Cancer In Asymptomatic Women Research Articles

Predicting risk of endometrial cancer in asymptomatic women (PRECISION): Model development and external validation.

Develop an endometrial cancer risk prediction model and externally validate it for UK primary care use. Cohort study. The UK Biobank was used for model development and a linked primary (Clinical Practice Research Datalink, CPRD) and secondary care (HES), mortality (ONS) and cancer register (NRCAS) dataset was used for external validation. Women aged 45-60 years with no history of endometrial cancer or hysterectomy. Model development was performed using a flexible parametric survival model and stepwise backward selection aiming to minimise the Akaike information criterion. Model performance on external validation was assessed through flexible calibration plots, calculation of the expected to observed ratio and C-statistic and decision curve analysis. Endometrial cancer diagnosis within 1-10 years of the index date. Model development included 222 031 women (902 incident endometrial cancer cases) and external validation 3 094 371 women (8585 endometrial cancer cases). The final model (with equation provided) incorporated age, body mass index, waist circumference, age at menarche, menopause and last birth, hormone replacement, tamoxifen and oral contraceptive pill use, type 2 diabetes, smoking and family history of bowel cancer. It was well calibrated on external validation (calibration slope 1.14, 95% confidence interval [CI] 1.11-1.17, E/O 1.03, 95% CI 1.01-1.05), with moderate/good discrimination (C-statistic 0.70, 95% CI 0.69-0.70) and had improved net benefit compared with previously developed models. The Predicting risk of endometrial cancer in asymptomatic women model (PRECISION), using easily measurable anthropometric, reproductive, personal and family history, accurately quantifies a woman's 10-year risk of endometrial cancer. Its use could determine eligibility for primary endometrial cancer prevention trials and for targeted resource allocation in UK general practices.

Abstract OT3-18-02: Clinical validation of “TriNetra™-Breast” test for breast cancer screening in a prospective, observational, case-cohort study

Abstract Introduction The Standard of Care for early detection of breast cancer in asymptomatic women is screening mammography, which has limitations such as radiation exposure and lower sensitivity to detect cancer in women with high breast density or invasive carcinomas. TriNetra™-Breast is a blood test for the detection of breast cancer associated circulating tumor cells in blood. Previously, this test has been used in a study for breast cancer detection in India, where it has shown a sensitivity of 92.5%. It has since been granted the United States Food and Drug Administration (USFDA) Breakthrough Device Designation, attesting its potential to provide for improved detection of breast cancer. This prospective, observational, case-cohort study will confirm the clinical performance characteristics of the technology in the US population. Patients and Methods The primary endpoint of this study will be to determine the sensitivity and specificity of the test for breast cancer screening, using mammography and histopathology confirmed diagnosis (when relevant) as the reference methods. Women ≥40 years, with no prior diagnosis of any cancer and undergoing screening mammography for breast cancer will be eligible for participation in this study. 700 women, representing the diverse ethnic US population, will be enrolled. Cohort A will have 500 women with BI-RADS score of 1, 2, or 3. Among these 500 participants, the age categories of 40-49 years, 50-74 years and >74 years will have 100, 300 and 100 women respectively. Cohort B will have 100 women with suspicion of DCIS (without a suspicion of simultaneous invasive carcinoma) and 50 women each with BI-RADS score of 4 or 5. These study population numbers will ensure optimal representation of in-situ carcinoma, malignant and benign cases. Blood samples will be collected from the enrolled women for TriNetra™-Breast, within sixty (60) days of the screening mammogram. If biopsy is indicated, sample collection will be required prior to the procedure. The lab investigators will be blinded to the clinical information of all participants, including mammography and histopathology results, while the participants and clinical investigators will be blinded to the TriNetra™-Breast test results. The results of TriNetra™-Breast will be compared with the results of mammography and/or histopathology for performance estimation of the test. Study participants will be followed for clinical outcomes for maximum duration of 2 years. Citation Format: Ulka Vaishampayan, Darshana Patil, Wahida Rahman, Stephanie Patterson, Emilija Mitrikeska, Joe Dib. Clinical validation of “TriNetra™-Breast” test for breast cancer screening in a prospective, observational, case-cohort study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT3-18-02.

