Care For Breast Cancer Screening Research Articles

Impact of breast density on classification of infrared spectroscopy for breath-based breast cancer screening.

e13558 Background: While mammography is currently the standard of care for breast cancer screening, dense breast tissue can significantly degrade results. Alternatively, infrared spectroscopy analysis of breath offers a highly sensitive method for identifying exhaled volatile organic compounds (VOCs), which may circumvent issues with breast density. Methods: Alveolar breath samples were collected onto Tenax TA sorbent tubes using a SohnoXB™ breath sampler. Using four desorb temperatures (75, 150, 225 and 300°C), absorption spectra were measured by infrared cavity ring-down spectroscopy (IR-CRDS), a technique for measuring absorption coefficients due to VOCs in exhaled breath. Missing values in the absorption spectra were backfilled using interpolation, and the spectrum was min-max normalized and quadratic detrended. First and second derivatives of the preprocessed absorption spectra were used as features for a support vector machine machine-learning model. Features were ranked based on minimum redundancy maximum relevance (mRMR). The top 20 ranked features were selected to limit the potential for overfitting and then optimized. Model performance was validated using non-nested leave-one-out cross-validation (LOOCV) and nested LOOCV to provide optimistic and pessimistic results, respectively. Results: Absorption spectra from 111 participants (71 positive, 40 control) were used. Of the positive subjects, 30 had low- and 31 had high-density breast tissue (measures missing for 10). Model performance is outlined. A subgroup analysis compared model performance for subjects with low- and high-density breast tissue for both non-nested and nested LOOCV models. Breast density data was not captured for control subjects thus they were not included in the subgroup analysis. Fisher’s exact test was performed to assess for significant difference between model performance for those with low- vs high-density breast tissue, resulting in a p-value of 1.00. Conclusions: Our results suggest that the classification of alveolar breath using IR-CRDS is a promising technique for the detection of breast cancer that is independent of breast density. Breath analysis may therefore become a new alternative or corroborative to mammography to support clinical decision-making. [Table: see text]

Abstract P2-05-03: Perceived Guideline Clarity & Deferral to Patient Preferences impact guideline concordant care for breast cancer screening in women age 40-49

Abstract Background: Canadian and US Task Forces recommend against routine mammography screening for women age 40-49 at average breast cancer risk on the basis that harms outweigh the benefits. Both cite the importance of supporting women’s individualized decisions based on the relative value placed on potential benefits and harms of screening (2, 4). Population-based data reveal that screening rates in this age group are influenced by the woman’s primary care provider (PCP), suggesting some providers refer more often than others. This highlights the need to explore PCP perspectives on screening and how this informs clinical behaviour. Methods: Qualitative semi-structured interviews were performed by phone with PCPs in Ontario, Canada. Interviews were structured using the Theoretical Domains Framework (TDF) to explore determinants (barriers/facilitators) of three screening-related behaviours: 1) conducting a risk assessment; 2) discussion regarding benefits and harms; and 3) making a decision regarding referral for mammographic screening. Analysis: Interviews were transcribed and analyzed iteratively until saturation was reached. Two independent researchers coded all transcripts deductively both by behaviour and according to TDF domain. Findings that did not fit within a TDF code were coded inductively. Data were then grouped by screening behaviour and the associated codes were used to generate descriptive narratives of the determinants influencing PCP behaviour. Results: Eighteen physicians (mean age 48, 72% identified female) were interviewed. Table 1 outlines the determinants of the three screening behaviours. Analysis of inductive codes revealed two key contextual themes that influenced behaviours and moderated TDF codes: perceived guideline clarity (a lack of clarity on which behaviours (if any) were guideline-concordant) and deferral to patient preference (patient decision regarding screening without a complete discussion of benefits and harms). PCPs who perceived that the guidelines stated definitively that screening was not recommended had improved knowledge of harms and stronger beliefs about capabilities to educate patients about why screening was not recommended routinely. Deferral to patient preference seemed to occur when PCP’s knowledge was low and/or if they were impacted by experience of a younger woman diagnosed with breast cancer, which often led to anticipated regret (TDF domain: emotion). Discussion/Conclusion: Low knowledge related to formal breast cancer risk assessment, combined with a tendency to over-estimate benefits of screening relative to harms could explain some inappropriate variation in practice. All 3 PCP screening behaviours appeared to be affected by both perceived guideline clarity and deferral to patient preferences. These may all be effective targets for future interventions to address variation in care. Table 1: Unique Barriers and Facilitators of Three Screening Behaviours Citation Format: Michelle Nadler, Ann Marie Corrado, Brooke E. Wilson, Alexandra Desnoyers, Eitan Amir, Noah Ivers, Laura Desveaux. Perceived Guideline Clarity & Deferral to Patient Preferences impact guideline concordant care for breast cancer screening in women age 40-49 [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 P2-05-03.

