Service Breast Screening Research Articles

Perceived Experiences of Discrimination in Health Care: A Barrier for Cancer Screening Among American Indian Women with Type 2 Diabetes

PurposeBreast and cervical cancer-mortality disparities are prominent among American Indian women. These disparities, in part, may result from patients perceived experiences of discrimination in health care. This report evaluates the impact of perceived discrimination on screening for breast and cervical cancer in a sample of 200 American Indian women with type 2 diabetes. MethodsData were collected from patient report and medical records. Prevalence of breast and cervical cancer screening were assessed. Unadjusted and adjusted logistic regression analyses were used to assess associations between perceived discrimination, cancer screening status, and patients' health care-seeking behaviors. FindingsSubstantial proportions of AI women in our sample were behind the recommended schedules of screening for breast and cervical cancer. Adjusted estimates revealed that perceived discrimination was significantly associated with not being current for clinical breast examination and Pap test, and was close to statistical significance with not being current for mammography. The number of suboptimal health care-seeking behaviors increased with higher mean levels of perceived discrimination. ConclusionsAmong AI women, perceived discrimination in health care may negatively influence use of breast and cancer screening services, and health care-seeking behaviors. More research is needed among AIs to examine features of health care systems related to the phenomenon patients perceived experience of discrimination.

Mucinous carcinomas of the breast: Imaging features and potential for misdiagnosis

Pure mucinous breast carcinomas (PMBC) are commonly lobulated, therefore appear relatively benign compared with the imaging features of invasive ductal carcinoma. The aim of this study was to determine mammographic and sonographic patterns of PMBC, in particular features that may result in misdiagnosis. Retrospective review of available mammography and sonography in 90 patients diagnosed with PMBC within the Monash BreastScreen service, 1993-2011 inclusive. PMBC commonly have indistinct or lobulated mammographic and sonographic margins. Mammographic calcifications are absent in the majority (82%). On ultrasound, these neoplasms are commonly isoechoic (51%) with normal posterior acoustic appearances (80%). However, most (77%) of these lesions have suspicious or definite imaging features of malignancy. PMBC are commonly lobulated with homogeneous, isoechoic and normal posterior acoustic sonographic appearances but rarely have benign imaging features.

Abstract P5-14-03: Breast cancer screening and follow-up of abnormal mammogram results: A population-based study comparing results from an urban university cancer center to a national database.

Abstract Background: To improve access to screening, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) was developed through the Centers for Disease Control and Prevention (CDC) to provide low-income, and uninsured underserved women access to timely breast and cervical cancer screening and diagnostic services. This population-based study investigates the demographics and diagnostic outcomes of women who underwent breast cancer screening through this program established at an urban university cancer center compared to data obtained from the national program database. Methods: The Kimmel Cancer Center at Jefferson (KCC) launched its screening program with resources from the CDC, the State of Pennsylvania, and the Susan G. Komen Foundation in 2008. The core of the program is staff lead by a Social Worker/Navigator who connects patients to education and screening services, institutional information and guidance, and follow-up to minimize barriers to access, lessen dropout, and ensure follow-through for timely diagnosis and treatment. Working with our Community-Based partner organizations, uninsured and underinsured women in Philadelphia are able to seamlessly travel from education and screening through to treatment and support. All KCC patients evaluated through this program from 2008–2011 were included and records of the NBCCDP database 2006–2010 for this study and analyses. Results: KCC has a substantially larger African American (54.44% vs. 13.8%), smaller Hispanic (8.59% vs. 27.6%), larger percentage of abnormal mammograms (25.96% vs. 14%), higher breast cancer diagnosed per mammogram (2.13 vs 1.0) and a much younger population than the national cohort. Fewer than 1% of KCC patients have been lost to follow-up. Conclusions: The KCC Breast and Cervical Screening and Treatment Program Services reaches a highly vulnerable and at-risk population, has a higher abnormal mammogram and breast cancer detection rate, and a higher continued participation rate than the national cohort. The Social/Worker/Navigator has a distinct role in providing follow-up for abnormal findings to minimize no-shows by providing creative problem-solving, support, counseling, finding resources to minimize barriers, and contributes significantly to the ease of operation and the continued participation of patients in the program. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-14-03.

Abstract A51: Understanding community-based primary care providers' attitudes toward caring for breast cancer survivors.

