger number of conditions than previously identified. Consensus is required to determine a standardized approach on how best to identify those with morbidity and determine solutions for overcoming barriers to screening participation based on specific morbidity profiles.

Abstract P2-10-05: The estimated impact of COVID-19 on population breast cancer screening outcomes, and options for risk-based recovery

Abstract OBJECTIVES AND RATIONALE Estimating the impact of COVID-19 on cancer screening programs and related outcomes can help health services prepare for potential delays in diagnoses and different demands on treatment services and plan for best approaches to recovery. Simulation modelling enables estimation of outcomes for a range of scenarios. In this study, we estimate the impact of various disruptions and recovery strategies for the Australian biennial mammographic breast screening program (BreastScreen). METHOD Policy1-Breast is a continuous-time, multiple-cohort micro-simulation model that simulates the whole Australian female population, incorporating breast cancer risk and natural history, breast density, menopause, hormone therapy use and breast cancer screening. Firstly, in the early stages of the COVID pandemic we used Policy1-Breast to evaluate how 3, 6, 9 and 12-month pauses to BreastScreen would impact on population-level breast cancer diagnoses, tumour staging, and breast cancer survival, compared to business-as-usual (BAU) outcomes. Secondly, to explore options for recovery after an actual one-month screening pause in April 2020, we evaluated a range of assumed throughput levels following screening resumption (50% or 80% up to December, then 100% to 120% from Jan 2021), comparing various protocols where specific sub-groups of clients were prioritised for screening during the recovery period. Outcomes are reported for the target age range for the BreastScreen program (50-74 years). RESULTS For 3- to 12-month pauses, we estimated a slight reduction in 5-year survival following diagnosis for women directly affected by a pause, but no discernible changes to population-level breast cancer mortality rates up to 2023. We estimated marked fluctuations in population rates of invasive breast cancer diagnoses with a 10% increase in cancer diagnoses between 2020-2021 and 2022-2023. For a 12-month pause to screening we estimate that population-level breast cancers would increase in size (with an additional 4% &amp;gt;15mm at diagnosis) and be more likely to involve the nodes (increasing from 26% to 30% of all cancers). We estimate that median screening intervals during 2020-2021 would increase from 104 weeks under BAU up to 130 weeks with a 12-month pause, and BreastScreen recall rates and false positive recall rates would fluctuate markedly over time. For the second evaluation of a one-month pause followed by various throughput and prioritisation scenarios, we estimated that screen-detected cancer rates would vary markedly with throughput but interval cancer rates would not, leading to fluctuations in program sensitivity of up to 6%. Reflecting the periodic nature of screening participation, we estimated the extent to which longer-term future screening participation rates are expected echo the peaks and troughs in participation due to the impacts of the COVID pandemic in 2020. We estimate that for a given throughput assumption, client prioritisation could lead to different rescreening rates, screening intervals, and time required for prioritisation protocols, with little change to cancer outcomes. CONCLUSION These modelled evaluations estimate short and longer-term effects of COVID-19 on the impact of population breast cancer screening in Australia. The estimated changes in breast cancer rates and characteristics would be expected to have a flow-on effect on the demand for treatment services in terms of throughput and case-mix. Preparing for such outcomes is critical given that treatment services are also directly impacted by the pandemic. The modelled outcomes are likely to be relevant to other high-income settings with established population breast cancer screening programs. Citation Format: Pietro Procopio, Sabine Deij, Louiza S Velentzis, Amanda Tattam, Lara Petelin, Carolyn Nickson. The estimated impact of COVID-19 on population breast cancer screening outcomes, and options for risk-based recovery [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-10-05.

Identifying barriers to Irish traveller women attending breast screening

IntroductionBreast cancer is one of the most prevalent cancers in women, however Irish Traveller women have lower breast screening rates than that of the general population. This work aims to address the gap in knowledge of Irish Traveller womens’ perceptions of breast screening and the perceived barriers and enablers to attendance. MethodsThis phenomenological qualitative study involves interviews with Irish Traveller women and Health Care Professionals and discusses the incentives and barriers to attending breast screening mammography in Ireland. The work investigated attitudes and decision making amongst the Irish Traveller women across breast screening and breast health. The research investigated the participants knowledge, experience and opinions about the topic of Irish Traveller womens’ attendance at BreastCheck and breast health ResultsInfluences that create barriers to breast screening for Irish Traveller women include inequality and family/community support, fear, literacy and education, embarrassment and the health care professional, stress and appointment suitability. Findings also demonstrate inadequate data and information is available in Ireland regarding Irish Traveller women attending breast screening. ConclusionIrish Traveller women face several influences when it comes to attending breast screening. The existing Irish national breast screening programme provides a health promotion service however, it is impossible to assess poor attendance at screening without the presence of an ethnic identifier. It would be very beneficial for screening promotion to record the ethnicity of attendees for statistical progress. This would benefit Irish Traveller women by recording the progress of attendance in the breast screening programme and creating a need for awareness and education within the annual reports. Implications for practiceCreating awareness and educating Irish Traveller women about the breast screening programme may remove barriers and lead to improved attendance rates.

