Future Breast Cancer Screening Research Articles

Abstract PO3-19-03: Addressing USPSTF 2023 Identified Key Gaps in Knowledge in Breast Cancer Screening through TMIST (ECOG-ACRIN EA1151) or its Ancillary Studies

Abstract Background The United States Preventative Services Task Force in their 2023 recommendations identified areas where more research data is needed to inform future breast cancer screening recommendations. Research areas identified are: improve clinicians and patients understanding and evaluation of dense breast tissue on a screening mammogram, benefits and harms of supplemental screening using ultrasound or MRI for women with dense breasts, health outcomes such as rates of breast cancer diagnosis requiring treatment, rates of advanced breast cancers diagnosed across consecutive screening rounds, and breast cancer-associated morbidity and mortality, causes of increased risk of breast cancer mortality in black women across spectrum of stages and biomarker patterns, understand why black women are more likely to be diagnosed with breast cancers that have biomarker patterns that are indicative of poor health outcomes, assess benefits/harms differences between annual and biennial screening for breast cancer in women overall and if there are differences between black and white women, approaches to reduce the risk of overdiagnosis leading to overtreatment of breast lesions found at screening that may not cause morbidity and mortality, natural history of DCIS, and identify prognostic indicators of breast tumors that are unlikely to affect quality or length of life. Methods The ongoing TMIST study, currently with 88,801 asymptomatic women presenting for screening mammography ages 45-74 enrolled out of 128,905, could contribute to scientific evidence to support the above research areas through existing study aims and planned ancillary studies. Supplemental Screening with US and MRI: TMIST PreSCRIB will utilize Machine Learning applied to TMIST and All of Us data, including genetics, mammograms, social determinates of health and other data to recommend individualized screening strategies for women. DxMRI is a study where women will get AbMRI at time of Dx work-up. There are plans to use these examinations plus supplemental screening MRIs performed on TMIST subjects in an enriched reader study to evaluate the role of supplemental screening MRI in moderate risk women. Rates of breast cancer treatment, consecutive screening, morbidity, and mortality: TMIST’s primary outcome is the proportion of women experiencing an advanced breast cancer and needing treatment. TMIST is also collecting information on health care utilization following a cancer diagnosis, including types of treatment given, and costs data from the screening and diagnostic work-up visits, and mortality data for study participants. Increased risk of breast cancer mortality in black women: TMIST is performing PAM50 plus p53 status, immune profile, DNA repair phenotype, and 21-gene recurrence assay on all breast cancers and a subset of benign tissue. Blood and buccal smears might also help address this issue. Ongoing work, funded by the Susan B. Komen Foundation, focuses on improving Black participation in TMIST Biorepository (currently about 45% participation of the 21% of TMIST US black subjects). Surveys are planned on perceived racism and social determinates of health as part of DxMRI Study. Screening Frequency: We are developing a collaboration with the UK-based clinical trial PROSPECTS to compare rates of all cancers and advanced cancers for annual, biennial, and 3-year screening. Overdiagnosis, natural history of DCIS, prognostic indicators of breast tumors not impacting quality of life: PRoGram- will use radiomics, genomics and pathomics to develop a greater understanding of the variability of the non-advanced cancers diagnosed in the TMIST population, including DCIS. It is hoped that this model will provide greater understanding of the risk of poor outcomes for women diagnosed with lower risk cancers, including DCIS. Citation Format: Etta Pisano, Constantine Gatsonis, Mitchell Schnall, Melissa Troester, Elodia Cole, Jean Cormack, Ilana Gareen, Martin Yaffe, Laura Collins, Amarinthia Curtis, Ruth Carlos, Kathy Miller, Christopher Comstock. Addressing USPSTF 2023 Identified Key Gaps in Knowledge in Breast Cancer Screening through TMIST (ECOG-ACRIN EA1151) or its Ancillary Studies [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-19-03.

Liposuction-Only Breast Reduction: A Systematic Review of Outcomes.