Effectiveness of mammogram and ultra-sonogram in the diagnosis of breast cancer in asymptomatic women at Central Karnataka

Background: Breast cancer is one of the most common cancers among women around the world. Some occult breast cancers can be missed when using ultrasound or mammogram alone. Considering this background, the study was performed to highlight the improved diagnostic efficacy of identifying breast cancer when using both ultrasound and mammogram as a combined modality.Methods: A total of 150 cases of suspected breast cancer were studied over a period of 2 years. Ultrasonography, and mammography were done by two independent radiologists and the results were analyzed. The patients were tested for BRCA1/2 gene mutations. Histopathology was done finally to confirm the diagnoses.Results: The 39 cases out of 150 asymptomatic women screened for breast cancer showed that they were positive for breast cancer by histopathology and 38 were positive by mammogram and ultra-sonogram. Cancer was prominently diagnosed in the age group of more than 40 years (92.3%) and 82.1% of women were in premenopausal stage. High BMI had a statistically significant correlation with breast cancer. The 71.7% of breast cancer cases were obese and 25.6% were overweight individuals. 89.7% of breast cancer cases were from the urban population. Detection of mutation in the BRCA gene showed 28 cases with a mutation in the BRCA-1 gene and 4 cases with a mutation in the BRCA-2 gene.Conclusions: The study confirms that mammography in addition to ultrasonography improves the sensitivity of detection of occult breast cancer in asymptomatic women.

Evidence and assessment of parenchymal patterns of ultrasonography for breast cancer detection among Chinese women: a cross-sectional study

BackgroundScreening of breast cancer in asymptomatic women is important to evaluate for early diagnosis. In China ultrasound is a more frequently used method than mammography for the detection of breast cancer. The objectives of the study were to provide evidence and assessment of parenchymal patterns of ultrasonography for breast cancer detection among Chinese women.MethodsBreast ultrasound examinations including the parenchymatous pattern of cytopathological confirmed breast cancer (n = 541) and age-matched cytopathological not confirmed breast cancer (n = 849) women were retrospectively reviewed by seven sonographer physicians. According to compositions of ducts, the thickness of the breast, diameter of ducts, fat lobules, and fibro glandular tissues, the breast parenchymatous pattern was categorized into heterogeneous (high percentage of fatty tissues), ductal (the inner diameters of ducts > 50% of the thick mass of the breast), mixed (the inner diameters of ducts was 50% of the thick mass of the breast), and fibrous categories (a dense classification of the breast).ResultsHeterogeneous (p < 0.0001, OR = 3.972) and fibrous categories (p < 0.0001, OR = 2.702) were higher among women who have cytopathological confirmed breast cancer than those who have not cytopathological confirmed breast cancer. The heterogeneous category was high-risk ultrasonographic examination category followed by the fibrous category. Agreements between sonographer physicians for categories of ultrasonic examinations were fair to good (Cohen’s k = 0.591).ConclusionsBreast cancer risk in Chinese asymptomatic women differ according to the ultrasonographic breast parenchymal pattern.Level of Evidence: III.Technical efficacy stage: 2.

The value of clinical breast examination in a breast cancer surveillance program for women with germline BRCA1 or BRCA2 mutations.