Abstract PS16-03: Clonal relatedness of LCIS with synchronous and asynchronous invasive disease

Abstract Background: Lobular carcinoma in situ (LCIS) is typically clinically undetectable but is being increasingly diagnosed as a result of breast screening mammography and is often found associated with other breast pathologies such as invasive lobular breast cancer (ILC), invasive carcinoma of ductal /no special type (IDC) and ductal carcinoma in situ (DCIS). It is also considered a risk factor for the development of subsequent invasive breast disease. The aim of this study was to understand the genetic relationship between LCIS that presents with synchronous DCIS, IDC and/or ILC in order to ascertain whether the components have common precursors and also to understand the clonal relationship between LCIS and subsequent invasive disease. Methods: 25 cases of LCIS with synchronous ILC, 7 cases of LCIS with synchronous DCIS &amp; IDC, and 8 pure LCIS that developed a subsequent invasive recurrence were identified from the GLACIER study (MREC 06/Q1702/64). DNA was extracted from archival paraffin embedded tissue and underwent copy number analysis using either the Oncoscan™ Array (Affymetrix) or HumanCytoSNP FFPE-12 BeadChip (Illumina). Four of 7 cases of LCIS with synchronous DCIS &amp; IDC also underwent targeted sequencing using a custom 121 breast cancer-associated gene panel (SureSelectXT HS kit, Agilent Technologies). Clonal relatedness was assessed using a novel methodology based on the presence of shared copy number aberration breakpoints and mutations. Results: Of the 25 synchronous LCIS and ILC cases, 17 appeared related, 4 were ambiguous (sharing the typical lobular signature of 1q gain and 16q loss) and 4 demonstrated no evidence of relatedness. Of the 7 cases with synchronous LCIS, DCIS and IDC, all had copy number data available and 4 had mutation data available. In 3 cases the synchronous LCIS, DCIS and IDC were clonally related according to copy number and for two there was mutation data that supported this (one sharing PIK3CA and CDH1 mutations, the other a TP53 mutation). In two cases the LCIS was not related to the DCIS or IDC, but the DCIS and IDC were related to each other; while in one case LCIS was related to IDC but not to the DCIS by copy number but all components shared the same CHEK2 mutation. Finally in one case none of the three components were related to each other by copy number but the LCIS and IDC shared a PIK3CA mutation, albeit at much lower allele frequency in LCIS than in IDC. Of the 8 patients with pure LCIS, 4 developed an ipsilateral invasive recurrence of various combinations of morphologies: 1 ILC &amp; LCIS, 1 ILC &amp; DCIS, 1 IDC &amp; DCIS, 1 ILC &amp; IDC, and 4 a contralateral recurrence (1 tubular, 1 IDC, 2 ILC), with a median time to recurrence of 69 months (range 34-175). The primary LCIS was related to at least one component of the recurrent disease in all four ipsilateral cases; in two the primary LCIS and all components of the recurrent disease were related, and in the remainder we observed a variety of putative evolutionary patterns. Conclusions: The majority (68%) of cases of synchronous LCIS and ILC appeared to be clonally related by copy number. 50% of cases of co-existing LCIS and IDC appeared to have a common clonal origin by either copy number or targeted sequencing. As these are genomically stable tumours, copy number data may also be underestimating relatedness. In the four cases of pure primary LCIS that developed an ipsilateral recurrence, different subtypes of breast cancer were noted as the recurrence morphology, supporting the historical view that LCIS is a risk lesion rather than a true precursor. However, in all cases the preceding LCIS was found to be related to at least one component of the subsequent invasive tumour including DCIS and IDC. This data shows that clonal relatedness between LCIS and both synchronous and asynchronous invasive disease and DCIS is more complex than previously thought, with LCIS acting as a precursor lesion even in some cases of IDC. Citation Format: Elinor Sawyer, Mateja Sborchia, Anargyros Megalios, Vandna Shah, Salpie Nowinski, Cloe Vassart, Anita Grigoriadis, Alastair Thompson, Ian Tomlinson, Rebecca Roylance, Sarah Pinder. Clonal relatedness of LCIS with synchronous and asynchronous invasive disease [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS16-03.