Over the past few decades, there have been multiple reports of liposuction assisted breast reduction. This technique appeals to patients due to the limited scars and complication profile, compared to traditional reduction mammaplasty techniques. We aimed to systematically review the literature, to elucidate the outcomes and safety of liposuction-only breast reduction. A systematic review was performed using the Ovid (Medline/PubMed) database, in accordance with the PRISMA checklist. In total 7 articles were included within this systematic review. A total of 652 patients were included. Liposuction-only breast reduction appears to lead to improvements in subjective outcome measures, patient satisfaction, and objective outcomes such as moderate breast volume reduction and reduction in breast ptosis. Overall, the procedure had a low complication profile. Liposuction did not preclude further surgery. No evidence of malignancy or difficulty in future breast cancer screening was noted. Macromastia leads to a considerable health burden, especially in health-related costs. From the current evidence base, liposuction-only breast reduction appears to be a safe and effective procedure, especially in patients requiring a mild-moderate breast volume reduction and mild ptosis correction. More research is required, with standardised subjective and objective outcome measures, and longer follow-up periods to confirm the effectiveness and safety of this technique. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

Single-Fiber Transducer Arrays for 3-D Ultrasound Computed Tomography: From Requirements to Results

A potential method for future breast cancer screening is 3D ultrasound computed tomography (USCT). The utilized image reconstruction algorithms require transducer characteristics fundamentally different from conventional transducer arrays, leading to the necessity of a custom design. This design has to provide random transducer positioning, isotropic sound emission as well as a large bandwidth and wide opening angle. In this paper, we present a new transducer array design to be utilized in a third generation 3D USCT system. Each system requires 128 cylindrical arrays, mounted into the shell of a hemispherical measurement vessel. Each new array contains a 0.6 mm thick disk with 18 single PZT fibers (0.46 mm diameter) embedded in a polymer matrix. Randomized positioning of the fibers is achieved with an arrange-and-fill process. The single-fiber disks are connected on both ends with a matching and backing disk using simple stacking and adhesives. This enables fast and scalable production. We characterized the acoustic field of 54 transducers with a hydrophone. Measurements in 2D showed isotropic acoustic fields. The mean bandwidth and opening angle are 131% and 42°, respectively (both -10 dB). The large bandwidth arises from two resonances within the utilized frequency range. Parameter studies using different models showed that the realized design is already close to the achievable optimum for the transducer technology used. Two 3D USCT systems were equipped with the new arrays. First images show promising results, with an increase in image contrast and a significant reduction of artifacts.

Malmö Breast ImaginG database: objectives and development.

We describe the design and implementation of the Malmö Breast ImaginG (M-BIG) database, which will support research projects investigating various aspects of current and future breast cancer screening programs. Specifically, M-BIG will provide clinical data to:1.investigate the effect of breast cancer screening on breast cancer prognosis and mortality;2.develop and validate the use of artificial intelligence and machine learning in breast image interpretation; and3.develop and validate image-based radiological breast cancer risk profiles. The M-BIG database is intended to include a wide range of digital mammography (DM) and digital breast tomosynthesis (DBT) examinations performed on women at the Mammography Clinic in Malmö, Sweden, from the introduction of DM in 2004 through 2020. Subjects may be included multiple times and for diverse reasons. The image data are linked to extensive clinical, diagnostic, and demographic data from several registries. To date, the database contains a total of 451,054 examinations from 104,791 women. During the inclusion period, 95,258 unique women were screened. A total of 19,968 examinations were performed using DBT, whereas the rest used DM. We describe the design and implementation of the M-BIG database as a representative and accessible medical image database linked to various types of medical data. Work is ongoing to add features and curate the existing data.