To assess the sensitivity and specificity of clinical breast examination for detecting breast cancer in asymptomatic women with predisposing germline mutations enrolled in a cancer risk management program that includes radiologic screening. Retrospective, longitudinal cohort study of women with BRCA1/2 mutations who attended the Breast and Ovarian Cancer Risk Management Clinic at the Peter MacCallum Cancer Centre, a tertiary referral centre in Melbourne, during 1 September 2001 - 31 December 2019. Consecutive women with BRCA1/2 mutations who did not have personal histories of cancer and had not undergone bilateral risk-reducing mastectomy, and who had visited the clinic at least twice during the study period. Participants had generally undergone breast examination at 6- or 12-month intervals, and annual breast imaging (mammography; and magnetic resonance imaging [MRI] for women aged 50 years or younger). Sensitivity (proportion of all biopsy-confirmed breast cancers detected by breast examination alone) and specificity of breast examination for detecting breast cancer. Of 414 eligible women (mean age, 35.5 years; SD, 11.2 years), 35 were diagnosed with breast cancer during 1761 woman-years of follow-up. Only two were diagnosed based on breast examination alone (ie, without radiologic evidence), neither of whom was undergoing MRI screening. The sensitivity of breast examination was 6% (95% CI, 1-19%), the specificity 97% (95% CI, 95-98%); the positive predictive value was 14% (95% CI, 2-43%), the negative predictive value 92% (95% CI, 89-94%). Clinical breast examination did not increase the number of breast cancers detected in MRI-screened women with BRCA1/2 mutations. Removing breast examination from surveillance programs that include MRI may be reasonable for these women.

Breast Self-Examination Practice and Associated Factors Among Women Attending Family Planning Service in Modjo Public Health Facilities Southwest Ethiopia.

PurposeBreast cancer is the leading cause of cancer death worldwide and the second common cancer overall. Breast self-examination is one of the cheapest methods used for the early detection of breast cancer in asymptomatic women. However, the practice of breast self-examination remains low in Ethiopia. Therefore, this study aimed to assess breast self-examination practice and associated factors among women attending family planning services in Modjo public health facilities in southwest Ethiopia.Patient and MethodsFacility-based cross-sectional study was conducted in Modjo public health facilities from October 01, 2020, to October 30, 2020. Data were collected from 420 women by using an interviewer-administered structured questionnaire. Variables with a P-value ≤0.2 in the bivariate analysis were included in the multivariable logistic regression model. Results of regression analysis were shown as odds ratio (OR) and confidence intervals (95% CI).ResultsOverall 86 (20.5%) of the participants had ever performed breast self-examination. The odds of breast self-examination practice among women with tertiary level of education were 2.14 [AOR: 2.14; 95% CI: (1.45, 6.74)] times higher compared to those with secondary education. Women who knew breast self-examination were 4.32 [AOR: 4.32; 95% CI: (1.81, 10.81)] times higher odds of breast self-examination practice compared to their counterparts. The odds of breast self-examination practice among women who had a positive attitude were 2.7 [AOR: 2.7; 95% CI: (1.03, 6.91)] times higher compared to women with a negative attitude towards breast self-examination.ConclusionBreast self-examination practice was low within the study area. Tertiary level of education, having Knowledge on breast self-examination and a positive attitude towards breast self-examination were found to have a significant association with breast self-examination practice. Breast self-examination should be promoted by improving awareness and providing special health education for women that had low educational level.

A cue-to-action pilot project to increase screening mammography.

Screening mammography is a preventive exam used to detect breast cancer in asymptomatic women. This cue-to-action pilot project sought to determine if outreach, education, and incentive would increase uptake of screening mammography among women aged 52 to 74 years who are members of a community-based health insurance plan. Cohort study design with retrospective and prospective components. Women were eligible to participate in accordance with the CMS Quality Rating System technical specification for breast cancer screening. Eligible women with no documented screening for a mammogram from January 1, 2016, through November 7, 2017, were invited to participate in a campaign that included outreach about screening mammography as a no-cost covered benefit, education about screening mammography to detect asymptomatic disease, and a gift card to a local grocery merchant if the member obtained screening mammography by December 31, 2017. During December 2017, 20.8% (27/130) of eligible women obtained a screening mammogram compared with 7.8% (5/64) of eligible women during the nonintervention reference period of December 2016. Mammography screening increased by 170% during the study period in comparison with the reference period of a year earlier (prevalence ratio [PR], 2.7; 95% CI, 1.1-6.6; P = .02). A one-time, time-limited cue-to-action pilot project consisting of outreach, education, and incentive increased uptake of screening mammography by women enrolled in a community health insurance plan providing health insurance coverage as part of the Affordable Care Act. This increase is statistically significant in the intervention period compared with the reference period (PR, 2.7; 95% CI, 1.1-6.6; P = .02). Despite a small sample size, the magnitude of the effect for this pilot study is encouraging and warrants future studies in a larger population.