Perceived guideline clarity impacts guideline-concordant care for breast cancer screening in women age 40–49

BackgroundCanadian and US Task Forces recommend against routine mammography screening for women age 40–49 at average breast cancer risk as harms outweigh benefits. Both suggest individualized decisions based on the relative value women place on potential screening benefits and harms. Population-based data reveal variation in primary care professionals (PCPs) mammography rates in this age group after adjusting for sociodemographic factors, highlighting the need to explore PCP screening perspectives and how this informs clinical behaviours. Results from this study will inform interventions that can improve guideline concordant breast screening for this age group.MethodsQualitative semi-structured interviews were performed with PCPs in Ontario, Canada. Interviews were structured using the theoretical domains framework (TDF) to explore determinants of breast cancer screening best-practice behaviours: (1) risk assessment; (2) discussion regarding benefits and harms; and (3) referral for screening.AnalysisInterviews were transcribed and analyzed iteratively until saturation. Transcripts were coded deductively by behaviour and TDF domain. Data that did not fit within a TDF code were coded inductively. The research team met repeatedly to identify potential themes that influenced or were important consequences of the screening behaviours. The themes were tested against further data, disconfirming cases, and different PCP demographics.ResultsEighteen physicians were interviewed. The theme of perceived guideline clarity (a lack of clarity on guideline-concordant practices) influenced all behaviours and moderated the extent to which the risk assessment and discussion occurred. Many were unaware of how risk-assessment factored into the guidelines and/or did not perceive that a shared-care discussion was guideline-concordant. Deferral to patient preference (screening referral without a complete discussion of benefits and harms) occurred when the PCPs had low knowledge regarding harms and/or if they experienced regret (TDF domain: emotion) resulting from prior clinical experiences. Older providers described patient’s influence impacting their decisions and physicians trained outside Canada, practicing in higher-resourced areas, and female physicians described being influenced by beliefs about consequences of benefits of screening.ConclusionPerceived guideline clarity is an important driver of physician behaviour. Improving guideline concordant care should start by clarifying the guideline itself. Thereafter, targeted strategies include building skills in identifying and overcoming emotional factors and communication skills important for evidence-based screening discussions.

Team Science Principles Enhance Cancer Care Delivery Quality Improvement: Interdisciplinary Implementation of Breast Cancer Screening Shared Decision Making.

Implementing shared decision making (SDM), recommended in screening mammography by national guidelines for women age 40-49 years, faces challenges that innovations in quality improvement and team science (TS) are poised to address. We aimed to improve the effectiveness, patient-centeredness, and efficiency of SDM in primary care for breast cancer screening. Our interdisciplinary team included primary and specialty care, psychology, epidemiology, communication science, engineering, and stakeholders (patients and clinicians). Over a 6-year period, we executed two iterative cycles of plan-do-study-act (PDSA) to develop, revise, and implement a SDM tool using TS principles. Patient and physician surveys and retrospective analysis of tool performance informed our first PDSA cycle. Patient and physician surveys, toolkit use, and clinical outcomes in the second PDSA cycle supported SDM implementation. We gathered team member assessments on the importance of individual TS activities. Our first PDSA cycle successfully generated a SDM tool called Breast Cancer Risk Estimator, deemed valuable by 87% of patients surveyed. Our second PDSA cycle increased Breast Cancer Risk Estimator utilization, from 2,000 sessions in 2017 to 4,097 sessions in 2019 while maintaining early-stage breast cancer diagnoses. Although TS activities such as culture, trust, and communication needed to be sustained throughout the project, shared goals, research/data infrastructure support, and leadership were more important earlier in the project and persisted in the later stages of the project. Combining rigorous quality improvement and TS principles can support the complex, interdependent, and interdisciplinary activities necessary to improve cancer care delivery exemplified by our implementation of a breast cancer screening SDM tool.

