Cancer Screening In Women Research Articles

Risk-adapted starting age of breast cancer screening in women with a family history of ovarian or other cancers: A nationwide cohort study.

There is a lack of evidence-based recommendations for the age at which women with a family history of cancers other than breast cancer should start breast cancer screening. Using Swedish family cancer data sets, the authors conducted a nationwide cohort study including 5,099,172 Swedish women born after 1931 (follow-up, 1958-2015). Accounting for calendar time, they calculated the relative risk of breast cancer for women with a family history of a discordant cancer in 1 first-degree relative. Furthermore, the authors used 10-year cumulative risk to determine the ages at which women with a family history of discordant cancer reached risk thresholds at which women in the general population were recommended to start breast cancer screening. A family history of cancer at 15 sites was associated with an increased risk of breast cancer. Among women younger than 50 years, the highest risk of breast cancer was observed for those with a family history of ovarian cancer (standardized incidence ratio, 1.44; 95% confidence interval, 1.26-1.64). In these women, the risk of breast cancer associated with a family history at other cancer sites ranged from 1.08-fold for prostate cancer to 1.18-fold for liver cancer. When breast cancer screening was recommended to be started at the age of 50 years for the general population, women with 1 first-degree relative with ovarian cancer attained the threshold risk for screening at the age of 46 years. Women with a family history of other discordant cancers did not reach the risk thresholds for screening at younger ages. Many cancers showed familial associations with breast cancer, but women with a family history of these cancers (except for ovarian cancer) did not reach risk thresholds for screening at younger ages.

Husband's role and relationship with cervical cancer screening for women 30-50 years old in Thanh Binh district, Dong Thap province, 2020

Objective: Describe cervical cancer screening practice for married women aged 30-50 years and the relationship between husband support and wife screening. Research method: Cross-section design with 255 couples living in Thanh Binh district, Dong Thap province from March to July 2020. Results: The proportion of women who had cervical cancer screening was 24.2%. Married women who do not regularly help their wives with housework, spend money on their wives to see health checks and encourage their wives to get screened have a 1.37, 1.31 and 1.35 times higher rate of non-screening. (p <0.05) compared with women with regular supportive husbands. Conclusion: Cervical cancer screening practices are low. The husband's support is related to the wife's cervical cancer screening. The role of the husband should continue to research to provide information for the cervical cancer screening program to be implemented more effectively. Key words: Cervical cancer, screening for cervical / cervical cancer, husband's role.

Experiences, expectations and preferences regarding MRI and mammography as breast cancer screening tools in women at familial risk

BackgroundSeveral studies have investigated MRI breast cancer screening in women at increased risk, but little is known about their preferences. In this study, experiences, expectations and preferences for MRI and mammography were evaluated among women undergoing screening with MRI and/or mammography in the randomized FaMRIsc trial. MethodsA 17-item questionnaire was sent to 412 women in the FaMRIsc trial. Participants were aged 30–55 years, had a ≥20% cumulative lifetime risk, but no BRCA1/2 or TP53 gene variant, and were screened outside the population-based screening program. Women received annual mammography (mammography-group), or annual MRI and biennial mammography (MRI-group). We asked whether women trust the screening outcome, what they consider as (dis)advantages, which screening they prefer and what they expect of the early detection by the screening tools. Results255 (62%) women completed our questionnaire. The high chance of early cancer detection was the most important advantage of MRI screening (MRI-group: 95%; mammography-group: 74%), while this was also the main advantage of mammography (MRI-group: 57%; mammography-group: 72%). Most important disadvantages of MRI were the small tunnel and the contrast fluid (for 23–36%), and of mammography were its painfulness and X-radiation (for 48–60%). Almost the whole MRI-group and half the mammography-group preferred screening with MRI (either alone or with mammography). DiscussionMost women would prefer screening with MRI. The way women think of MRI and mammography is influenced by the screening strategy they are undergoing. Our outcomes can be used for creating information brochures when MRI will be implemented for more women.

