Breast Cancer Screening Guidelines Research Articles

Breast Cancer in Asia: Incidence, Mortality, Early Detection, Mammography Programs, and Risk-Based Screening Initiatives.

Simple SummaryNearly all breast cancer patients survive for more than five years when the tumor is found early and in the localized stage. Regular clinical breast examinations, mammograms, and monthly self-exams of the breasts all contribute to early detection. However, late-stage breast cancers are common in many Asian countries. Low-income countries suffer from a lack of resources for breast cancer screening. High-income countries, on the other hand, are not benefiting fully from national breast screening programs due to an underutilization of the preventive healthcare services available. Existing reviews on Asian breast cancers are heavily focused on risk factors. The question of whether we should adopt or adapt the knowledge generated from non-Asian breast cancers would benefit from an extension into screening guidelines. In addition, several Asian countries are piloting studies that move away from the age-based screening paradigm.Close to half (45.4%) of the 2.3 million breast cancers (BC) diagnosed in 2020 were from Asia. While the burden of breast cancer has been examined at the level of broad geographic regions, literature on more in-depth coverage of the individual countries and subregions of the Asian continent is lacking. This narrative review examines the breast cancer burden in 47 Asian countries. Breast cancer screening guidelines and risk-based screening initiatives are discussed.

Review of the scientific literature on the use of automated breast ultrasound for screening

Several technological developments have been carried out recently to improve the effectiveness of breast cancer screening. Most of them have emerged as a complementary method to mammography. Automated breast ultrasound is one of these technologies. The objective of this study is to provide an overview on guidelines and recommenda-tions related to the application of automated breast ultrasound as a screening modality and to summarize the scien-tific literature. Targeted literature review was performed to collect information. We searched in publicly available databases for guidelines and recommendations as well as scientific publications on screening and early detection. We found substantial amount of information about automated breast ultrasound mainly for patients with dense breast; however, breast cancer screening guidelines have not yet incorporated this technology. 9 clinical studies were in-cluded in the review, most of them were single-arm studies with relatively short follow-up time. Most of them were performed in the USA. Results were presented mainly for short-term outcomes of breast cancer screening: sensitiv-ity, specificity, tumor detection rate and recall rate. The opportunity for retrospective evaluation of the images and the reproducibility are considered the most important advantages. Evidence suggest that the cancer detection rate can be improved compared to mammography alone in women with dense breast. The main disadvantages of this technology are the high recall and false positive rates. Further scientific evidence is required to reduce uncertainty related to the use of automated breast ultrasound for breast cancer screening.

Sociodemographic Determinants in Breast Cancer Screening among Uninsured Women of West Texas.

Background and Objectives: Early detection through appropriate screening is key to curing breast cancer. The Access to Breast Care for West Texas (ABC4WT) program offers no-cost mammography to underserved women in West Texas. The U.S. Preventative Task Force (USPSTF) guidelines are breast cancer screening guidelines which suggest screening for all women at the age of 50 years. The focus of this study was to identify sociodemographic barriers and determinants for breast cancer screenings, as well as screening outcomes, in low income, uninsured, or under-insured communities in West Texas. Materials and Methods: The ABC4WT program’s patient database was queried from 1 November, 2018, to 1 June, 2021, for sociodemographic variables, screening history, and results to identify high-risk groups for outreach. The American College of Radiology’s risk assessment and quality assurance tool, BI-RADS (Breast Imaging-Reporting and Data System), a widely accepted lexicon and reporting schema for breast imaging, was used for risk differentiation. Results: The cancer rate for ABC4WT’s program was significantly higher than the national mean (5.1), at 23.04 per 1000 mammograms. Of the 1519 mammograms performed, women between 40 and 49 years old represented the highest percentages of BI-RADS 4 and 5 (42.0% and 28.0%, respectively; p = 0.049). This age group also received 43.7% of biopsies performed and comprised 28.6% (n = 10) of cancers diagnosed (n = 35) (p = 0.031). Additionally, participants with a monthly household income of less than USD 800/month/person were more likely to result in a cancer diagnosis (70.6%) than higher incomes (29.4%) (p = 0.021). Conclusions: These determinants most starkly impacted women 40–49 years old who would not have been screened by U.S. Preventative Services Task Force (USPSTF) guidelines. This population with increased cancer risk should be encouraged to undergo screening for breast cancer via mammography.

Patient-Physician Relationships and Mammography Use in Korean American Women.