The correlation of deep learning-based CAD-RADS evaluated by coronary computed tomography angiography with breast arterial calcification on mammography

This study sought to evaluate the association of breast arterial calcification (BAC) on breast screening mammography with the Coronary Artery Disease-Reporting and Data System (CAD-RADS) based on Deep Learning-coronary computed tomography angiography (CCTA). This prospective single institution study included asymptomatic women over 40 who underwent CCTA and breast cancer screening mammography between July 2018 and April 2019. CAD-RADS was scored based on Deep Learning (DL). Mammograms were assessed visually for the presence of BAC. A total of 213 patients were included in the analysis. In comparison to the low CAD-RADS (CAD-RADS < 3) group, the high CAD-RADS (CAD-RADS ≥ 3) group, more often had a history of hypertension (P = 0.036), diabetes (P = 0.017), and chronic kidney disease (P = 0.006). They also had a significantly higher level of LDL-C (P = 0.024), while HDL-C was lower than in the low CAD-RADS group (P = 0.003). BAC was also significantly higher in the high CAD-RADS group (P = 0.002). In multivariate analysis, the presence of BAC [odd ratio (OR) 10.22, 95% CI 2.86–36.49, P < 0.001] maintained a significant associations with CAD-RADS after adjustment by meaningful variable. The same tendency was also found after adjustment by all covariates. There was a significant correlation between the severities of CAD detected by DL based CCTA and BAC in women undergoing breast screening mammography. BAC may be used as an additional diagnostic tool to predict the severity of CAD in this population.

WHAT CAN WE ACTUALLY SEE USING COMPUTER AIDED DETECTION IN MAMMOGRAPHY?

SUMMARYThe main goal of this study was to compare the results of computer aided detection (CAD) analysis in screening mammography with the results independently obtained by two radiologists for the same samples and to determine the sensitivity and specificity of CAD for breast lesions. A total of 436 mammograms were analyzed with CAD. For each screening mammogram, the changes in breast tissue recognized by CAD were compared to the interpretations of two radiologists. The sensitivity and specificity of CAD for breast lesions were calculated using contingency table. The sensitivity of CAD for all lesions was 54% and specificity 16%. CAD sensitivity for suspicious lesions only was 86%. CAD sensitivity for microcalcifications was 100% and specificity 45%. CAD mainly ‘mistook’ glandular parenchyma, connective tissue and blood vessels for breast lesions, and blood vessel calcifications and axillary folds for microcalcifications. In this study, we confirmed CAD as an excellent tool for recognizing microcalcifications with 100% sensitivity. However, it should not be used as a stand-alone tool in breast screening mammography due to the high rate of false-positive results.

Lifestyle and occupational factors associated with participation in breast mammography screening among Western Australian women.

Various lifestyle and occupational factors have been associated with an increased risk of breast cancer, but there is limited research investigating the relationship between these factors and participation in breast cancer screening. This study explores the associations between lifestyle and occupational factors and participation in breast mammography screening among women living in Western Australia. This study involved 1705 women aged 40 and older who participated as controls in the Breast Cancer Environment and Employment Study conducted in Western Australia. Self-reported questionnaire data were collected on participation in mammography screening, demographic factors, and lifestyle and occupational variables (smoking, physical activity, alcohol consumption, body mass index, use of contraceptive pill and hormone replacement therapy, breastfeeding, occupation, and participation in shift work). Multivariate modified Poisson regression was used to identify variables associated with ever participation in breast mammography screening. Just over 88% of women reported having ever had a mammogram. Likelihood of having ever had a mammogram was higher among women who had ever used hormone replacement therapy (adjusted prevalence ratio (aPR) = 1.05, 95% CI 1.02-1.07). Women who worked in clerical occupations (aPR = 1.06, 95% CI 1.01-1.11) or home duties (aPR = 1.05, 95% CI 1.00-1.11) were also more likely to report having ever had a mammogram compared with those in professional or technical occupations. Participation in mammography screening was found to differ by lifestyle and occupational factors. These results have important implications for public health strategies on improving screening participation.

Pilot trial of digital breast tomosynthesis (3D mammography) for population-based screening in BreastScreen Victoria.