Addition of Screening Breast US to Digital Mammography and Digital Breast Tomosynthesis for Breast Cancer Screening in Women at Average Risk

Background Digital breast tomosynthesis (DBT) with or without digital mammography (DM) is the primary method of breast cancer screening. However, the sufficiency of DBT screening for women at average risk and the need for supplemental whole-breast US needs further investigation. Purpose To evaluate the added value of supplemental US screening following combined DM/DBT. Materials and Methods A retrospective database search identified consecutive asymptomatic women who underwent DM/DBT and radiologist-performed screening breast US simultaneously between March 2016 and December 2018. The cancer detection rate (CDR) per 1000 screening examinations, sensitivity, specificity, and abnormal interpretation rate of DM/DBT and DM/DBT combined with US were compared. Results A total of 1003 women (mean age, 56 years ± 8.6 [standard deviation]) were included. Among them, 12 cancers (mean invasive tumor size, 14 mm; range, 6-33 mm) were diagnosed. With DM/DBT and DM/DBT combined with US, the CDRs were 9.0 per 1000 screening examinations (nine of 1003 women; 95% CI: 4.1, 17) and 12 per 1000 screening examinations (12 of 1003 women; 95% CI: 6.2, 21), respectively, and the abnormal interpretation rates were 7.8% (78 of 1003 women; 95% CI: 6.2, 9.6) and 24% (243 of 1003 women; 95% CI: 22, 27). In women with negative findings at DM/DBT, supplementary US yielded a CDR of 3.2 per 1000 examinations (three of 925 women; 95% CI: 0.7, 9.4), sensitivity of 100% (three of three women; 95% CI: 29, 100), specificity of 82% (760 of 922 women; 95% CI: 80, 85), and abnormal interpretation rate of 18% (165 of 925 women; 95% CI: 15, 21). The three additional US-detected cancers were identified in women with dense breasts; no benefit was observed in women with nondense breasts. Conclusion The addition of breast US to digital mammography and digital breast tomosynthesis yielded an additional 0.7-9.4 cancers per 1000 women at average risk, with a substantial increase in the abnormal interpretation rate. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Rahbar in this issue.

Rastreamento do câncer de colo do útero durante o acompanhamento pré-natal

Objetivo: Avaliar o rastreamento do câncer do colo do útero em mulheres no período de acompanhamento pré-natal. Método: Revisão integrativa de literatura realizada em março de 2020, nas bases de dados LILACS, Web of Science, Scopus e MEDLINE. Para a seleção dos estudos foram utilizados os Descritores em Ciências da Saúde, seus respectivos sinônimos e os Medical Subject Headings correspondentes. Resultados: Os achados fortalecem as atuais recomendações sobre a realização do exame citopatológico (CP), inclusive durante o acompanhamento pré-natal, visto que a situação gravídica não impede a ocorrência e desenvolvimento de neoplasias cervicais. Conclusão: Existem lacunas no rastreio em gestantes. Os artigos incluídos neste estudo permitiram alavancar a importância do rastreio de câncer cervical em gestantes e subsidiar a atuação de profissionais à realização da prática nesse período.

No Evidence of Increased Risk of Breast Cancer in Women With Lynch Syndrome Identified by Multigene Panel Testing.

Prior estimates of breast cancer risk in women with Lynch syndrome (LS) range from population risk to 18-fold increased risk with reported differences by gene. Here, breast cancer rates were determined in a large cohort of women with pathogenic variants (PVs) in a mismatch repair (MMR) gene detected through multigene panel testing and compared with rates in the US population and women undergoing panel testing. MMR gene PV carriers were identified among women tested for suspicion of LS or hereditary breast and ovarian cancer (HBOC) who met inclusion criteria. Standardized incidence ratios (SIRs) and 95% CIs of breast cancer were calculated compared with age-matched incidence in the general US female population and with women negative for PVs stratified by the test indication. In total, 0.8% of women (30,362 of 441,966 women) carried MMR gene PVs. PVs in PMS2 (37.5%) and MSH6 (29.3%) were more common than in MLH1 (13.7%) and MSH2/EPCAM (19.4%). Women with PVs in PMS2 and MSH6 were tested more frequently for HBOC, whereas those with PVs in MLH1 and MSH2/EPCAM were tested more frequently for LS. Breast cancer rates in women with LS were lower than those in the general female population (SIR, 0.88; 95% CI, 0.81 to 0.96) and did not differ compared with women with negative panel testing for HBOC (SIR, 0.90; 95% CI, 0.82 to 0.99) or LS (SIR, 1.02; 95% CI, 0.78 to 1.30). In this large cohort of women with LS identified through panel testing, there was no evidence for increased risk of breast cancer compared with the general US population or women undergoing panel testing. These findings support average-risk breast cancer screening in women with LS.