Breast Cancer Screening Disparity in a Safety Net Health System: The Intersection of Race, Ethnicity, Language, and Mental Health

INTRODUCTION: Breast cancer screening (BCS) disparity leaves historically underserved groups vulnerable to worse adverse outcomes. This study seeks to explore association between BCS and granular patient sociodemographic factors in a uniquely resourced safety-net health system. METHODS: A retrospective review of female patients ages 50–74 years within an urban safety-net health system was conducted in 2019. Patients who had a primary care provider (PCP) visit within 2 years were included, and those with a history of breast cancer or breast operation were excluded. Multiple patient health and sociodemographic characteristics were obtained, as well as PCP gender. Univariate analyses and multivariable logistic regression were performed. RESULTS: Of 12,363 included patients, 8,540 (69.1%) received BCS. Most of the cohort (72.4%) had public insurance, 37% of the population was White, and 44.2% had a non-English primary language. Latino patients had the highest screening rate (77%), whereas White patients had the lowest (63.2%). In multivariable analysis, the odds of BCS significantly increased with Spanish language, African ethnicity, commercial insurance, increased PCP visits, higher median household income, or having a female PCP. BCS odds significantly decreased with substance use disorder or severe mental health diagnoses. CONCLUSION: Challenging traditional US cancer screening disparity in our large safety-net health system, patients who were non-White, non–North American/European ethnicity, and non–English-speaking had significantly higher odds of BCS compared with their counterparts. Our data emphasize how specific communities and sociodemographic characteristics can have unique BCS disparity, which may help guide future BCS outreach and implementation strategies.

Inference of Onset Age of Preclinical State and Sojourn Time for Breast Cancer.

Accurate estimation of the three key parameters (sensitivity, time duration in disease-free state and sojourn time in preclinical state) in cancer screening are critical. Likelihood method with a new link function was applied to the Health Insurance Plan of Greater New York (HIP) breast cancer screening data, to estimate the onset age of preclinical state and the sojourn time in the preclinical state for breast cancer. A new link function to model sensitivity as a function of time in the preclinical state and the sojourn time was adopted. Markov Chain Monte Carlo simulations were used to obtain posterior samples and make inference on the three key parameters. Maximum likelihood estimate was also used for comparison. The onset age of the preclinical state has a wide range for breast cancer; the peak onset age was 65.07 years (95% credible interval [C.I.], 55.76 to 73.02). The mean sojourn time was 2.00 years (95% C.I., 0.85 to 2.95). The 95 % C.I. for the sojourn time was 0.16 to 5.53 years. Sensitivity at onset of the preclinical state was 0.75 (95% C.I., 0.54 to 0.88); and sensitivity at the end of the preclinical state was 0.84 (95% C.I., 0.67 to 0.88). The HIP study was the oldest breast cancer mass screening. The estimates reflect key parameters in those days with lower screening sensitivity. However, it is helpful to know other parameters in the planning for future breast cancer screening.

Impact of Awareness of Breast Density on Perceived Risk, Worry, and Intentions for Future Breast Cancer Screening among Korean Women.

PurposeThis study sought to examine perceived risk and concerns for breast cancer according to awareness of breast density and states thereof among Korea women and to identify the impact of such awareness on screening intentions.Materials and MethodsThis study was based on the 2017 Korean National Cancer Screening Survey of a nationally representative and randomly selected sample of Koreans. Ordinal logistic regression was conducted to examine associations for awareness of and knowledge on breast density in relation to psychological factors. Multivariate logistic regression analyses were conducted to investigate significant factors associated with intentions to undergo breast cancer screening.ResultsAmong a total of 1,609 women aged 40-69 years, 62.0% were unaware of their breast density, and only 29.7% had good breast density knowledge. Awareness of one’s breast density and knowledge about breast density were positively associated with perceptions of absolute and comparative risk and cancer worry. Women aware of their breast density (adjusted odds ratio [aOR], 1.35 for women aware of having a non-dense breast; aOR, 4.17 for women aware of having a dense breast) and women with a good level of breast density knowledge (aOR, 1.65) were more likely to undergo future breast cancer screening.ConclusionBreast density awareness and knowledge showed positive associations with psychological factors and breast cancer screening intentions. However, the majority of Korean women were not aware of their breast density status and demonstrated poor knowledge about breast density. These results demonstrate a need for better health communication concerning breast density.

Artificial intelligence for breast cancer detection in mammography and digital breast tomosynthesis: State of the art.