To estimate detection measures for tomosynthesis and standard mammography; to assess the feasibility of using tomosynthesis in population-based screening for breast cancer. Prospective pilot trial comparing tomosynthesis (with synthesised 2D images) and standard mammography screening of women attending Maroondah BreastScreen, a BreastScreen Victoria service in the eastern suburbs of Melbourne. Women at least 40 years of age who presented for routine breast screening between 18 August 2017 and 8 November 2018. Cancer detection rate (CDR); proportion of screens that led to recall for further assessment. 5018 tomosynthesis and 5166 standard mammography screens were undertaken in 10146 women; 508 women (5.0% of screens) opted not to undergo tomosynthesis screening. With tomosynthesis, 49 cancers (40 invasive, 9 in situ) were detected (CDR, 9.8 [95% CI, 7.2-13] per 1000 screens); with standard mammography, 34 cancers (30 invasive, 4 in situ) were detected (CDR, 6.6 [95% CI, 4.6-9.2] per 1000 screens). The estimated difference in CDR was 3.2 more detections (95% CI, -0.32 to 6.8) per 1000 screens with tomosynthesis; the difference was greater for repeat screens and for women aged 60 years or more. The recall rate was greater for tomosynthesis (4.2%; 95% CI, 3.6-4.8%) than standard mammography (3.0%; 95% CI, 2.6-3.5%; estimated difference, 1.2%; 95% CI, 0.46-1.9%). The median screen reading time for tomosynthesis was 67 seconds (interquartile range [IQR] 46-105 seconds); for standard mammography, 16 seconds (IQR, 10-29 seconds). Breast cancer detection, recall for assessment, and screen reading time were each higher for tomosynthesis than for standard mammography. Our preliminary findings could form the basis of a large scale comparative evaluation of tomosynthesis and standard mammography for breast screening in Australia. Australian New Zealand Clinical Trials Registry, ACTRN12617000947303.

Estimation of the benefit and harms of including clinical breast examination in an organized breast screening program

BackgroundThere is controversy about the value of clinical breast examination (CBE) in addition to mammography for breast screening. The study investigates the associations between risk factors such as mammographic density, hormone therapy use and family history and the effectiveness of screening mammography with or without CBE. MethodsThe cohort consists of women 50–69 years old screened at the Ontario Breast Screening Program. The associations of the risk factors were investigated using a joint logistic regression model that accommodates the partially unobserved disease status, clustered data structures, individual risk factors, and the dependence between true and false detection. ResultsHaving high mammographic density, a first degree relative with breast cancer and using hormone therapy generally increased a woman's probability of being referred correctly. For low risk group (defined as without dense breasts, family history, and not currently using hormone therapy), the average loss of specificity ranged from 3.6% to 5.7% and the gain of sensitivity was between 10.6% and 21.2% with the addition of CBE. ConclusionsThe addition of CBE to mammography would increase the overall sensitivity and decrease the specificity. CBE can be targeted to those women in which it has the highest net benefit.

Indications and the Outcome of the Mammography at Douala General Hospital (Cameroon)

Background: Recent reports indicate that the use of mammography in breast screening plays a major role in reducing breast cancer-related deaths. It helps to improve quality of care and patient information. However, in Cameroon, there are no organized general breast screening programs which give women the opportunity to regularly screen their breasts, except for the few who take their own initiative for breast screening. Purpose: This study aimed to list indications and results of mammography and/or breast ultrasounds at Douala General Hospital in order to determine the proportion of routine mammographic screening. Method: This descriptive cross-sectional study was carried out at Douala General Hospital using pre-established data sheets. The study recruited all patients who met the selection criteria and reported to the radiology and medical imaging department for breast screening using physical examinations, mammography and/or ultrasounds. Results: The study recruited 372 patients, 96.8% of whom were between 40 to 50 years old. The reasons given for the medical consultation were systematic screening (33.01%); pain (27.18%) and lumps (25.24%). Breast examination by inspection was normal in 87.1% of women, and by palpation in 66.7%. Mammography revealed nodular opacities (18.3%), spiculated images (4.3%) and micro calcifications (3.2%), while ultrasound identified fibroadenomas (16.48%) and cysts (6.18%). Suspicious lesions (ACR 4 and 5) were discovered in 7.6% of cases by mammography and 8.51% of cases by ultrasound. The results indicated that there was no significant association between the use of clinical examination and mammography (p = 0.754). The use of clinical examination alone for breast screening may not be sufficient. Conclusion: Our findings indicate that in Cemaroon, the routine screening mammography accounts for less than one-third (33.1%) of all indications. Benign lesions were most common, however 7.6% and 8.51% of suspicious malignant lesions were observed using mammography and ultrasound respectively.