Human papillomavirus infection and risk factors to cervical cancer in asymptomatic women in the region of the Northeast of Brazil

Objective: This study sought to identify the presence of HPV infection and the risk factors related to susceptibility to cervical cancer in asymptomatic women. Methods: It is a cross-sectional study with 428 users attended Basic Health Units, in Arapiraca, Alagoas, Brazil. Sociodemographic, behavioral variables, and cytopathological reports were collected. Molecular detection of the HPV virus was performed by Nested-PCR. Statistical analysis was conducted with SPSS version 22.0. Results: A total of 428 women were studied, HPV DNA detected in 39.2% (n = 168), with a mean age of 41 years old. There was an association of HPV with use of oral contraceptives (p &lt;0.016) and alcoholism (p &lt;0.038). It was showed a higher frequency of positive HPV in women older than 25 years old (88.7%), up to 5 sexual partners (93.4%), up to 3 pregnancies (71.4%), and with the cytopathologic results within the limits of normality (61.9%). HPV was identified in 40.3% (104/258) of the women with results within the limits of normality. Conclusion: Our results suggest that the use of oral contraceptives and alcoholism may be considered as possible risk factors related to cervical oncogenesis. With this, it is necessary to propose interventions aimed at the health education of this population, actions of prevention, and early detection.

Knowledge and Practice of Breast Self-examination and Associated Factors among Women Students in West Arsi Zone, Southeast Ethiopia

Background: Breast cancer is the leading cause for maternal mortality globally, especially in developing countries like Ethiopia. The incidence is increasing specially in developing regions. Regular breast self-examination is one of the most cost-effective methods for early detection of breast cancer in asymptomatic women. Objective: The aim of the study is to assess the level of knowledge and breast self-examination practice, and its associated factors among students in private universities at west Arsi zone, south east Ethiopia. Methods: A facility based cross-sectional study design was conducted from April 1 to 30, 2018. A total of 355 undergraduate female students were participated in the study. Simple random sampling technique was used to select the study participants. Binary and multivariate logistics regression analyses was applied using backward step wise method with p 0.25 criteria to enter and exit from the model respectively. Odds ratios with 95% confidence intervals were computed and significance of all tests was determined at p ≤ 0.05. Results: From all participants 84(23.7%) were knowledgeable about breast self-examination and 148(41.7%) and 65(18.3%) of them have knowledge about sign and risk of breast cancer respectively. Only 112(31.5%) ever practiced breast self-examination, from those 79(22.3) of them practice breast self-examination monthly and most them started breast self-examination between age of 20-30 years. After adjusting for possible confounders; Field of study, knowledge of breast cancer risk and sign were significantly associated with knowledge of breast self-examination. Knowledge about breast self-examination and from constructs of health belief model perceived susceptibility and perceived barriers were significantly associated with breast self-examination practice. Conclusion: knowledge and practice of breast self-examination of undergraduate female students was low as a National guideline of Ethiopia FMOH that states all female age above 20 years should practice BSE. Therefore, the health sector should design strategies to improve female students’ knowledge and practice of breast self-examination.

Evidence base for cervical cancer screening and prevention among average-risk women in family practice

Objective The aim was to perform a systematic review to identify and summarize evidence base for cervical cancer screening in asymptomatic women who were aged 21 years or older attending family practice. Materials and methods Medline, articles in Medscape, American Academy of Family Physicians, and PubMed were searched. Data were collected from April 1, 2015 till August 1, 2015. The initial search presented 150 articles. The researches which met the inclusion criteria were 24 articles. The articles included screening modalities for cervical cancer in asymptomatic women who were aged 21 years or older attending family practice. If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, adequate information, and assessment measures defined. Comparisons were made by a structured review with the results tabulated. Recent findings Total 24 potentially relevant publications were included. All relevant studies stated that screening should start at 21 years, mean age (±3) till 65 years (grade A recommendation). Regarding the screening test, all studies recommended cervical cytology (pap test) with a 3-year screening interval (grade A recommendation). All studies recommended screening with a combination of cytology and human papillomavirus (HPV)(co-testing) every 5 years for women in the age group of 30–65 years who want to lengthen the screening interval (grade A recommendation). All studies recommended against using HPV testing as a primary screening method or under 30 years. Regarding vaccination two studies suggest HPV vaccine for cervical cancer prevention. Conclusion Screening for cervical cancer is recommended from 21 to 65 years old with cytology (Pap) test with a 3-year screening interval. Women 30 years and older who want to lengthen the screening interval are screened by cytology plus HPV (co-testing) every 5 years.