Assessing Breast Cancer Risks to Improve Care for an Increased-Risk Population within Eastern North Carolina.

BACKGROUND The average lifetime risk of breast cancer for an American woman is 12.5%, but individual risks vary significantly. Risk modeling is a standard of care for breast cancer screening and prevention with recommended tools to stratify individual risks based on age, family history, breast density, and a host of other known risk factors. Because of a lack of resources rurally, we have not consistently met this standard of care within all of North Carolina.METHODS We implemented a quality improvement project to assess the risk for breast cancer by gathering data on community risks. We implemented an evidence-based tool (Tyrer-Cuzick) for quantifying risk within a mostly rural population of Eastern North Carolina and developed customized services for women meeting elevated-risk definition. These services included additional imaging for elevated-risk women and a risk-reduction program. We also assessed genetic risks for hereditary breast and ovarian cancer in our at-risk population using National Comprehensive Cancer Network (NCCN) guidelines based on family history and added local genetics extenders to help test more women. We analyzed data regularly using Plan-Do-Study-Act methods to improve outcomes over 1 year.RESULTS We screened a population of 4500 women at a community hospital over a 1-year period for their individual lifetime cancer risk and genetic risk. Breast cancer risk was quantitated at the time of mammography, and women were stratified into 3 groups for risk management. Within our screening population, 6.3% of women were at high risk (defined by a lifetime breast cancer risk greater than or equal to 20%) and another 8.1% were above-average risk (defined by a lifetime breast cancer risk of 15%-20%). These women (14.4%) could potentially benefit from additional risk-management strategies. Additionally, 20% of all unaffected women within a typical screening population of Eastern North Carolina met NCCN guidelines for hereditary breast cancer and ovarian cancer testing independent of their cancer risk score. Using a model of targeted intervention within a population with elevated risks can be helpful in improving outcomes.LIMITATIONS This population within Eastern North Carolina is mostly rural and represents a potentially biased population, as it involves older women undergoing annual mammography. It may not be broadly applicable to the entire population based on age, geography, and other risks.CONCLUSIONS This model for improving cancer risk assessment and testing at a small community hospital in Eastern North Carolina was successful and addressed a community need. We discovered a high rate of increased-risk women who can benefit from individualized risk management, and a higher percentage of women who potentially benefit from genetic testing. These higher cumulative risks may in part explain some of the disparities seen for breast-cancer-specific outcomes in some parts of the state.

Breast cancer screening in Primary Health Care in Brazil: a systematic review

to analyze care strategies for breast cancer screening in Primary Health Care in Brazil. this is a systematic review following the Cochrane Collaboration recommendations. among 355 manuscripts, five were eligible. The patient navigation program by Community Health Agent stood out with the best result, among the strategies: flexibility of goals considering viability; community engagement; team training; active search of the target population by Community Health Agent; request for mammography by physicians; actions integrated to women's health; monitoring of mammography results, absent users, and population coverage by physician and nurse; and assessment of criteria for requesting screening mammography by means of an information system. The population coverage rate in the program ranged from 23% to 88%. Primary Health Care in Brazil presents devices with potential to induce the production of care for breast cancer screening.

Abbreviated Breast Magnetic Resonance Imaging for Supplemental Screening of Women With Dense Breasts and Average Risk