Is cervical cytology testing as a part of co-test unnecessary for HPV 16/18-infected women? A retrospective cohort study of 1647 women.

We aimed to present the biopsy results of women with HPV 16/18 infection and investigate whether cytology is necessary as a part of routine cervical cancer screening in women with HPV 16/18. This is a retrospective cohort study conducted on 1647 patients between the ages of 30 and 65 years with HPV 16/18 undergoing colposcopy-guided biopsy at a tertiary gynecological cancer center between January-2016 and January-2019. We compared the preinvasive lesion rates and the invasive cervical cancer rates of women with HPV 16/18 between the negative and the abnormal cytology group. Of the 1647 women, 1105 (67.1%) had negative cytology and 542 (32.9%) had abnormal cytology. Among women with initial negative cytology, cervical intraepithelial neoplasia (CIN) 2+ lesion was detected in 205 (18.6%) women. The rate of CIN 2+ lesion in women with abnormal cytology was 28%. There was a significant difference between negative and abnormal cytology group in terms of CIN 2+ lesion rates (P < .001). Among women with initial negative cytology, invasive cervical cancer was detected in 6 (0.5%) women. The rate of invasive cervical cancer in women with abnormal cytology was 8 (1.5%). There was no significant difference between negative and abnormal cytology group in terms of invasive cervical cancer rates (P = .082). The rate of cervical cancer among HPV 16/18-infected women with negative cytology is similar to women with abnormal cytology. Based on the results of this study, Pap testing could be unnecessary in HPV 16/18-infected women to diagnose invasive cervical cancer who will undergo colposcopy biopsy.

Knowledge and Attitude Regarding Cervical Cancer Screening in Women attending Obstetrics and Gynaecological Opd at Birat Medical College Teaching Hospital

Introduction: Cervical cancer is the most common Gynaecological cancer in Nepal which is preventable if appropriate screening and prevention measures are employed. Considerable reduction in cervical cancer incidence and cervical cancer related deaths can be achieved by effective screening. However, lack of knowledge and awareness can result in underutilization of the preventive measures. &#x0D; Objectives: The objective of this study was to assess the knowledge and attitude regarding cervical cancer screening in women visiting Obstetrics and Gynaecology OPD at tertiary care Hospital in Eastern Nepal. &#x0D; Methodology: A cross-sectional questionnaire-based study was conducted in Obstetrics and Gynaecology outpatient department of Birat Medical College Teaching Hospital from 1 January 2019 to 31 December 2019. Women were enrolled in the study by convenient sampling methods. Structured questionnaire was used to collect the data. The collected data was entered in Microsoft excel and analyzed by using SPSS version 22. &#x0D; Results: Among 374 participants, the mean age was 31.13 years. More than three fourth (89.6%) of participants were literate. Regarding occupation, 89.8% of participants were housewives, and 82.9 % of participants were married. As per the findings, only 43.27 % of participants i.e. less than the mean, had adequate knowledge of cervical cancer and its screening. 65.50 % of participants had a negative attitude towards cervical cancer screening. Literate participants had good knowledge and positive attitude regarding cervical cancer screening than illiterate participants (P value less than 0.05). &#x0D; Conclusion Considerable proportions of participants had inadequate knowledge and negative attitude regarding cervical cancer screening in Gynaecological patients visiting tertiary care Hospital in Eastern Nepal.

Breast cancer screening in women at high risk of hereditary breast cancer: an Australian experience.