Automated Breast Ultrasound Screening for Dense Breasts.

Mammography is the primary screening method for breast cancers. However, the sensitivity of mammographic screening is lower for dense breasts, which are an independent risk factor for breast cancers. Automated breast ultrasound (ABUS) is used as an adjunct to mammography for screening breast cancers in asymptomatic women with dense breasts. It is an effective screening modality with diagnostic accuracy comparable to that of handheld ultrasound (HHUS). Radiologists should be familiar with the unique display mode, imaging features, and artifacts in ABUS, which differ from those in HHUS. The purpose of this study was to provide a comprehensive review of the clinical significance of dense breasts and ABUS screening, describe the unique features of ABUS, and introduce the method of use and interpretation of ABUS.

Breast pain and cancer: should we continue to work-up isolated breast pain?

To assess the cancer detection rate (CDR) in patients presenting with isolated breast pain. A retrospective review was performed of consecutive patients presenting to a large tertiary care academic center or an affiliated hospital with isolated breast pain from October 1, 2013 to September 30, 2015. Medical records were reviewed for patient demographics, pain characteristics, imaging findings, and outcome. The study cohort was comprised of 971 exams in 953 patients, with a median age of 50years. A total of 62.5% (607/971) of the cases were assessed by mammography and ultrasound, 24.4% (237/971) by ultrasound only, and 13.1% (127/971) by mammography only. Including the abnormalities detected in the asymptomatic breast, 88.7% (861/971) of the cases were negative or had benign findings (BI-RADS 1 and 2), 6.8% (66/971) were probably benign (BI-RADS 3), 3.9% (38/971) were suspicious (BI-RADS 4), and 0.6% (6/971) were highly suggestive of malignancy (BI-RADS 5). CDR on initial work-up was 0.8% (8/953), of which 0.6% (4/690) was in average-risk patients while 1.5% (4/263) was in higher-than-average risk patients. CDR in patients presenting with isolated breast pain overall was low, comparable to the expected incidence of breast cancer in asymptomatic women. Work-up for isolated breast pain may therefore be unnecessary and lead to overutilization of healthcare resources. Routine screening mammography should be encouraged and higher-than-average risk patients may benefit from additional tests.

Mammographic screening patterns in Sokoto, Northwestern Nigeria

Background: Screening mammography is a radiographic examination of the breast performed for early detection of breast cancer in asymptomatic women. The American College of Radiology recommends that women should have mammography at the age of 40 years and annually thereafter. However, those who are at increased risk of breast cancer should start screening mammography earlier. These include patients with a strong family history of breast cancer or those who had radiotherapy to the chest wall. Objective: This study is aimed at evaluating the mammographic outcomes among 77 Nigerian females who had screening mammographic breast examination. Materials and Methods: From December 2010 and November 2012, 77 females had routine screening mammography in the department with the general electric alpha-RT machine with model number MGF-101 (manufactured 2010). All the participants had to fill a mammographic form consisting of variables such as age, sex, occupation, family history of breast cancer, tribe, contraception, parity and caffeine consumption, history of surgical intervention (lumpectomy, biopsy, and/or mastectomy), previous mammography, and last childbirth. Mediolateral-oblique and cranial-caudal views were done for the breast examination though additional were occasionally employed. Results: Seventy-seven females had screening mammography. The minimum age recruited was 40 years. The mammographic outcome for those who had screening was normal in 51 (66.2%) and abnormal in 26 (33.8%) participants. The abnormal mammographic outcomes were architectural distortion in either or both breasts in 13 (16.9%) participants, masses in either or both breast in 11 (14.3%) participants, while isolated calcification in either or both breast among 2 (2.6%) participants. Two (18.2%) of the subjects with masses had associated macrocalcification. No masses with malignant features were seen. Conclusion: Screening mammography was found out to be useful in detecting various forms of breast pathologies which were mostly breast masses, calcifications, and architectural distortions. Screening mammography is, therefore, advised yearly and routinely for women age 40 years and above.