Although mammography is the standard of care for breast cancer screening, dense breast tissue decreases mammographic sensitivity. We report the prevalent cancer detection rate (CDR) from the first clinical implementation of abbreviated breast magnetic resonance imaging (AB-MR) as a supplemental screening test in women with dense breasts. The study was approved by the institutional review board and is Health Insurance Portability and Accountability Act complaint. This retrospective review includes women who were imaged between January 1, 2016 and February 28, 2019. On a 1.5 Tesla magnet, the imaging protocol consisted of three sequences: Short-TI Inversion Recovery (STIR), precontrast, and postcontrast. A subtraction sequence and a maximum intensity projection were generated. We report the patient-level CDR and the positive predictive value of AB-MR examinations after negative/benign digital breast tomosynthesis (DBT). Out of 511 prevalent rounds of AB-MR examinations, 36 women were excluded. The remaining 475 asymptomatic women with dense breasts had negative/benign DBT examinations before the AB-MR. There were 420 of 475 (88.4%) benign/negative examinations, 13 of 475 (2.7%) follow-up recommendations, and 42 biopsy recommendations. Thirty-nine biopsies were completed, resulting in 12/39 (30.8%) malignancies in 12 women: seven invasive carcinomas and five ductal carcinoma in situ. One additional patient was diagnosed with invasive ductal carcinoma at the time of 6-month follow-up. The CDR was 27.4 per 1,000 (13 of 475; 95% CI, 16.1 to 46.3). The size of invasive carcinomas ranged from 0.6-1.0 cm (mean, 0.5 cm). Of the seven women who underwent surgical evaluation of the axilla, zero of seven patients had positive nodes. There were no interval cancers at 1-year follow-up. Preliminary results from clinical implementation of screening AB-MR resulted in a CDR of 27.4/1,000 at the patient level after DBT in women with dense breasts. Additional evaluation is warranted.

Abstract P2-12-08: Triaging breast care center patients to supportive care services based on the Athena Breast Health Network online intake form and the patient-reported outcomes measurement information system (PROMIS)

Abstract Background: The Athena Breast Health Network is a multi-site effort aimed at integrating cutting-edge research and clinical care for breast cancer screening and treatment. At the University of California, San Francisco (UCSF) Breast Care Center (BCC), an Athena-based electronic Health Questionnaire System (eHQS) is distributed to all new patients. This questionnaire assesses self-reported personal and familial health history, comorbidities, and Patient-Reported Outcome Measurement and Information System (PROMIS) quality of life domains. Based on these responses, patients are proactively triaged to genetic counseling, psycho-oncology, onco-fertility, smoking cessation, peer support, nutritional counseling, behavioral sleep, and social work. These referrals are based on pre-defined thresholds, such as Ashkenazi Jewish Ancestry (referral to Genetic Counseling), or PROMIS Depression and Anxiety scores greater than or equal to 9 and 11, respectively. This analysis aims to assess the eHQS as a means to refer patients to supportive care services and assess if high-need patients (those with the highest symptom burden as assessed by quality of life PROMIS scores) are referred to services more frequently. Patients and Methods: Since Athena’s launch in 2013, over 6,000 patients have completed the online intake questionnaire at the UCSF BCC, 4,984 of whom have consented to research. 3,627 patients completed all relevant data to this study and were used in our analysis. A review of patient referrals was conducted to assess the number of referrals as a result of eHQS completion. PROMIS T-Scores in 8 domains (depression, anxiety, fatigue, sleep-related impairment and disturbance, cognitive function, applied cognition and physical function) were calculated with the Health Measures system and compared across patients stratified by age and cancer type and against the US general population. Results: When compared to the US population as a whole, PROMIS scores indicate that UCSF BCC patients have impaired quality of life in every assessed PROMIS domain except for depression. As age increases, PROMIS scores across multiple domains (depression, anxiety, sleep disturbance, cognitive function) increase, signifying lower symptom burden. Importantly, high symptom burden in the anxiety PROMIS domain was suggestive of lower quality of life scores in 6 out of the other 7 assessed PROMIS domains. 39% (1408 patients) of all analyzed BCC patients received at least one referral to a supportive care service. 721 of 1450 (50%) patients with an Invasive Breast Cancer (IBC) diagnosis and 246 of 571 (43%) patients with a DCIS diagnosis triggered at least one referral. 31% of all patients received a referral to genetic counseling, 16.3% to psycho-oncology, 11% to behavioral sleep, 8% to nutritional counseling, 7.6% to social work, 2.4% to smoking cessation, and 1.6% to onco-fertility. When compared to patients with DCIS or without a cancer diagnosis, patients with IBC are most likely to receive a referral to genetic counseling and psychosocial services. Referrals to supportive care services are less frequent as age increases. Conclusion: The Athena online intake form at the UCSF BCC effectively triages patients with high levels of anxiety (PROMIS > 8) and depression (PROMIS >10) to supportive care services. Preliminary results regarding the correlation between anxiety and overall poor quality of life suggest that referrals to psycho-oncology may be most efficacious in decreasing symptom burden. Using these analyses, we aim to refine our use of the eHQS to tailor the most relevant and effective referrals to the highest-need patients. Citation Format: Madeline Matthys, André Dempsey, Amrita Basu, Emily Wong, Nickolas Dreher, Irene Acerbi, Suzanne Ackerson, Laura Esserman, Athena Breast Health Network Investigators and Advocate Partners, Michelle Melisko, Laura van 't Veer. Triaging breast care center patients to supportive care services based on the Athena Breast Health Network online intake form and the patient-reported outcomes measurement information system (PROMIS) [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-12-08.