Breast cancer is prevalent and fatal in Korean American women (KAW) and KAW report low screening rates. This study examined the impact of patient-physician relationships on mammography use in KAW, focusing on patient-physician ethnic and gender concordance, distrust in health professionals, and accessibility to health care. Cross-sectional survey data were collected from 340 KAW in North Carolina, and logistic regression was conducted to identify factors associated with mammography use. Having a non-Korean physician, regular check-ups, and physician recommendations were positively associated with getting mammography. Neither gender concordance nor distrust in health professionals predicted adherence to breast cancer screening guidelines. The findings highlight the critical roles of routine health care practice and usual source of care in compliance with the screening guidelines in KAW. Additional research is warranted to explore breast cancer screening recommendation behaviors and patterns of Korean American physicians compared to non-Korean counterparts.

RWD133 Adherence to Breast Cancer Screening Guidelines and Its Association with Survival in Women Treated for Breast Cancer in Colombia: A National Cohort Study Based on Administrative Claims

Breast cancer (BC) is the most common neoplasm among women in Colombia. Colombian guidelines recommend screening women aged 50 to 69 years with biannual mammography, yet adherence to screening or its impact on mortality at a national level have not been assessed. We aimed to determine adherence to BC screening guidelines and its association with 3-year overall survival in women treated for BC in 2015 in Colombia.

Breast cancer incidence in patients with BRCA-related advanced ovarian cancer receiving olaparib-based maintenance therapy: A pooled analysis from phase III clinical trials.

5566 Background: As the prognosis of BRCA-related advanced ovarian cancer (AOC) continues to improve thanks to the introduction of targeted therapies like poly ADP-ribose polymerase inhibitors (PARPi) and bevacizumab, the occurrence of second primary tumors, in particular breast cancer (BC), is assumed to be more common. Despite this, data on the incidence of BC in this population are poor and guidelines for BC screening or risk reducing strategies are lacking. Methods: Published data from recent PARPi-based, phase III clinical trials involving germline BRCA mutated AOC were reviewed and analyzed. Only studies in which the incidence of at least one second primary solid tumor was reported were included. Cases of second primary BC cancers were pooled to calculate cumulative incidence according to the median follow-up period for each trial. 95% confidence interval (CI) was considered. Results: Four trials (SOLO1, PAOLA1, SOLO2 and SOLO3) involving 1186 germline BRCA 1-2 mutated AOC patients were included ( BRCA1, n = 816; BRCA2, n = 360; BRCA1 + BRCA2, n = 4; missing, n = 6). In all trials, patients were randomized to receive olaparib +/- bevacizumab (n = 788) versus placebo or standard therapies (n = 398). Median age at diagnosis of AOC was 56 years (range, 29-87). With a follow-up ranging from 3.9 months to 5 years, 16 new cases of BC were recorded, 10 in PARPi-based arms and 6 in control arms. Only two patients had a previous history of BC. The total cumulative incidence of BC was 1.37% (95% CI, 0.77-2.18), while cumulative incidences were 1.26% (95% CI, 0.61-2.31) and 1.51% (95% CI, 0.55-3.25) in PARPi-based arms and control arms, respectively. In a sensitivity analysis excluding the SOLO3 trial with the shortest follow-up, the total cumulative incidence was 1.63% (95% CI, 0.92-2.67). Other 20 cases of second primary solid tumors were registered, including 4 cases of non-small cell lung cancer. Conclusions: Patients with germline BRCA-related AOC receiving PARPi-based maintenance therapy can be reassured about the risk of second primary BC and intensive screening should be avoided at least in early treatment phase. More data with long term follow-up are needed.

Perceptions towards breast and cervical cancer development and screening in transgender and nonbinary persons.