Molecular Breast Imaging in Breast Cancer Screening and Problem Solving

In the United States, legislative actions in over 28 states require radiologists to notify women who undergo breast screening mammography of their breast density. This has led to increased public interest in supplemental screening, but radiologists have not come to a consensus on a supplemental screening modality. In choosing between the most common options, whole-breast ultrasonography (US) and magnetic resonance (MR) imaging, one must weigh the benefits and drawbacks of each modality, as increased cancer detection may be accompanied by increased examination costs and biopsy rates. There has been recent interest in molecular breast imaging (MBI) for supplemental screening because of its high sensitivity, as well as its high specificity. This article describes how MBI fits into clinical practice alongside digital breast tomosynthesis (DBT), targeted US, and MR imaging. The authors describe their approach to breast cancer screening, which uses DBT as the primary imaging modality. DBT is complemented by automated density calculations and supplemented with functional imaging techniques, including MR imaging or MBI, for women with dense breasts. An algorithm based on the patient's breast cancer risk is used to determine if either MR imaging or MBI for supplemental screening is appropriate. MBI is also used as a problem-solving tool for the evaluation of clinical indications following complex mammography or US, or for unexplained physical findings. This article describes aspects related to implementing MBI in clinical practice, including the clinical workflow, patient management, radioactive tracer administration, and procedure reimbursement. © RSNA, 2017.

Abstract IS-3: IS-3 Overcoming obstacles to breast conservation surgery in Malaysia

Abstract The rates of breast conservation in breast cancer can vary from 75% in highly developed countries where mammographic breast screening programmes has led to detection of small tumours, to 0% in low income countries where there are no early detection programmes and women present with large tumours. Mastectomy is the only choice in countries where there are no radiation therapy facilities, an essential component of breast conservation surgery (BCS). Malaysia is a high middle income country in South East Asia, with population of 31 million and an incidence of breast cancer of 38.9 per 100 000. According to the International Atomic Energy Agency, 78.9% of the population in Malaysia have access to radiation facilities, so access to radiation does not pose a major barrier to BCS. However BCS is only suitable for women who present with small tumours. In Malaysia, 40-60% of women present with Stage 3 and 4 breast cancer, with a mean size of 4 cm. Hence the majority of patients are not suitable for BCS. In a tertiery urban institution, the BCS rate was reported as 22%. Early detection programmes are essential to improve the rates of BCS. However before any early detection programme can be implemented, the public must know the benefits of early detection. Early detection consists of screening for asymptomatic disease by mammography, and downstaging of symptomatic disease. Population-based mammographic screening is not recommended in low and middle income countries, where there have been no randomized controlled trials on mammographic screening to determine effectiveness in reducing breast cancer mortality, and may not be cost-effective in a country with a lower incidence of breast cancer. Malaysia does not have a population-based mammographic breast screening programme; however there are opportunistic programmes where mammograms are provided free of charge. Despite this, several surveys showed that only 5-15% of eligible women in Malaysia had a screening mammogram done. In addition, the same surveys show that women have poor knowledge of the signs and symptoms of breast cancer. Barriers to early detection (and treatment) appear to be at an individual level. A qualitative study on the reasons for late presentation showed that fear of mastectomy, a fatalistic attitude, belief in alternative therapy and poor decision making were seen in women who present late. Deconstructing why women present with advanced cancer and default treatment would provide opportunities for intervention, such as developing materials to assist in decision making and providing culturally sensitive educational materials. An important message is that early detection save lives and save breasts because BCS will be possible. Malaysia is a multi-ethnic country made up of three main races, ie, Chinese, Malays and Indians. Although there is no difference in overall survival between BCS and mastectomy, there are ethnic differences in BCS rates, with the Chinese women opting for mastectomy, with the misconception that more surgery gives them a better change of cure. In conclusion, the most important obstacle to BCS is the large size of the tumour. Psychosocial and cultural barriers to early detection and treatment programmes need to be addressed to reduce the mastectomy rate. Citation Format: Yip CH. IS-3 Overcoming obstacles to breast conservation surgery in Malaysia [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr IS-3.

Can mechanical imaging increase the specificity of mammography screening?