Abstract Background: Of the 13.7 million cancer survivors in the United States, 22% are breast cancer survivors. By 2050, this number is expected to double. The 2005 Institute of Medicine's Report “From Cancer Patient to Cancer Survivor: Lost in Transition,” identified 4 essential components of survivorship care. Central to this includes the coordination between specialists and primary care providers. Primary Care Providers (PCPs) often play a critical role in the follow-up care for patients with chronic diseases. Cancer survivorship can now be viewed as a chronic disease however PCPs have little access to training and education in survivorship care. By offering culturally appropriate and trusted care in a setting that is familiar and accessible to their patients, PCPs in the community setting are in a unique position to impact cancer follow-up care for their patients. Thus greater involvement by community PCPs is likely to impact cancer survivorship disparities. We sought to survey PCP attitudes regarding cancer survivorship care delivery. Methods: The Illinois Breast and Cervical Cancer Program (IBCCP) is part of the Center for Disease Control's National Breast and Cervical Cancer Early Detection Program. This program provides access to breast and cervical cancer screening services to underserved women. Illinois has 36 lead agencies. A 10-question survey based on the National Cancer Institute's Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) was given to IBCCP providers. Providers were surveyed about their attitudes and self-efficacy as well as preferences for breast cancer care delivery. The SPARCCS surveyed over 1000 PCPs on their knowledge and attitudes on breast cancer survivorship care. 83% of SPARCCS PCPs work in either private practice or as part of a large healthcare system. Results: 110 PCPs completed the IBCCP survey. 54% (n=59) were physicians, 28% (n= 31) nurse practitioners, and 17% (n= 19) identified as other. 94.5% (n= 104) of the respondents reported having patients with a breast cancer history. Compared to PCPs in the original SPARCCS survey, 37% IBCCP providers' preferred oncologists take primary responsibility (SPARCCS 25%, p=0.0057) and 13% IBCCP providers' preferred survivorship care be delivered in specialized survivorship clinics led by a clinician other than a physician (SPARCCS 4%, p=0.0002). The other survivorship care model preference differences were not statistically significant. Overall, community-PCPs surveyed preferred follow-up care be delivered through specialized clinics and/or by cancer specialists. Conclusions: Limited information exists regarding the role of community PCPs in breast cancer survivorship follow-up care for the underserved. Most providers in our survey stated they preferred follow-up care be delivered by the cancer specialist or through specialized survivorship clinics. The role to which improving provider knowledge, attitudes, and self-efficacy can impact preferences for care delivery needs to be explored. Citation Format: Zakiya Moton, Danielle Weston, Rebecca McFarland, Tamara Hamlish, Daniel Johnson, Maureen Mencarni, Shannon Lightner, Jean Becker, Funmi Olopade, Susan Hong. Understanding community-based primary care providers' attitudes toward caring for breast cancer survivors. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A51.

13. Outcomes following B3/B4 needle core biopsy in South East London Breast Screening Service 2000–2010

13. Outcomes following B3/B4 needle core biopsy in South East London Breast Screening Service 2000–2010

Factors Facilitating Acceptable Mammography Services for Women with Disabilities

BackgroundPrior research has described general barriers to breast cancer screening for women with disabilities (WWD). We explored specific accommodations described as necessary by WWD who have accessed screening services, and the presence of such accommodations in community-based screening programs. MethodsWe surveyed WWD in the Carolina Mammography Registry to determine what accommodations were needed when accessing breast screening services, and whether or not these needs were met. The sample of 1,348 WWD was identified through a survey of limitations, with a response rate of 45.5% (4,498/9,885). Of the 1,348 WWD eligible for the second survey, 739 responded for a response rate of 54.8%. ResultsThe most frequently needed accommodations were an accessible changing area with a bench (60.0%), oral description of the procedure by the technologist (60.5%), and handicapped/accessible parking (27.6%). Handicapped parking was the need most likely to go unmet (3.1%). ConclusionMost needs are being met by radiology facilities and staff, and the few needs going unmet are related to the physical/built environment. Overall, for WWD who are in screening, the mammography system seems to be more accessible than generally perceived.

A clinical "near miss" highlights risk management issues surrounding ultrasound-guided and wire-localised breast resections

BackgroundThe introduction of the National Health Service (NHS) Breast Screening Programme has led to a considerable increase in the detection of impalpable breast cancer. Patients with impalpable breast cancer typically undergo oncological resection facilitated either by the insertion of guide wires placed stereo-tactically or through ultra-sound guided skin markings to delineate the extent of a lesion. The need for radiological interventions on the day of surgery adds complexity and introduces the risk that a patient may accidentally transferred to the operating room directly without the image guidance procedure.Case reportA case is described of a patient who required a pre-operative ultrasound scan in order to localise an impalpable breast cancer but who was accidentally taken directly to the operating theatre (OR) and anaesthetised without pre-operative intervention. The radiologist was called to the OR and an on-table ultrasound was performed without further consequence.ConclusionIt is evident that breast cancer patients undergoing image-guided resection are exposed to an additional layer of clinical risks. These risks are not offset by the World Health Organisation surgical safety checklist in its present guise. Here, we review a number of simple and inexpensive changes to the system that may improve the safety of the breast cancer patient undergoing surgery.