Screening for breast cancer with mammography has been introduced in various countries over the last 30 years, initially using analog screen-film-based systems and, over the last 20 years, transitioning to the use of fully digital systems. With the introduction of digitization, the computer interpretation of images has been a subject of intense interest, resulting in the introduction of computer-aided detection (CADe) and diagnosis (CADx) algorithms in the early 2000's. Although they were introduced with high expectations, the potential improvement in the clinical realm failed to materialize, mostly due to the high number of false positive marks per analyzed image. In the last five years, the artificial intelligence (AI) revolution in computing, driven mostly by deep learning and convolutional neural networks, has also pervaded the field of automated breast cancer detection in digital mammography and digital breast tomosynthesis. Research in this area first involved comparison of its capabilities to that of conventional CADe/CADx methods, which quickly demonstrated the potential of this new technology. In the last couple of years, more mature and some commercial products have been developed, and studies of their performance compared to that of experienced breast radiologists are showing that these algorithms are on par with human-performance levels in retrospective data sets. Although additional studies, especially prospective evaluations performed in the real screening environment, are needed, it is becoming clear that AI will have an important role in the future breast cancer screening realm. Exactly how this new player will shape this field remains to be determined, but recent studies are already evaluating different options for implementation of this technology. The aim of this review is to provide an overview of the basic concepts and developments in the field AI for breast cancer detection in digital mammography and digital breast tomosynthesis. The pitfalls of conventional methods, and how these are, for the most part, avoided by this new technology, will be discussed. Importantly, studies that have evaluated the current capabilities of AI and proposals for how these capabilities should be leveraged in the clinical realm will be reviewed, while the questions that need to be answered before this vision becomes a reality are posed.

Barriers and Attitudes toward Breast Cancer Screening among Omani Women.

Background:Breast cancer (BC) is the most common cancer accounting for 24.5% of Omani female cancer. Early detection of BC through regular breast cancer screening (BCS) has been found to decrease mortality rates. The aim of this study was to identify knowledge, attitudes and barriers of Omani women toward BCS. Methods:A cross-sectional study was conducted among adult Omani women attending the Sultan Qaboos University Hospital (SQUH). Results:A total of 358 Omani women participated from 420 invited (response rate = 85.2%). Most women (92.1%) thought that BC could be cured if detected early, but less than half (46.8%) thought that they were at risk of BC if a relative had BC. The majority (81.1%) were aware that BCS was available in Oman, though less than half (48.5%) knew where to go for BCS and most (83.8%) had not undergone BCS before. The most common personal-related barriers to BCS were fear of BC diagnosis (40.8%), fear of treatment (52.1%) and embarrassment of the breast examination (46.6%). The most perceived system-related barriers to BCS were the concern over the availability of a male doctor (46.6%) or a non-Arabic speaking doctor (38.7%) and not recommended by the doctor (46.3%). Univariate binary logistic regression showed that attitudes toward BCS were influenced by their previous experiences of BCS (odds ratio [OR] = 2.28; 95% confidence interval [CI]: 1.18-4.41) and their willingness to participate in the future BCS [OR = 1.96; 95% CI: 1.14-3.37). Conclusion:Although Omani women showed an interest toward BCS, few had undergone BCS. Several cultural, practical and personal-related barriers were noted to interfere with BCS in Oman. Addressing these concerns through involving healthcare providers to reassure the women and implementing a national strategy of BCS could improve BCS screenings and early diagnosis of BC.

Public awareness of and responses to media coverage of invitation errors in the Breast Screening Programme in England: a cross-sectional population survey

ObjectivesIn May 2018, the British Health Secretary announced the ‘serious failure’ that 450 000 women had missed out on invitations to breast screening in England, leading to extensive media coverage....

Promoting Breast Cancer Awareness and Screening Practices for Early Detection in Low-Resource Settings.