Back to the Future? The Fallopian Tube, Precursor Escape and a Dualistic Model of High-Grade Serous Carcinogenesis.

Beginning with the discovery of the BRCA-associated ovarian cancer susceptibility genes and subsequent detailed examination of risk-reducing salpingo-oophorectomy (RRSO) specimens, a new paradigm of ovarian carcinogenesis has unfolded with attention to the distal fallopian tube. The primary focus has been an early cancer or neoplasm in the fallopian tube which is seen in virtually all incidentally discovered high-grade serous cancers in asymptomatic women. This high-frequency of tubal involvement in early serous neoplasm (usually in the form of serous tubal intraepithelial carcinoma—STIC) has galvanized attention to this organ as a primary source of this disease. However, an enduring mystery has been the relatively low frequency of STIC in the fallopian tubes of women with advanced malignancy. This paradox, a high frequency of tubal involvement early on and a low frequency of involvement later in the disease process, has spurred interest in other potential sources, such as the ovarian surface epithelium or cortical inclusions and the secondary Mullerian system. However, because essentially all high-grade serous carcinomas are linked by TP53 mutations, and because fallopian tubes frequently contain early serous proliferations (ESPs) with these mutations, attention has turned to the possibility that the nonmalignant but TP53 mutated tubal epithelium could be responsible for an eventual malignancy. Recent data have shown evidence of a lineage continuity between ESPs and concurrent serous carcinomas prompting the concept of “precursor escape”. This creates a second component of the paradigm by which cells from early precursors are shed from the tube and undergo subsequent malignant transformation, emerging suddenly as widespread intraperitoneal malignancy. This dualistic model thus provides a unique pathway by which the future outcome (wide spread high-grade serous carcinomas—HGSC) is ultimately explained by going back in time to an early serous proliferation. This paradigm also brings the peritoneal cavity into focus, raising new questions about the potential co-variables or exposures that might facilitate the occasional malignant transformation of an ESP in the peritoneal cavity or on the peritoneal surface.

PO-498 Spliced RNA panels from tumor-educated platelets (TEP) enable detection of early breast cancer

IntroductionDetection of early-stage breast cancer from blood is a highly desirable screening application of liquid biopsies. Tumor-educated platelets (TEP) contain distinct spliced RNA repertoires and can function as a blood-based biosource for the detection of cancer (Best et al. Cancer Cell 2015). Here, we investigated the potential of TEP RNA profiles as an early breast cancer diagnostics algorithm.Material and methodsWe sequenced platelets of women with stage I-III breast cancer (n=134) and asymptomatic non-cancer females (n=121). Samples were divided over a training, evaluation and validation set. We developed a TEP RNA-based classification algorithm, which was tailored towards two clinically relevant diagnostic applications. The first application is to rule out breast cancer in women with an abnormal mammography. The second application is to rule in breast cancer in asymptomatic women carrying an elevated baseline breast cancer risk. We examined if classifications depended on patient age, tumour stage, subtype, BRCA mutation status, and breast density. In addition, we tested if the algorithm was breast cancer specific by testing our algorithm in a pan-cancer cohort (n=192).Results and discussionsIn the evaluation cohort (n=48 of which n=24 early breast cancer cases) the TEP RNA-based breast cancer classification had an accuracy of 90% with an AUC of 0.96 (95% confidence interval (CI) 0.92–1.00; p<0.001). In the validation cohort, the TEP RNA-based classification algorithm reached an overall accuracy of 86% and an AUC of 0.93 (95% CI 0.89–0.98, p<0.001). Most important, the accuracy was 91% in stage I/II disease. In a confirmatory rule-out application (positive mammography) sensitivity would be 94% with a specificity of 67%; whereas in a screening setting sensitivity would be 80% with a specificity of 93%. The classifier performance is consistent across subgroups based on patient age, tumour stage, subtype, tissue density, or BRCA1/2-status. The breast cancer TEP profiles were distinct from those of women with other tumour types (n=192, accuracy: 87%, AUC: 0.91, 95% CI 0.87–0.96, p<0.001). Although results look promising, sensitivity and specificity should be improved for clinical implementation. Follow-up studies should, among others, require sample collection in actual screening and confirmatory settings.ConclusionWe show that platelet RNA signatures may enable blood-based screening for early breast cancer, and warrant validation in a confirmatory and screening setting.