Training radiographers to deliver an intervention to promote early presentation of breast cancer

AimTo evaluate the feasibility of training sufficient radiographers to deliver an intervention to promote early presentation of breast cancer to all older women attending for their final routine mammogram within the NHS Breast Screening Programme. If the Promoting Early Presentation (PEP) intervention is demonstrated to be cost-effective, it may be implemented across the NHS requiring at least four radiographers per screening service to deliver the intervention. MethodsA pilot study in a single breast screening service was conducted to assess the feasibility of training sufficient radiographers to meet this objective. Quantitative and qualitative methods were used to evaluate the impact of training on participating radiographers and the screening service. Competency to deliver the intervention was assessed at key points during training according to quality criteria based on delivery of the key messages and style of delivery. Confidence to deliver the intervention was assessed using a self-report measure before and after training. Radiographers' experiences of training were elicited in face-to-face qualitative interviews. ResultsSeven of eight radiographers who were released to undertake the training achieved the required level of competency to deliver the intervention within four months. All improved over time in their confidence to deliver the key messages of the intervention. The qualitative analysis revealed the benefits and challenges of training from the perspective of the radiographers. ConclusionIt was feasible and acceptable to train sufficient radiographers to deliver the PEP Intervention. The training package will be streamlined to improve efficiency for large implementation trials and clinical practice across the NHS.

A comparison of mean glandular dose diagnostic reference levels within the all-digital Irish nationalbreast screening programme and the Irish symptomatic breast services

Data on image quality, compression and radiation dose were collected from symptomatic breast units within the Republic of Ireland. Quantitative and qualitative data were analysed using SPSS. Recommendations of mean glandular dose (MGD) diagnostic reference levels were made at various levels for film-screen and full field digital mammography units to match levels published worldwide. MGDs received by symptomatic breast patients within Ireland are higher than those received in the all-digital Irish Breast Screening service; 55-65 mm breast: 1.75 mGy (screening) vs. 2.4 mGy (symptomatic) at the 95th percentile; various reasons are proposed for the differences. MGDs achieved in the screening service may be lower because of the exacting requirements for radiographer training, characteristics of the patients and equipment quality assurance levels. More precise imaging guidelines, standards and training of symptomatic radiographers performing mammography are suggested to remediate MGDs delivered to the breasts of Irish women attending the symptomatic breast services.

P04.79. Navigating breast and cervical cancer screening services for Tongan women in Southern California

Purpose Patient Navigation (PN) has the potential to increase timely utilization of cancer prevention, early detection and treatment services among underserved populations. Few such navigators exist in community-based settings. Tongans in Southern California experience some of the largest cancer health disparities in the state. In addressing breast and cervical cancer, a pilot project was launched with the aim to increase cancer screening, treatment and support for Tongan American women ages 40 and above through cancer-related PN services.

Promoting Early Presentation of Breast Cancer in Older Women: Implementing an Evidence-Based Intervention in Routine Clinical Practice

Background. Women over 70 with breast cancer have poorer one-year survival and present at a more advanced stage than younger women. Promoting early symptomatic presentation in older women may reduce stage cost effectively and is unlikely to lead to overdiagnosis. After examining efficacy in a randomised controlled trial, we piloted a brief health professional-delivered intervention to equip women to present promptly with breast symptoms, as an integral part of the final invited mammogram at age ~70, in the English National Health Service Breast Screening Programme. Methods. We trained mammographers, who then offered the intervention to older women in four breast screening services. We examined breast cancer awareness at baseline and one month in women receiving the intervention, and also in a service where the intervention was not offered. Results. We trained 27 mammographers to deliver the intervention confidently to a high standard. Breast cancer awareness increased 7-fold at one month in women receiving the intervention compared with 2-fold in the comparison service (odds ratio 15.2, 95% confidence interval 10.0 to 23.2). Conclusions. The PEP Intervention can be implemented in routine clinical practice with a potency similar to that achieved in a randomised controlled trial. It has the potential to reduce delay in diagnosis for breast cancer in older women.

Esperanza y Vida: A Culturally and Linguistically Customized Breast and Cervical Education Program for Diverse Latinas at Three Different United States Sites

Breast cancer is the most common cause of cancer and the leading cause of cancer death among Latinas in the United States. In addition, Latinas experience a disproportionate burden of cervical cancer incidence, morbidity, and mortality compared with non-Hispanic White women. Lower use of breast and cervical cancer screening services may contribute to these disparities. To address the underutilization of breast and cervical cancer screening among diverse subgroups of Latinas, a peer-led education program called Esperanza y Vida (“Hope and Life”) was developed and administered at 3 sites (2 in New York and 1 in Arkansas). Immigrant Latina women and their partners were educated about the importance of breast and cervical cancer screening, with the goals of increasing their knowledge about these cancers and their screening behavior. An analysis of the intervention's findings at baseline among female participants demonstrated significant sociodemographic, interpersonal, cultural, health care system, and program variability in 3 distinct geographic regions in the United States. These data indicate the need for and feasibility of customizing cancer outreach and educational programs for diverse Latina subgroups living in various U.S. regions, with implications for informing the expansion and replication of the program in other regions of the country.