Study of role of digital breast tomosynthesis over digital mammography in the assessment of BIRADS 3 breast lesions

BackgroundBreast cancer is the most common malignancy in women and thus, screening has become an important health issue. Although mammography remains the standard of care for breast cancer screening and diagnosis (with biopsy), tomosynthesis (3D DBT) allows the separation of overlapping structures seen on 2D mammography and thus enables better depiction of masses or asymmetries.ResultsA prospective study for mammographic cases referred to our radiology unit included 60 lesions detected in 59 patients that were performed during the period from January 2016 to September 2017. Patients’ ages ranged from 26 to 72 years with mean age 51 ± 12 SD. Sixty percent of breast imaging-reporting and data system (BIRADS) 3 lesions detected by 2D digital mammography (36/60) changed their category after 3D DBT, 40% (24/60) digital mammography noticed lesions did not change their BIRADS after 3D DBT. Twenty-nine BIRADS 3 lesions out of the 60 were downgraded to BIRADS 1and 2, while 7 BIRADS 3 lesions out of the 60 were upgraded to BIRADS 4 and 5 which were all biopsied. Six out of the 7 lesions were pathologically proven ducal carcinoma and 1 out of 7 pathologically proven to be atypical ductal hyperplasia.Conclusion3D DBT significantly reduced the need for additional mammographic views and frequent follow-up studies as it gave better characterization for all BIRADS 3 lesions.

Why Patients Decline Digital Breast Tomosynthesis? Results From a Patient Survey in an Urban Academic Breast Center

BackgroundDespite the advantages of reduced callback rates, higher sensitivity, and higher specificity associated with digital breast tomosynthesis (DBT) over traditional full-field digital mammography (FFDM), many patients declined DBT at our urban academic breast center. Most states also do not have mandated insurance coverage for DBT. MethodsA patient survey was conducted at our breast center from February 2017 to April 2017. All patients were informed regarding the potential benefits of DBT as well as the potential additional charge related to DBT, which depended on the insurance coverage. The survey aimed to examine why the patient declined the DBT option. Reasons included cost, increased radiation risk, anxiety about newer technology, discomfort associated with the exam, lack of education about potential benefits, or patient belief that she will not benefit from DBT. We also inquired if patients would change their opinion about DBT if cost were removed. Patients answered each question by rating their responses on a scale of 1-5, from strongly disagree, disagree, neutral, agree, and strongly agree. ResultsPotential additional cost associated with tomosynthesis had the highest influence on patient decision to decline DBT with an average score of 4.68 out of 5. Other factors as described above had less impact on the patient decision with an average score ranging from 1.53-1.72 out of 5. ConclusionPotential out-of-pocket cost for patients remains one of the major obstacles in adoption of DBT as standard of care for breast cancer screening.

Digital Breast Tomosynthesis: Clinical Operations.