Role of elastography for downgrading BI-RADS category 4a breast lesions according to risk factors.

Elastography has been introduced as an additional diagnostic tool to ultrasonography (US) which helps clinicians decide whether or not to perform biopsy on US-detected lesions. To evaluate the role of strain elastography in downgrading Breast Imaging Reporting and Data System (BI-RADS) category 4a breast lesions according to personal risk factors for breast cancer in asymptomatic women. Strain elastography features of a total of 255 asymptomatic category 4a lesions were classified as soft and not soft (intermediate and hard). Malignancy was confirmed by surgery or biopsy, and benignity was confirmed by surgery or biopsy with no change on US for at least six months. Malignancy rates of lesions with soft and not soft elastography were calculated according to the presence of risk factors. Of 255 lesions, 25 (9.8%) were malignant and 230 (90.2%) were benign. Of 195 lesions in average-risk women, the malignancy rate of lesions with soft elastography was 1.5% (1/68), which was significantly lower than the 14.2% (18/127) of lesions with not soft elastography ( P = 0.004). Of 60 lesions in increased-risk women, the malignancy rate of lesions with soft elastography was 15.0% (3/20), which was not significantly different from the 7.5% (3/40) of lesions with not soft elastography ( P = 0.390). In average-risk women, category 4a lesions with soft elastography could be followed up with US because of a low malignancy rate of 1.5%.

Abstract IS-3: Breast Imaging in Resource Constrained Regions: Lessons from Uganda

Abstract Breast cancer is the leading cause of cancer death in women and the most common cancer among women world-wide. Five-year survival rates in patients with breast cancer in the United States, Australia and Canada approach 90%, while in parts of Africa survival rates are less than 15%. In October 2013 the international New York Times front page reported on “Uganda's Neglected Epidemic of Breast Cancer.” In December 2013 the WHO International Agency for Research on Cancer (IARC) issued an update on the world's cancer statistics with the headline including the alarm that “marked increase in breast cancers must be addressed.” In Uganda, resources for surgical intervention (mastectomy) and medical oncology (hormonal therapy and limited chemotherapy) are available. Strong recent efforts by the National Cancer Institute, American Cancer Society, and global partners will increase the availability of affordable chemotherapy. In parallel, there is a growing community of breast cancer survivors in Uganda who are sharing their stories and emphasizing the importance of early detection and prompt treatment. Women with palpable breast lumps, identified by themselves or their healthcare providers, are encouraged to seek treatment. But with so many women having palpable breast lumps, and no efficient way to sort the majority of lumps that are benign from the minority of lumps that are malignant, systems are overwhelmed. Clinics do not have the capacity to detect the cancers amongst all the women who present with palpable lumps, and breast cancers remain undiagnosed and untreated, and mortality rates continue to rise. The delays in diagnosis can be significantly reduced with ultrasound (US) technology placed in the hands of non-physician healthcare providers, to streamline the diagnostic process and separate women with lumps that have features warranting biopsy from lumps that can be safely followed clinically in the patient's local, healthcare clinic. Mammography has little added value in countries with limited resources. With so many women who have clear symptoms of breast cancer, and with a significantly higher pre-test probability of cancer in women with (rather than without) symptoms, interventions targeted to asymptomatic women are neither logical nor feasible. The need is not to screen for breast cancers in asymptomatic women but rather to detect the breast cancers in women with symptoms, most notably palpable lumps. Innovative, effective, affordable strategies that emphasize prompt and accurate diagnostic methods in women with palpable breast lumps are needed to improve breast cancer survival in LMICs. These programs can be based on inexpensive, portable ultrasound machines that support triage of patients with palpable lumps to those that need biopsy and those that don't. These technologies are already being used by local health care personnel in developing countries for other prenatal and urgent care purposes. Going forward, novel ultrasound techniques for automated sonogram acquisition and machine learning and deep learning methods can combine to extend the impact of ultrasound imaging in breast cancer diagnosis by reducing the need for highly specialized breast imagers in both acquisition and interpretation. Citation Format: Lehman CD. Breast Imaging in Resource Constrained Regions: Lessons from Uganda [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr IS-3.