While population-based breast screening is a well-documented health strategy worldwide, very few centres offer breast-screening programmes specifically targeted at women at high risk of hereditary breast cancer. We present our experience with multimodality breast screening in a high-risk population. The outcomes from a familial breast cancer clinic at the North Brisbane BreastScreen Queensland Service providing a multimodality screening programme for high-risk women were reviewed from the prospectively maintained database between 2011 and 2018. Over the 8 years of study period, a total of 6686 annual screening rounds were performed for 823 asymptomatic women at high risk of hereditary breast cancer. As a result, 40 cancers were diagnosed including 25 invasive ductal cancers, three invasive lobular cancers, two invasive cancers with mixed ductal and lobular features and 10 ductal carcinomas in situ. Ultrasound and mammography detected 72.5% (29/40) and 55% (22/40) of the cancers, respectively. A total of 3672 magnetic resonance imaging studies were performed. Ten (25%) cancers were initially only seen on magnetic resonance imaging including seven invasive ductal cancers, one invasive lobular cancer and two high-grade ductal carcinomas in situ. The cancer detection rate for first-round screening was 13.3 cancers per 1000 women screened, with 4.9 cancers per 1000 women detected on subsequent-round screening. One interval cancer occurred in the study period. Multimodality breast screening of younger women at high risk of hereditary breast cancer is effective with the yield substantially exceeding the results from established breast screening programmes in older women. Co-location of this service within BreastScreen Australia efficiently shares resources.

Breast cancer screening for women at high risk: review of current guidelines from leading specialty societies.

The purpose of this article is to overview the existing breast cancer screening guidelines for women at high risk from world-leading specialty societies. Accumulation of evidence and development of accessible genetic testing strategies have changed the idea of breast cancer screening for high-risk women. Personalized tailor-made screening adjusted for risk factors has been conducted in accordance with guidelines. The use of imaging modalities other than mammography including contrast-enhanced MRI and other various strategies for improving screening are discussed. The present review also mentions the existing challenges in high-risk screening and the latest information based on two large-scale studies.

A Systematic Review of Intervention on Improving Cervical Cancer Screening Rates

Cervical cancer is a disease that can be prevented through early detection. However, cervical cancer is the fourth leading cause of death for women globally due to the low coverage of cervical cancer screening. An intervention is needed to increase the coverage of cervical cancer screening. This study aimed to provide current evidence of effective interventions to improve cervical cancer screening coverage, especially with low socio-economic conditions. This study uses a systematic design review to review the literature that has been evaluated in a structured, classified, and categorized based on evidence-based previously. The study's inclusion characteristics are as follows: all article searches are limited to those in English or Indonesian only, and scan bibliography to identify relevant articles, method design is RCT studies, or quasi-experiments. The study results found the characteristics of the article as follows: the majority of studies were conducted in the Americas, two studies in Asia, and one in Europe. The respondents' age varied from&gt; 18 years to 75 years; the number of samples ranged from 102 to 12,061 respondents. Interventions were grouped into three types, namely: health education, self-testing, and reminders of the screening schedule. Among the three types of interventions most recommended is counseling with video media, because providing information with exciting media will increase knowledge which will increase women's interest in screening. Independent screening interventions can also increase the coverage of cervical cancer screening in women with low socio-economic conditions because this method allows more savings in funding

An RCT to Increase Breast and Colorectal Cancer Screening

Adherence to breast and colorectal cancer screenings reduce mortality from these cancers, yet screening rates remain suboptimal. This 2 × 2 RCT compared 3 theory-based interventions to usual care to simultaneously increase breast and colon cancer screening in women who were nonadherent to both screenings at study entry. RCT. Women (n=692) who were nonadherent to both breast and colon cancer screenings and aged 51-75 years were recruited. Enrollment, intervention delivery, and data collection were completed between 2013 and 2017, and data analyzed in 2018. The randomized intervention included the following 4 groups: 3 intervention arms (personally tailored messages using a web-based intervention, phone delivery by a trained navigator, or both) compared with usual care. Women at an average risk for colon cancer were allowed to select either colonoscopy or stool test as their preferred colon cancer screening. Mammography was promoted for breast cancer screening. Outcome data at 6 months included self-report and medical records for screening activity. All intervention arms significantly increased receipt of either a mammogram or stool test compared with control (web: p<0.0249, phone: p<0.0001, web + phone: p<0.0001). When considering receipt of both mammogram and stool test, all intervention arms were significantly different from usual care (web: p<0.0249, phone: p<0.0003, web + phone: p<0.0001). In addition, women who were adherent to mammography had a 4.5 times greater odds of becoming adherent to colonoscopy. The tailored intervention simultaneously supporting both breast and colon cancer screenings significantly improved rates of obtaining one of the screenings and increased receipt of both tests. This study is registered with the clinical trials identifier NCT03279198 at www.clinicaltrials.gov.