Breast cancer is the most common type of cancer among women in the Philippines. Philippines has one of the highest breast cancer mortality rate and the lowest mortality-to-incidence ratio in Asia. This study has three objectives: 1) explore Filipino women's knowledge, attitudes toward, and practices of breast cancer and cancer screening, 2) examine if an educational program increases women's intention to seek future breast cancer screening, and 3) examine associations between demographic variables and breast cancer screening practices. A total of 944 women from two urban areas (Calasciao and Tacloban City) and one rural area (Sogood) of the Philippines participated in this cross-sectional study. Study participants attended an educational program and completed study questionnaires regarding demographics, knowledge about, and practices of breast self-exams, clinical breast exams and mammography as well as reported barriers toward future screening. The results showed a disparity between knowledge of routine breast cancer screening and actuals screening behaviors. Following breast health education and screening programs, participants reported greater intention to adhere to recommended breast cancer screening guidelines. The multivariate analyses showed that education level is a significant predictor for CBE and mammography uptake in current study. This study has implications for breast cancer control among women in low-resources settings. Designing and implementing effective educational programs that increase women's awareness about breast cancer and promote screening uptake are important steps to reduce the burden affected by breast cancer among women in the Philippines and other South Asian low- to middle-income countries.

Screening by Clinical Breast Examination in Western Kenya: Who Comes?

PurposeMore than 80% of women with breast cancer in Kenya present to medical care with established late-stage disease. We sought to understand why women might not participate in breast cancer screening when it is offered by comparing the views of a cohort of those who attended a screening special event with those of community controls who did not attend.MethodsAll residents living close to three health centers in western Kenya were invited to participate in screening. Participants (attendees) underwent clinical breast examination by trained physician oncologists. In addition, women who consented were interviewed by using a modified Breast Cancer Awareness Module questionnaire. Nonattendees were interviewed in their homes the following day.ResultsA total of 1,511 attendees (1,238 women and 273 men) and 467 nonattendee women participated in the study. Compared with nonattendees, the women attendees were older, more often employed, knew that breast cancer presented as a lump, and were more likely to have previously felt a lump in a breast. In addition, they were more likely to report previously participating in screening activities, were more likely to have performed breast self-examination, and were less concerned about wasting a doctor’s time. Almost all those surveyed (attendees and nonattendees) expressed interest in future breast cancer screening opportunities.ConclusionThe women who volunteer for breast cancer screening in western Kenya are more aware of breast cancer than those who do not volunteer. Screening recruitment should seek to close these knowledge gaps to increase participation.

Self-assessed health, perceived stress and non-participation in breast cancer screening: A Danish cohort study

ObjectivePopulation-based cancer screening is offered in many countries to detect early stages of cancer and reduce mortality. Screening efficiency and equality is susceptible due to a group of non-participants. We investigated associations between self-assessed health, perceived stress and subsequent non-participation in breast cancer screening. MethodsThis population-based cohort study included 4512 women who had participated in a Health Survey in 2006 and who were also the target group (aged 50–69years) for the first organised breast cancer screening programme -3years later in the Central Denmark Region in 2008–2009. ResultsA U-shaped association was observed for physical health assessment as women with the highest (PR=1.28, 95% CI: 1.06–1.55), and the lowest (PR=1.41, 95% CI: 1.18–1.68) physical health scores were less likely to participate in the programme than women with physical health scores in the middle range. Women with low mental health assessment were more likely not to participate than women with mental health scores in the middle range (PR=1.44, 95% CI: 1.22–1.69). Higher non-participation propensity was also observed for women with the highest perceived stress scores (PR=1.27, 95% CI: 1.07–1.51) compared with women scoring in the middle range. ConclusionsWomen with highest and lowest self-assessed physical health, with lowest mental health or highest perceived stress were significantly more likely not to participate in breast cancer screening 2-3years later than women who reported average health. Interventions targeting these groups may promote equal participation in future breast cancer screening programmes.

Dense Breast Tissue Notification: Impact on Women’s Perceived Risk, Anxiety, and Intentions for Future Breast Cancer Screening