Digital breast tomosynthesis (DBT) is rapidly becoming the standard of care for breast cancer screening. Implementing DBT into practice is relatively straightforward. However, there are important elements of the transition that one must consider to facilitate this process. Understanding the Digital Imaging and Communications in Medicine (DICOM) standard for DBT, as well as how images are displayed, is critical to a successful transition. Standardization of these processes will allow easier transmission of images from facility to facility, and limit the potential for errors in interpretation. Additionally, recent changes in federal regulations will require compliance with mandated training for the radiologist, technologist, and physicist, as well as accreditation for each DBT unit. These regulations aim to ensure high-quality imaging across the country as has been previously seen with standard digital mammography. Synthesized imaging is the most recent improvement for DBT, potentially obviating the need for a simultaneous traditional digital mammogram exposure. Studies have demonstrated near equivalent performance when comparing the combination imaging of DBT and digital mammography versus DBT combined with synthetic imaging. As the quality of the synthetic images continues to improve, it is increasingly likely that it will replace the traditional mammogram. Adherence to DBT-specific parameters will enhance the physician experience and ultimately translate to increased cancer detection and fewer false positive examinations, benefiting all women who are screened for breast cancer.

Calcifications at Digital Breast Tomosynthesis: Imaging Features and Biopsy Techniques.

Full-field digital mammography (FFDM), the standard of care for breast cancer screening, has some limitations. With the advent of digital breast tomosynthesis (DBT), improvements including decreased recall rates and increased cancer detection rates have been observed. The quasi-three-dimensional capability of DBT reduces breast tissue overlap, a significant limitation of FFDM. However, early studies demonstrate that a few cancers detected at FFDM may not be diagnosed at DBT-only screening, and lesions with calcifications as the dominant feature may look less suspicious at DBT or not be visible at all. These findings support the use of combined FFDM and DBT protocols to optimize screening performance. However, this combination would approximately double the patient's radiation exposure. The development of computer algorithms that generate two-dimensional synthesized mammography (SM) views from DBT has improved calcification conspicuity and sensitivity. Therefore, SM may substitute for FFDM in screening protocols, reducing radiation exposure. DBT plus SM demonstrates significantly better performance than that of FFDM alone, although there are reports of missed malignant calcifications. Thus, some centers continue to perform FFDM with DBT. Use of DBT in breast imaging has also necessitated the development of DBT-guided biopsy. DBT-guided biopsy may have a higher success rate than that of stereotactic biopsy, with a shorter procedure time. While DBT brings substantial improvements to breast cancer imaging, it is important to be aware of its strengths and limitations regarding detection of calcifications. This article reviews the imaging appearance of breast calcifications at DBT, discusses calcification biopsy techniques, and provides an overview of the current literature. Online supplemental material is available for this article. ©RSNA, 2019 An earlier incorrect version of this article appeared online. This article was corrected on February 13, 2019.

Can Tomosynthesis Replace 2D Mammography as a Future Breast Screening Tool?

Digital 2D mammography is the current standard of care for breast cancer screening. False positives and overdiagnosis have been cited as potential harms of screening mammography, and efforts to improve this technology have led to the development of digital breast tomosynthesis (DBT). The literature thus far has shown screening with tomosynthesis to simultaneously decrease recall rates and increase cancer detection. This review evaluates the possibility for 2D plus tomosynthesis mammography to replace conventional 2D screening. It outlines the requirements of an effective screening modality, reviews early and recent literature on performance outcomes, including results by age and density, and highlights potential challenges.

Abstract P1-11-06: Mammograms on-the-go: Predictors of repeat visits to mobile mammography vans in St. Louis, Missouri