e18500 Background: Approximately 1.4 million adult Americans identify as transgender (TG) or non-binary (NB), a number that has steadily increased over time. In this population, cancer risk is unclear, and screening and treatment guidelines are lacking. We sought to assess TG and NB persons’ perceptions towards breast and cervical cancer screening, risk of cancer development, and thoughts towards gender-affirming hormone therapy in the setting of a hormone-receptor positive breast cancer. Methods: A single-institution online survey was administered from October 2021-January 2022 at our comprehensive LGBTQ+ Inclusion Health Clinic. Participants with female sex at birth were asked about breast and cervical cancer, while those assigned male sex at birth were exclusively asked about breast cancer. A 5-point Likert scale was used to assess attitudes toward cancer screening and concerns regarding cancer development. Results: 40 patient responses were collected: 13% were TG women, 45% TG men, 23% NB, and 20% identified as other (i.e., agender, genderqueer, etc). 71% were assigned female sex at birth (59% of whom had chest masculinization surgery), 27% were assigned male sex at birth, and one individual was intersex at birth. 52.5% were age < 30, 84% were Caucasian, 65% had at least a bachelor’s degree, and all but one respondent had health insurance. The majority reported they were not familiar with breast (77%) or cervical (60%) cancer screening recommendations for their sex-assigned at birth or current gender identity. 23% reported concern regarding breast cancer development and cited family history as the primary reason. In patients age > 40, 50% had a mammogram (MMG) in the past 10 years. When presented with information regarding screening MMG and automated breast ultrasonography (ABUS), 78% reported they would prefer ABUS over MMG for breast cancer screening. 84% of respondents were currently using or had previously used gender-affirming hormone therapy, and of these, 61% reported they would stop therapy in the event they developed a hormone-receptor positive breast cancer. In patients assigned female sex at birth, 25% had a hysterectomy and, in those who still had a cervix, 50% reported having a Pap smear in the past 5 years and 38% were concerned about cervical cancer development. Conclusions: This survey identified that > 60% of TG and NB individuals are unaware of breast and cervical cancer screening guidelines, > 20% are concerned about breast and cervical cancer development, and < 50% of patients eligible for breast and cervical cancer screening had undergone screening in recent years. Additionally, in the setting of a hormone-receptor positive breast cancer, only 61% would consider stopping gender-affirming hormone therapy. Further data on the risk of breast and cervical cancer development and incidence in TG and NB persons is needed to inform optimal screening and treatment guidelines.

The Impact of Dense Breasts on the Stage of Breast Cancer at Diagnosis: A Review and Options for Supplemental Screening.

The purpose of breast cancer screening is to find cancers early to reduce mortality and to allow successful treatment with less aggressive therapy. Mammography is the gold standard for breast cancer screening. Its efficacy in reducing mortality from breast cancer was proven in randomized controlled trials (RCTs) conducted from the early 1960s to the mid 1990s. Panels that recommend breast cancer screening guidelines have traditionally relied on the old RCTs, which did not include considerations of breast density, race/ethnicity, current hormone therapy, and other risk factors. Women do not all benefit equally from mammography. Mortality reduction is significantly lower in women with dense breasts because normal dense tissue can mask cancers on mammograms. Moreover, women with dense breasts are known to be at increased risk. To provide equity, breast cancer screening guidelines should be created with the goal of maximizing mortality reduction and allowing less aggressive therapy, which may include decreasing the interval between screening mammograms and recommending consideration of supplemental screening for women with dense breasts. This review will address the issue of dense breasts and the impact on the stage of breast cancer at the time of diagnosis, and discuss options for supplemental screening.

Association Between Body Mass Index and Cancer Screening Adherence Among Latinas in the United States and Puerto Rico.

Research on the role of body size on cancer screening is mixed with few studies among Latinas in the United States. We evaluated the association between body size and cancer screening adherence among Latinas living in Puerto Rico and the rest of the United States. We conducted a cross-sectional study using 2012-2018 Behavioral Risk Factor Surveillance System data among Latinas 50-64 years of age (n = 16,410). Breast, cervical, and colorectal cancer screening (guideline adherent: yes/no), height and weight were self-reported. Prevalence ratios (PRs) derived from Poisson models were estimated for each cancer screening utilization for Puerto Rico versus rest of the United States by body mass index (BMI) category. Nearly a quarter of women lacked adherence with breast and cervical cancer screening and 43.6% were nonadherent to colorectal cancer screening. Latinas with BMI ≥40.0 kg/m2 in both groups were more likely to lack adherence to cervical cancer screening than women with BMI 18.5-24.9 kg/m2. For those with BMI ≥40.0 kg/m2, Latinas in Puerto Rico were more likely to lack adherence to colorectal cancer screening recommendations than Latinas living in the rest of the United States (adjusted PR: 1.38; 95% confidence interval = 1.12-1.70). The role of body size in cancer screening utilization among Latinas differs in women living in Puerto Rico versus in the rest of the United States and varies by cancer type. Understanding Latinas' experience can inform culturally adapted interventions to promote cancer screening.

Body Mass Index and Breast and Cervical Cancer Screening.