PurposeThe aim of this study was to explore how women respond to the wording of dense breast tissue notifications, which are increasingly required by state law after mammography. The specific aims were to (1) determine whether perceived lifetime risk for breast cancer and intentions to undergo mammography increase after reviewing a sample notification, (2) explore individual difference variables (eg, minority status, insurance coverage) that may influence intentions for additional ultrasound screening, and (3) assess whether anxiety mediates the relationship between perceived risk and screening intentions. MethodsA total of 184 women aged >40 years in the United States were recruited from Amazon Mechanical Turk to respond to a dense breast tissue notification as if they had personally received it. ResultsAfter reviewing a notification, women reported greater perceived risk (d = 0.67) and intentions to undergo mammography (d = 0.25) than before. Most women intended to undergo additional ultrasound screening, although to a lesser extent when ultrasound was covered by insurance than when it was not (d = 1.03). All screening intentions were lower in women with ambiguity aversion, a tendency to avoid tests without medical consensus, and those who preferred an active decision-making role. Anxiety mediated the relationship between perceived breast cancer risk and all screening intentions. ConclusionsWomen who receive dense breast tissue notifications may generally increase their breast cancer screening intentions; however, intention strength varies depending on internal (eg, ambiguity aversion) and external (eg, insurance for ultrasound) factors. Although perceived risk increases after notification, it is anxiety that drives women’s intentions for future screening.

Capsule commentary on Schonberg et al., Older women's experience with a benign breast biopsy—a mixed methods study.

Women 65 years and older are commonly screened for breast cancer with mammography. Models estimate that screening 1,000 women biannually for 10 years after the age of 69 would result in two fewer cancer deaths, 200 false positive mammograms, and 13 cases of over-diagnosis (breast cancer that would not have been clinically evident otherwise).1 The study by Schonberg et al. evaluates the effects of benign breast biopsies upon older women, using validated scales of psychological and physical consequences measured at the time of biopsy and after 6 months, and uses qualitative data to develop a conceptual model of undergoing a benign breast biopsy.2 At the time of biopsy, 76 % of women reported negative psychological consequences, which persisted at 6 months for 39 %. After 6 months, one in five women felt that worry interfered with their daily activities, and there was a trend for women with ≤ 9 years life expectancy to have higher negative psychological consequences compared to healthier women. Women also noted competing health issues in the qualitative data, all of which support the need for personalized decision making to balance risks and benefits of breast cancer screening in this age group. Opportunities identified for optimizing the experience of breast biopsies for women include positive interactions with radiology staff and physicians and systematic processes that minimize the wait time for test results. Women want information that explains biopsy procedures and diagnosis-specific information post-biopsy. Patient education materials would need to reflect current recommendations,3 particularly for diagnoses that are associated with higher risk for breast cancer, such as atypia, and to acknowledge the paucity of evidence supporting mortality benefit from such follow-up. Delivering this information via the primary care provider, with whom women wanted to communicate, would improve on-going shared decision making about future breast cancer screening. Decision aids that personalize screening recommendations based upon women’s competing medical issues and life expectancy4,5 would ideally be easily accessible in the primary care setting within an electronic medical record. These supports are needed to decrease the harms of breast cancer screening among women 65 years and older.

Consequences of false-positive screening mammograms.

False-positive mammograms, a common occurrence in breast cancer screening programs, represent a potential screening harm that is currently being evaluated by the US Preventive Services Task Force. To measure the effect of false-positive mammograms on quality of life by measuring personal anxiety, health utility, and attitudes toward future screening. The Digital Mammographic Imaging Screening Trial (DMIST) quality-of-life substudy telephone survey was performed shortly after screening and 1 year later at 22 DMIST sites and included randomly selected DMIST participants with positive and negative mammograms. Mammogram requiring follow-up testing or referral without a cancer diagnosis. The 6-question short form of the Spielberger State-Trait Anxiety Inventory state scale (STAI-6) and the EuroQol EQ-5D instrument with US scoring. Attitudes toward future screening as measured by women's self-report of future intention to undergo mammographic screening and willingness to travel and stay overnight to undergo a hypothetical new type of mammography that would identify as many cancers with half the false-positive results. Among 1450 eligible women invited to participate, 1226 (84.6%) were enrolled, with follow-up interviews obtained in 1028 (83.8%). Anxiety was significantly higher for women with false-positive mammograms (STAI-6, 35.2 vs 32.7), but health utility scores did not differ and there were no significant differences between groups at 1 year. Future screening intentions differed by group (25.7% vs 14.2% more likely in false-positive vs negative groups); willingness to travel and stay overnight did not (9.9% vs 10.5% in false-positive vs negative groups). Future screening intention was significantly increased among women with false-positive mammograms (odds ratio, 2.12; 95% CI, 1.54-2.93), younger age (2.78; 1.5-5.0), and poorer health (1.63; 1.09-2.43). Women's anticipated high-level anxiety regarding future false-positive mammograms was associated with willingness to travel overnight (odds ratio, 1.94; 95% CI, 1.28-2.95). False-positive mammograms were associated with increased short-term anxiety but not long-term anxiety, and there was no measurable health utility decrement. False-positive mammograms increased women's intention to undergo future breast cancer screening and did not increase their stated willingness to travel to avoid a false-positive result. Our finding of time-limited harm after false-positive screening mammograms is relevant for clinicians who counsel women on mammographic screening and for screening guideline development groups.