Beyond Resettlement: Sociocultural Factors Influencing Breast and Colorectal Cancer Screening Among Afghan Refugee Women.

Immigrants and refugees have an increased risk for developing chronic health conditions, such as breast and colorectal cancer, the longer they reside in the USA. Moreover, refugees are less even likely to use preventive health services like mammography and colonoscopy screening when compared with US-born counterparts. Focused ethnography was employed to examine sociocultural factors that influenced cancer screening behaviors among aging Afghan refugee women. We conducted 19 semi-structured interviews with Afghan women 50 and older and their family member/caregivers. Interview transcripts were inductively coded using Atlas.ti, where focused codes were sorted and reduced into categories, and we extracted meaning around groups of categories. Findings of this study revealed factors like fear of cancer, pre-migration experiences, family involvement, provider recommendation, and provider gender concordance influenced women's cancer screening behaviors. This study also found that women who have had a recent mammogram or colonoscopy described empowerment factors that helped them withstand the stressful process of screening, through encouragement and reminders from providers, support from adult family members, and finding strength through duaas (prayers). As refugee women continue to age in the USA, clinicians should incorporate multi-level strategies, including family-centered and faith-based approaches to promote preventive screening behaviors in this population.

The Connection Between Social Determinants of Health and Human Papillomavirus Testing Knowledge Among Women in the USA.

Human papillomavirus (HPV) causes 99% of cervical cancers. In the USA, HPV testing has recently been recommended as a stand-alone option for cervical cancer screening in women over 30years of age. Yet, studies have shown low awareness of HPV testing. This study examines awareness and knowledge that US women possess regarding HPV testing using the social determinants of health (SDOH) framework. Women aged 30 to 65years, without hysterectomy, completed an online survey (N = 812). The outcome variables included HPV testing awareness and HPV testing knowledge, a six-item validated scale. Predictor variables included three domains of the Healthy People 2020 SDOH framework: economic stability, education, and health and healthcare. Other important sociodemographic predictors were also included. Multiple logistic and linear regression identified variables associated with HPV testing awareness and knowledge, respectively. 62.4% of the women were aware of HPV testing, and the mean knowledge score was 2.8 (out of 6). Lower awareness and knowledge were observed in older women compared with younger women and among women who had either not received HPV vaccination or were unsure of their vaccination status. Higher education attainment was associated with greater awareness and knowledge. Also, women who had a well-woman visit in the last year had better knowledge. Findings from the study can be used to develop targeted prevention strategies and initiatives to improve HPV testing awareness and knowledge to help women make more informed health decisions and promote uptake of this screening tool.

Impact of cervicitis on performance of cervical cancer screening using HRHPV testing and visual evaluation in women living with HIV in Botswana.

HIV co-infection and poor access to primary and secondary prevention mean cervical cancer mortality is highest in low- and middle-income countries (LMIC). In 2018, the World Health Organization (WHO) made a call to action for the elimination of cervical cancer. Achievement of this relies on scale-up of effective screening for pre-invasive disease. WHO recommends screening algorithms using primary high-risk human papilloma virus (hrHPV) testing followed by visual inspection with acetic acid (VIA) or colposcopy. There is concern that the accuracy of visual assessment may be affected by cervicitis.

Abstract C126: Challenges implementing anal cancer screening for women living with HIV: Clinical providers and staff perspectives