Background:Breast and cervical cancer screening are responsible for dramatically reducing cancer deaths. Overweight and obesity are associated with deleterious health outcomes, including increased risk of developing cancer. This study adds to the existing literature examining the association of having overweight and obesity and receipt of breast or cervical cancer screening.Methods:Using the 2013 Brazos Valley Community Health Needs Assessment, we examined the association between body mass index (BMI) and receipt of breast or cervical cancer screening among women meeting age recommendations for breast cancer and cervical cancer screening (n = 1979 and n = 2040), respectively. We used SPSS 22 statistical software for descriptive and logistic regression analysis.Results:Overall, 26.6% of women missed the breast cancer screening guidelines, and 13.3% missed the cervical cancer screening guidelines. BMI had a weak association with missing cervical cancer screenings (odds ratio [OR] = 1.02; confidence interval [CI] = 1.01–1.04), but no association with missing breast cancer screenings (OR = 1.01; CI = 0.99–1.03). Higher age, race (non-White), rural area, no health insurance, smoking, and delayed health care were associated with missing breast cancer screenings. Higher age, marital status (single), lower education, no health insurance, smoking, and delayed health care were associated with missing cervical cancer screening. Further research is needed to better understand the association using larger, more diverse samples.

Sociodemographic correlates of colorectal cancer screening completion among women adherent to mammography screening guidelines by place of birth

IntroductionColorectal cancer screening rates in the U.S. still fall short of national goals, while screening rates for other cancer sites, such as breast, remain high. Understanding characteristics associated with colorectal cancer screening among different groups of women adherent to breast cancer screening guidelines can shed light on the facilitators of colorectal cancer screening among those already engaged in cancer prevention behaviors. The purpose of this study was to explore which demographic characteristics, healthcare access factors, and cancer-related beliefs were associated with colorectal cancer screening completion among U.S. and foreign-born women adherent to mammography screening recommendations.MethodsAnalyses of the 2015 National Health Interview Survey were conducted in 2019. A sample of 1206 women aged 50–74 who had a mammogram in the past 2 years and were of average risk for colorectal cancer was examined. Logistic regression was used to determine demographic, health service, and health belief characteristics associated with colorectal cancer screening completion.ResultsFifty-five percent of the sample were adherent to colorectal cancer screening recommendations. Women over the age of 65 (AOR = 1.76, 95% CI 1.06–2.91), with any type of health insurance, and who were bilingual (AOR = 3.84, 95% CI 1.83–8.09) were more likely to complete screening, while foreign-born women (AOR = 0.53, 95% CI 0.34–0.83) were less likely. Cancer-related beliefs did not influence adherence. Stratified analyses by nativity revealed additional associations.ConclusionsDemographic and health service factors interact to influence colorectal cancer screening among women completing breast cancer screening. Colorectal cancer screening interventions targeting specific underserved groups and financing reforms may enhance women’s colorectal cancer screening rates.

Breast cancer screening and early diagnosis in Chinese women.

Breast cancer is the most common malignant tumor in Chinese women, and its incidence is increasing. Regular screening is an effective method for early tumor detection and improving patient prognosis. In this review, we analyze the epidemiological changes and risk factors associated with breast cancer in China and describe the establishment of a screening strategy suitable for Chinese women. Chinese patients with breast cancer tend to be younger than Western patients and to have denser breasts. Therefore, the age of initial screening in Chinese women should be earlier, and the importance of screening with a combination of ultrasound and mammography is stressed. Moreover, Chinese patients with breast cancers have several ancestry-specific genetic features, and aiding in the determination of genetic screening strategies for identifying high-risk populations. On the basis of current studies, we summarize the development of risk-stratified breast cancer screening guidelines for Chinese women and describe the significant improvement in the prognosis of patients with breast cancer in China.

Global disparity in breast cancer screening guidelines- Is there a need for an individualized approach for breast cancer screening?

Breast cancer screening is the key to better clinical outcomes. Cancer diagnosed at the stage where it is still within the ducts has the highest potential for best survival. A screening mammogram is a key for early detection. However, there is variation in the age guidelines for starting the screening and cessation. Given the rate of breast cancer in the region, the government's economic resources and the priority of the screening service all play a role. Developed countries have benefited from screening mammogram facilities and improved disease outcomes, but underdeveloped countries have not yet developed national screening programs. Thus nations must take the incidence of the biology of breast cancer into account and make evidence-based