ObjectivesThis study aimed to investigate the effects of adding adjunct mechanical imaging to mammography breast screening. We hypothesized that mechanical imaging could detect increased local pressure caused by both malignant and benign breast lesions and that a pressure threshold for malignancy could be established. The impact of this on breast screening was investigated with regard to reductions in recall and biopsy rates.Methods155 women recalled from breast screening were included in the study, which was approved by the regional ethical review board (dnr 2013/620). Mechanical imaging readings were acquired of the symptomatic breast. The relative mean pressure on the suspicious area (RMPA) was defined and a threshold for malignancy was established.ResultsBiopsy-proven invasive cancers had a median RMPA of 3.0 (interquartile range (IQR) = 3.7), significantly different from biopsy-proven benign at 1.3 (IQR = 1.0) and non-biopsied cases at 1.0 (IQR = 1.3) (P < 0.001). The lowest RMPA for invasive cancer was 1.4, with 23 biopsy-proven benign and 33 non-biopsied cases being below this limit. Had these women not been recalled, recall rates would have been reduced by 36% and biopsy rates by 32%.ConclusionsIf implemented in a screening situation, this may substantially lower the number of false positives.Key Points• Mechanical imaging is used as an adjunct to mammography in breast screening.• A threshold pressure can be established for malignant breast cancer.• Recalls and biopsies can be substantially reduced.

Breast cancer inequities between Māori and non-Māori women in Aotearoa/New Zealand.

Māori women have one of the highest incidences of breast cancer in the world. This high incidence is generally unexplained although higher rates of obesity and alcohol intake are modifiable risk factors that may be important. Māori women are less likely to attend mammographic breast screening and are likely to be diagnosed with more advanced disease. This is one of the reasons for the excess mortality. Another factor is differences in the treatment pathway. Māori women are more likely to experience delay in receiving treatment, are less likely to receive radiotherapy, are more likely to be treated with a mastectomy and are less likely to adhere to long-term adjuvant endocrine therapy. However, genetic factors in Māori women do not seem to impact significantly on mortality. This review looks at the inequity between Māori and non-Māori women and addresses the causes. It proposes ways of reducing inequity through primary prevention, increased participation in breast screening and greater standardisation of the treatment pathway for women newly diagnosed with breast cancer. We believe that health system improvements will decrease barriers to health care participation for Māori women and suggest that further research into identifying and modifying obstacles within health systems is required.

Screen detection of ductal carcinoma in situ and subsequent incidence of invasive interval breast cancers: a retrospective population-based study

SummaryBackgroundThe value of screen detection and treatment of ductal carcinoma in situ (DCIS) is a matter of controversy. At present, the extent to which the diagnosis and treatment of DCIS could prevent the occurrence of invasive breast cancer in the future is not clear. We sought to estimate the association between detection of DCIS at screening and invasive interval cancers subsequent to the relevant screen.MethodsWe obtained aggregate data for screen-detected cancers from 84 local screening units within 11 regional Quality Assurance Reference Centres in England, Wales, and Northern Ireland from the National Health Service Breast Screening Programme. Data for DCIS diagnoses were obtained for women aged 50–64 years who were invited to and attended mammographic breast screening from April 1, 2003, to March 31, 2007 (4 screening years). Patient-level data for interval cancer arising in the 36 months after each of these were analysed by Poisson regression with invasive interval cancer screen detection rate as the outcome variable; DCIS detection frequencies were fitted first as a continuous and then as a categorical variable. We repeated this analysis after adjustment with both small size and high-grade invasive screen-detected cancers.FindingsWe analysed data for 5 243 658 women and on interval cancers occurring in the 36 months after the relevant screen. The average frequency of DCIS detected at screening was 1·60 per 1000 women screened (median 1·50 [unit range 1·54–3·56] per 1000 women). There was a significant negative association of screen-detected DCIS cases with the rate of invasive interval cancers (Poisson regression coefficient −0·084 [95% CI −0·13 to −0·03]; p=0·002). 90% of units had a DCIS detection frequency within the range of 1·00 to 2·22 per 1000 women; in these units, for every three screen-detected cases of DCIS, there was one fewer invasive interval cancer in the next 3 years. This association remained after adjustment for numbers of small screen-detected invasive cancers and for numbers of grade 3 invasive screen-detected cancers.InterpretationThe association between screen-detected DCIS and subsequent invasive interval cancers suggests that detection and treatment of DCIS is worthwhile in prevention of future invasive disease.FundingUK Department of Health Policy Research Programme and NHS Cancer Screening Programmes.