Abstract Purpose: The HIV Medicine Association recommends anal Pap tests for women living with HIV (WLWH) with a history of abnormal cervical Pap tests, ano-receptive intercourse, or genital warts. This study describes current anal cancer screening practices and provider- and staff-identified challenges conducting anal cancer screening for WLWH in an integrated safety-net healthcare institution and community healthcare organization serving underinsured patients in a metropolitan city in Texas. Findings inform our understanding of factors that need to be addressed prior to implementation of system-level anal cancer screening policies and protocols for WLWH, a population at increased risk for anal cancer due to persistent HPV infection. Methods: We purposefully sampled providers, clinical staff, and administrative staff to participate in in-person semi-structured interviews assessing participant experiences with anal cancer screening, documentation, and follow up, and attitudes toward future anal cancer screening among WLWH. Audio-recorded interviews and field notes were transcribed and thematically analyzed using an iterative deductive and inductive coding scheme. Results: We completed interviews with 25 individuals: providers (n=11: 7 safety-net, 4 community), clinical staff (n=10: 8 safety-net, 2 community), and administrative staff (n=4: safety-net). Current practices. No system-level policies or protocols for anal cancer screening existed within the safety-net institution or community organization for WLWH. Instead, HIV providers performed anal Pap tests ad hoc, most frequently as diagnostic evaluations based on visual inspections or patient-reported symptoms. To follow up on abnormal test results, providers referred patients to Proctology Clinic, where wait for an appointment was about one year. Challenges. Without anal cancer screening policies or protocols, clinical teams were unclear on whether the HIV team or gynecology specialty team should lead screening efforts. Electronic health records only recorded cervical Pap test results in the “Pap” field, leaving providers to record anal Pap results in a notes section. This limited the ability to produce systematic reports or track screening. Finally, providers and staff expressed reluctance to conduct systematic anal cancer screening until greater infrastructure existed to manage referrals for abnormal anal Pap test results. Conclusions: Anal cancer screening and follow-up for WLWH require organization and coordination between multiple care teams, and protocols should clarify clinical pathways and responsibilities as patients transition between HIV, gynecology, and proctology teams. Further, clinical information systems must be updated to facilitate teams’ communication and to support anal Pap test ordering and documentation. Finally, downstream infrastructure to support follow-up must accompany upstream implementation of an anal cancer screening policy. Citation Format: Serena A Rodriguez, Robin T Higashi, Andrea B Betts, Cynthia Ortiz, Jasmin A Tiro, Amneris Luque, Arti Barnes. Challenges implementing anal cancer screening for women living with HIV: Clinical providers and staff perspectives [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C126.

Urinary HPV DNA testing as a tool for cervical cancer screening in women who are reluctant to have a Pap smear in France

In France, cervical cancer screening is based on human papillomavirus (HPV) testing on cervical samples (women aged 30-65) and cytological examination of Pap smears (25-29), but screening coverage is unsatisfactory. The CapU3 study aimed to propose urinary HPV testing on 13,535 women aged 35 to 65 who had not had a Pap smear since 2010. High-risk HPV (HR-HPV) detection was performed using a real-time PCR (Anyplex II HPV 28 Detection, Seegene®). Women with HR-HPV positive results were encouraged to have a cervical smear as soon as possible to detect the presence of cervical lesions. The participation rate was 15.4%. Out of the 1,915 analyzed specimens, 1,711 and 190 were negative and positive, respectively, for at least 1 HR-HPV genotype. HR-HPV genotypes other than HPV-16 or HPV-18 were mostly detected as HPV-53 (23.7%) and HPV-68 (14.2%). A satisfactory gynecological follow-up was observed for HPV-positive women (92.1%). 23 abnormal smears were observed and eight high-grade cytological lesions after colposcopy and biopsy were diagnosed. As home HPV urinary testing is non-invasive and does not require medical attention, this method may be an alternative for women who are reluctant to have a Pap smear and thus extend screening coverage.

Racial/ethnic differences in supplemental imaging for breast cancer screening in women with dense breasts.