Cellular characteristics of nipple aspiration fluid during the menstrual cycle in healthy premenopausal women.

Cellular characteristics of nipple aspiration fluid during the menstrual cycle in healthy premenopausal women Fifteen healthy premenopausal female volunteers underwent weekly nipple aspiration of ductal fluid from both breasts during two menstrual cycles to investigate the variability of the cellular profile of the ductal fluid. Ductal fluid was successfully obtained using breast massage and nipple-areolar suction from 247/280 (89%) breasts. 83% of samples available for cytological analysis were cellular and 30% of cellular aspirates contained ductal epithelial cells identified using standard morphological criteria. No significant variation in cell number or cell type was identified during the menstrual cycle. All samples tested had an 'H' score of zero for oestrogen receptor. Seven out of 14 women expressed the proliferation marker Mcm-2 in the cells of at least one of the specimens, with no evidence of a menstrual cycle influence on expression. In conclusion, the cellular profile of breast ductal fluid did not vary consistently during the menstrual cycle, permitting future breast cancer screening studies incorporating serial nipple aspirations to be performed independent of the phase of the cycle.

Pain experienced by women attending breast cancer screening.

The purpose of this study was to evaluate the pain experience of women during mammography for breast cancer screening. Possible associations with personal and medical history, sociodemographics and/or situational factors were studied. It was also investigated whether this pain influenced the intention to return for future breast cancer screening. In the Netherlands, women between 50-75 years are invited for screening every two years. A total of 1200 participants were asked to fill up a questionnaire. The response rate was 79.5% (n = 954), and 945 questionnaires contained adequate information for analyses. A total of 689 women (72.9%) described mammography as mild to severely painful. In this group, compared to the group that reported no pain, the following factors occurred significantly more often: sensitive breasts (P = 0.001), family history of breast diseases (P = 0.017); expected pain based on former mammography (P = 0.001), high education (P = 0.008), anxiety (P = 0.001), breast sensitivity in last three days (P = 0.001), insufficient attention of technologist (P = 0.001). Other factors like age, hormonal status, breast size and hormone use were not associated with the pain experienced. Thirty-two women (3.3%) indicated that they would not attend further screening, 25 (2.6%) reported that the pain might deter them, six women (0.6%) had other reasons, one woman (0.1%) was sure not to come because of severe pain. In conclusion, a large majority of women attending breast cancer screening describes mammography as painful (72.9%). Factors associated with pain were described. Relatively few women (2.7%) indicated that the pain might deter them from future mammography. Recommendations are given to reduce the pain experienced during screening mammography.

Mammography knowledge and intentions among insured women

Method. A survey was conducted among 1,113 randomly selected insured state university employees to evaluate knowledge of the American Cancer Society mammography guidelines, awareness of insurance coverage for screening mammograms, previous guideline adherence, and future mammography intentions. Results. The survey, which included two mailings with follow-up phone calls of nonresponders, had a refusal rate of 6%. Respondents were relatively more likely to know the guidelines for older age groups; 77% knew the guideline for women 50+. Over one-third of the respondents were not aware that their insurance policy covered screening mammograms. For women who had never had a mammogram, insurance knowledge was significantly related to intentions to have a mammogram in the future. Previous screening adherence, as well as future intentions, was positively related to the age of the respondent. The results are contrasted with those of previous studies, and the implications for the content of future breast cancer screening campaigns are discussed.