Abstract Background: Among women, breast cancer is the most common noncutaneous cancer and second most common cancerous cause of death. The American Cancer Society recommends that all healthy women over age 40 have a mammogram annually because early detection and treatment of tumors has been associated with a 15% decrease in breast cancer mortality. African American women have higher mortality rates than white women and, in general, uninsured women have low rates of screening. To increase screening rates, mobile mammography has been implemented in many cities. Previous studies have investigated women’s self-reported adherence to screening guidelines at the time of participation in mobile mammography, but no study has examined if women use it as an annual screening tool. Objective: The purpose of this study was to determine if women are using mobile mammography vans as their established source of medical care for breast cancer screening and the factors that predict repeat visits to these vans. Methods: A prospective cohort study was conducted from 2006 to 2013 in which 8450 women who received a mammogram as part of Siteman Cancer Center’s Breast Health Outreach Program responded to surveys and provided access to their clinical records. Only visits on the mammography van were included. The predictor variables explored in this study were: urban status, insurance coverage, age group, race, marital status, mammography experience at baseline visit, employment status, and year of screening. Data were analyzed using chi-square tests, logistic regression, and negative binomial regression. Results: Among the study participants, 25.3% (N=2134) had multiple visits to the mobile mammography van. Of these women, 57.2% had good mammography experiences at baseline, 48.2% were from urban settings, 70.6% were uninsured, 51.2% were ages 50-65, 69.7% were Black, 76.4% were not currently married, and 63.3% were unemployed. Women who were ages 50-65, uninsured, or Black had a higher odds of a repeat visit to the mobile mammography van compared to women who were ages 40-50, insured, or White (OR=1.135, 95% CI: 1.013-1.271; OR=1.302, 95% CI: 1.146-1.479; OR=1.281, 95% CI: 1.125-1.457), respectively. However, the odds of having a repeat visit to the van was lower among women who reported a rural zip code or were unemployed compared to women who provided a suburban zip code or were employed (OR=.503, 95% CI: .411-.616; OR=.868, 95% CI: .774-.972), respectively. Conclusion: This study has identified key characteristics of women who are either more or less likely to use mobile mammography vans as their primary source of medical care for breast cancer screening and have repeat visits. It is important that mobile mammography is maintained and remains easily accessible to women who continuously use the service. Further research should be done to discover ways to make mobile mammography a more effective resource for those more likely to use it for routine screening. Citation Format: Bettina F Drake, Salmafatima S Abadin, Sarah Lyons, Su-Hsin Chang, Lauren T Steward, Susan Kraenzle, Melody S Goodman. Mammograms on-the-go: Predictors of repeat visits to mobile mammography vans in St. Louis, Missouri [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-11-06.

Mammograms on-the-go—predictors of repeat visits to mobile mammography vans in St Louis, Missouri, USA: a case–control study

ObjectivesAmong women, breast cancer is the most common non-cutaneous cancer and second most common cause of cancer-related death. The purpose of this study was to determine the extent to which...

Magnetic Resonance Imaging and Breast Ultrasonography as an Adjunct to Mammographic Screening in High-Risk Patients

Screening mammography remains the standard of care for breast cancer screening of the general population and is likely to remain so in the foreseeable future. We discuss the current role of breast ultrasound and magnetic resonance imaging (MRI) in screening for breast cancer in the high-risk population. Breast ultrasound finds small cancers not seen on mammography particularly in women with dense breasts. Breast MRI has sensitivity significantly higher than that of mammography, breast ultrasound, or a combination of mammography and breast ultrasound.

A community effort to reduce the black/white breast cancer mortality disparity in Chicago

The Metropolitan Chicago Breast Cancer Taskforce was formed to address a growing black/white breast cancer mortality disparity in Chicago. The Taskforce explored three hypotheses: black women in Chicago receive fewer mammograms, black women receive mammograms of inferior quality, and black women have inadequate access to quality of treatment for breast cancer. A total of 102 individuals from 74 Chicago area organizations participated in the Task Force participating in three work groups from January to September 2007. The work groups held focus groups of providers, organized town hall meetings in four Chicago communities, gathered black/white breast cancer mortality data for Chicago, the United States, and New York City, and conducted a mammography capacity and quality survey of mammography facilities. Chicago's black and white breast cancer mortality rates were the same in 1980. By the late 1990 s, a substantial disparity was present, and by 2005, the black breast cancer mortality rate was 116% higher than the white rate. In 2007, 206,000 screening mammograms were performed for women living in Chicago, far short of the 588,000 women in the 40-69 age range in Chicago. Facilities that served predominately minority women were less likely to be academic or private institutions (p < .03), less likely to have digital mammography (p < .003), and less likely to have dedicated breast imaging specialists reading the films (p < .003). Black women and providers serving them reported significant difficulties in accessing needed care for breast cancer screening and treatment. There are significant access barriers to high quality mammography and treatment services that could be contributing to the mortality differences in Chicago. A metropolitan wide taskforce has been established to address the disparity.