Screening for Ovarian Cancer in Asymptomatic Women

Screening for Ovarian Cancer in Asymptomatic Women

The Value of Quality-Assured Magnetic Resonance Imaging of the Breast for the Early Detection of Breast Cancer in Asymptomatic Women.

The aim of this study was to evaluate the exclusive performance of quality-assured high-resolution breast magnetic resonance imaging (MRI) for early detection of breast cancer in a population of asymptomatic women. A total of 1189 MRI examinations performed in 789 asymptomatic women (mean age, 51.1 years) were evaluated. All examinations were performed using open bilateral surface coil, dedicated compression device, and high spatial resolution (matrix, 512 × 512). Digital mammography was available for all participants. Assessment included density types, artifact level, and Breast Imaging Reporting and Data System classification. Evaluation was performed by 2 readers. In addition, a computer-assisted diagnosis (CAD) system was used for image assessment. Breast MRI showed density types I and II in 87.6% and artifacts categories III and IV in 3.1%. Study included 32 carcinomas (8 ductal carcinoma in situ, 24 invasive tumors). Both readers detected 29 of 32 correctly (sensitivity 90.6%). The variation between the readers was low (reader 1: specificity, 94.4% and positive predictive value (PPV), 25.7%; reader 2: specificity, 97.6% and PPV, 34.1%). Sensitivity of CAD was 62.5% (specificity, 84.4%; PPV, 5.2%). Digital mammography detected 13 of 32 carcinomas (sensitivity, 56.3%; specificity, 98.4%; PPV, 32.1%). The exclusive use of quality-assured breast MRI allows the early detection of breast cancer with a high sensitivity and specificity. The CAD analysis of MRI does not give additional information but shows results comparable with digital mammography.

English

Breast cancer is the leading cause of cancer mortality worldwide. Breast cancer incidence is increasing both in developed and developing regions. Regular breast self-examination (BSE) is one of the most cost effective methods for early detection of breast cancer in asymptomatic women. The aim of this study is to assess the magnitude of BSE practice and its associated factors among female health professionals working in public health facilities in Western Ethiopia. The study applied is health facility based cross-sectional study design. Simple random sampling technique was used to recruit a total of 390 female health professionals. The study was conducted from January to March, 2015. Bivariate and multivariable logistic regression model was used, odds ratios with 95% confidence intervals were computed and significance of all tests was decided at p-value of 0.05. From the total respondents, 77% had ever practiced BSE and only one third (33.7%) of them practiced regularly. Not experiencing breast problem (12.7%) was the main reason for not practicing regular BSE. After adjusting for possible confounders; personal history of breast cancer (AOR=4.7, 95%CI: 1.32-17.07), having knowledge of BSE (AOR=4.1, 95%CI: 1.36-5.65), positive attitude (AOR, 3.8, 95%CI: 2.10-9.17) and ever taught BSE to a client (AOR=5.2, 95%CI: 2.35-8.14) were found to be statistically significant predictors of BSE. Even though the life time BSE practice in this study was high, the regular BSE practice was low. Thus, trainings on BSE practice will be important to improve the practice level of health professionals and their counseling skill for the clients.&nbsp; &nbsp;&nbsp; &nbsp; Key words: Breast self-examination, health professionals, practice, females.