Outcomes following B3/B4 needle core biopsy in South East London Breast Screening Service 2000 to 2010

Needle core biopsy (NCB) is frequently used in assessing screen-detected breast lesions. Uncertainty remains over appropriate management of NCBs reported as 'uncertain malignant potential' (B3) or 'suspicious of malignancy' (B4). This study aims to analyse a large screening dataset to establish positive predictive values (PPVs) for malignancy on excision biopsy, for different classifications of B3 and for B4 NCBs.

Symptomatic breast services in Ireland: how do they compare with national and international standards?

A study of symptomatic breast units geographically spread over Ireland collected image quality, compression and radiation dose data from 18 mammography units; so how do these optimisation parameters compare nationally and internationally? The mean glandular dose (MGD) diagnostic reference level was proposed for the all-digital breast screening service [1] but not for the symptomatic breast service.

Comparison of analogue and digital mammographic appearances of screen-detected invasive breast cancers

Our UK Breast Screening Service changed overnight wholesale from analogue to digital mammography on 5 October 2009. This has meant that we have two unmixed cohorts to directly compare. We wish to evaluate whether any digital mammography has changed our cancer detection, and whether any features of these cancers have altered.

Should we be using nonscreening symptomatic units' mammogram machines for screening? Women's attitudes and factors likely to affect whether they attend

Symptomatic mammogram machines in trusts that do not run screening services are rarely used by the National Breast Screening Service. This is a potential untapped site for screening. This study surveyed whether women attending current screening sites would go to hospital-based symptomatic units instead.

Commentary on: Breast screening policy: Are we heading in the right direction?

0009-9260/$ e see front matter 2011 The Royal Co doi:10.1016/j.crad.2011.06.006 Evans and Whelehan1 tackle a difficult issue in breast cancer screening, that of the age range over which screening should be conducted and the screening interval that should be used. The original UK National Health Service (NHS) Breast Screening Programme age range was 50e64 years, which was later extended to 50e70 and more recently 47e73 by including an extra screen at ages 47e49 and an extra screen at ages 71e73 (providing nine screens in total). The extra screening invitation at age 71e73 guarantees women an invitation to screening over the age of 70 and some women will have their last invitation close to their 74th birthday and some women will have their last screen the year they turn 71. There is, however, no arguing that these screens are outside the age range 50e69 recommended by International Agency for Research on Cancer (IARC)2 as the range where there is sufficient evidence and that screening women from age 47 is more than just making sure they get their first screen by age 50. Is the age extension, therefore, justified or does it represent age-range “creep”? If the upper limit was once 64 and then 70 and now 73, what is the chance that it will continue to move upward to say 76 and then 79? The central argument of the paper by Evans and

Effect of Health Care System Distrust on Breast and Cervical Cancer Screening in Philadelphia, Pennsylvania

We investigated whether health care system distrust is a barrier to breast and cervical cancer screening and whether different dimensions of distrust-values and competence-have different impacts on cancer screening. We utilized data on 5268 women aged 18 years and older living in Philadelphia, Pennsylvania, and analyzed their use of screening services via logistic and multinomial logistic regression. High levels of health care system distrust were associated with lower utilization of breast and cervical cancer screening services. The associations differed by dimensions of distrust. Specifically, a high level of competence distrust was associated with a reduced likelihood of having Papanicolaou tests, and women with high levels of values distrust were less likely to have breast examinations within the recommended time period. Independent of other covariates, individual health care resources and health status were associated with utilization of cancer screening. Health care system distrust is a barrier to breast and cervical cancer screening even after control for demographic and socioeconomic determinants. Rebuilding confidence in the health care system may improve personal and public health by increasing the utilization of preventive health services.

Evaluation and implementation of an intervention to promote early presentation

Introduction and aimsOlder women are more likely to delay presentation in breast cancer,1 which in turn contributes to poorer survival.2 We have developed a health professional-delivered intervention to promote early...

COMPASS collaborative research Strand 3: Research into practice: implementing a complex psychoeducational intervention to promote early presentation in older women with breast cancer

Women over 70 have poorer breast cancer survival than younger women, largely due to later stage at diagnosis. Promoting early presentation (PEP) in women attending for final round of breast...