Mammography is limited when analyzing dense breasts for 2 reasons: (1) breast density masks underlying cancers and (2) breast density is an independent risk factor for cancer. We undertook this study to assess whether there is a racial/ethnic difference in supplemental image ordering for women with dense breasts. We conducted a retrospective, observational cohort study of women aged 50-75 from an academic medical center who had completed a screening mammogram between 2014 and 2016 that was read as BI-RADS 1 with heterogeneously or extremely dense breasts or BI-RADS 2 with extremely dense breasts. Data were abstracted on type, timing and frequency of supplemental imaging tests ordered within two years of an initial screening mammogram. Patient characteristics (age, race/ethnicity, insurance, and comorbidities) were also abstracted. We used bivariate and multivariate logistic regression to assess for differences in supplemental imaging ordered by race/ethnicity. Three hundred twenty-six women met inclusion criteria. Mean age was 58years: 25% were non-Hispanic white, 30% were non-Hispanic black, 27% were Hispanic, 6% were Asian and 14% unknown. Seventy-nine (24%) women were ordered a supplemental breast ultrasound after the initial screening mammogram. Non-Hispanic black and Hispanic women were less likely to have supplemental imaging ordered compared to non-Hispanic white women (15% and 10%, respectively, vs. 45%, p < 0.0001). After controlling for patient age, ordering physician specialty, insurance, BI-RADS score, breast density, and family history of breast cancer, non-Hispanic black and Hispanic women remained less likely to be ordered supplemental imaging (OR 0.38 [95% CI 0.17-0.85] and OR 0.24 [95% CI 0.10-0.61], respectively, p < 0.0001). Minority women with dense breasts are less likely to be ordered supplemental breast imaging. Further research should investigate physician and patient behaviors to determine barriers in supplemental imaging. Understanding these differences may help reduce disparities in breast cancer care and mortality.

PIH79 PATTERNS OF CERVICAL CANCER IN WOMEN OVER 65: RATIONALE FOR EXTENSION OF SCREENING AGE

Evaluate the burden of cervical cancer in women 65 and over and screening patterns leading to and after age 65. Burden of cervical cancer in women 65 and over and screening patterns in the US was evaluated using data published by the NIH’s Surveillance, Epidemiology, and End Results (SEER) program and IBM® MarketScan® Claims-Electronic Health Records (EHR) Databases, which includes administrative medical and pharmacy claims data and clinical and laboratory information found in electronic health records. The look back period to evaluate screening patterns were 10 years before cervical cancer diagnosis from 2000 to 2017. According to the SEER, approximately 1 in 5 newly diagnosed cervical cancers are found in women 65 and older. Among women aged 30 to 59 years, 59.3% of commercially insured and 31.4% of Medicaid insured women received two or more Pap tests. In IBM claims-EHR databases, 1,054 women 65 and older were newly diagnosed with cervical cancer. Of these, 70% were insured for an average of 5.9 years before their cancer diagnosis. 61% of the women had evidence of prior screening, 44% had ≥1 screening in the past 5 years and 33% had ≥1 screening in the past 3 years. Among one-third (39%) who did not have a prior screening, 83% had ≥1 physician visit in the year before their cancer diagnosis. Approximately 20% of newly diagnosed cervical cancer cases are found in women 65 and older. Patterns of cervical cancer screening in women 50 to 65 is suboptimal thus failing to identify precancerous lesions. Only two-third of newly diagnosed women had a prior screening while among the remaining one-third without prior screening, 85% had ≥1 encounter with a healthcare provider prior to cancer diagnosis. Underscreening before age 65 highlights the need for increased surveillance in past 65 years of age.

Preferences and Attitudes Regarding Adjunct Breast Cancer Screening Among Patients with Dense Breasts.

New breast screening modalities are being investigated to address the need for more sensitive breast cancer screening in women with dense breasts. We investigated the preferences and attitudes of these patients regarding adjunct screening modalities to help evaluate the acceptability of these exams. In this institutional review board-approved prospective study, patients with dense breasts on their prior mammogram were invited to complete a survey. Patients were asked to estimate their personal breast cancer risk compared with peers, indicate their level of concern related to screening callbacks, radiation exposure, and intravenous (IV) contrast allergies, and identify which factors might deter them from getting adjunct screening exams. Five hundred eight patients with dense breasts presenting for screening mammography completed surveys. While most patients (304/508, 59.9%) felt it was likely or very likely that cancer could be missed on their mammogram, only 8.9% (45/508) had undergone adjunct screening exams in the past 3 years. The most commonly cited deterrents to adjunct screening were cost (340/508, 66.9%), pain (173/508, 34.1%), and concern that adjunct screening could lead to additional procedures (158/508, 31.1%). When asked to select among three hypothetical breast cancer screening modalities, patients strongly preferred the more sensitive examination, even if this involved greater cost (162/508, 31.9%) or IV-contrast administration (315/508, 62.0%). Our data suggest that patients with dense breasts prefer adjunct screening exams that are both sensitive and inexpensive, although an increase in sensitivity could outweigh additional cost or even IV-line placement.