Personalized Disease Screening Decisions Considering a Chronic Condition

Clinical practice guidelines do not sufficiently address the needs of patients with chronic conditions as these guidelines focus on single disease management and ignore unique patient-specific conditions. As a result, a nonpersonalized approach to the management of the patients with chronic conditions leads to adverse events and increases the financial burden on the healthcare system as over 150 million Americans experience chronic conditions. To this end, we develop a stochastic modeling framework to personalize the disease screening decisions for patients with or at risk for developing a chronic condition and provide an exact solution algorithm. We consider the optimal management of the screening decisions for an index disease (e.g., breast cancer, colorectal cancer, human immunodeficiency virus, etc.) while accounting for the existence of a chronic condition (e.g., hypertension, diabetes, Alzheimer’s disease, etc.). Our modeling framework is particularly useful for the cases where the chronic condition affects the risk of the index disease. In a case study using real breast cancer epidemiology data, we demonstrate how our modeling framework can be used to personalize breast cancer screening for women with type 2 diabetes. In addition to providing a personalized breast cancer screening schedule for women with diabetes, we find some important policy insights that were not previously recognized by the medical community. More specifically, we find that compared with women without diabetes, women with diabetes should be screened less aggressively, but screening should end at similar ages. We also find that adherence to the optimal screening policy is more crucial for women with diabetes compared with nondiabetic women. Our main insight on screening recommendations also has important resource implications as it leads to fewer screening mammograms. That is, compared with the current national breast cancer screening guidelines, the optimal breast cancer screening policy for women with diabetes could save the healthcare system approximately 2.6 million mammograms annually. This paper was accepted by Stefan Scholtes, healthcare management. Funding: This work was supported in part by the National Institutes of Health under the National Cancer Institute [Grants U01CA152958 and U01CA253911]. Supplemental Material: The data files and online appendix are available at https://doi.org/10.1287/mnsc.2022.4336 .

Effect of inpatient breast cancer education and risk assessment on mammography utilization among hospitalized women post discharge

ABSTRACT Objective To evaluate prevalence of nonadherence to breast cancer screening guidelines after bedside educational intervention and informed individualized risk assessment score during an inpatient stay. Methods A prospective intervention study was conducted among 507 cancer-free (except skin cancer) women aged 50–75 years hospitalized to a general medicine service. Study intervention included one-on-one bedside education via handout and videos about breast cancer screening and informed individualized risk assessment using the Gail risk model to predict 5-year risk for breast cancer development. Study outcomes were measured using posthospitalization follow-up survey to determine if intervention resulted in improved adherence to breast cancer screening. Chi-square and unpaired t-tests were utilized to compare population characteristics. Results The mean age for the study population was 60.5 years (SD = 6.9), the mean 5-year Gail risk score was 1.77 (SD = 1), and 36% of women were African American. One hundred sixty nine (33%) hospitalized women were nonadherent to breast cancer screening recommendations. Only 15% of the nonadherent women were reachable for follow-up survey, and 42% of these women self-reported adherence to screening mammography after a mean follow-up period of 27 months. Conclusion This study provides evidence that most women who are nonadherent to breast cancer screening remain nonadherent after hospital discharge despite educational interventions. Our study intervention was only partially successful in enhancing breast cancer screening among hospitalized women who were overdue and at high risk. Further studies need to evaluate strategies to overcome the barriers and improve adherence whenever patients encounter health care system regardless of clinical locale.

Examining the Association of Food Insecurity and Being Up-to-Date for Breast and Colorectal Cancer Screenings.

Food insecurity (FI) has been associated with poor access to health care. It is unclear whether this association is beyond that predicted by income, education, and health insurance. FI may serve as a target for intervention given the many programs designed to ameliorate FI. We examined the association of FI with being up-to-date to colorectal cancer and breast cancer screening guidelines. Nine NCI-designated cancer centers surveyed adults in their catchment areas using demographic items and a two-item FI questionnaire. For the colorectal cancer screening sample (n = 4,816), adults ages 50-75 years who reported having a stool test in the past year or a colonoscopy in the past 10 years were considered up-to-date. For the breast cancer screening sample (n = 2,449), female participants ages 50-74 years who reported having a mammogram in the past 2 years were up-to-date. We used logistic regression to examine the association between colorectal cancer or breast cancer screening status and FI, adjusting for race/ethnicity, income, education, health insurance, and other sociodemographic covariates. The prevalence of FI was 18.2% and 21.6% among colorectal cancer and breast cancer screening participants, respectively. For screenings, 25.6% of colorectal cancer and 34.1% of breast cancer participants were not up-to-date. In two separate adjusted models, FI was significantly associated with lower odds of being up-to-date with colorectal cancer screening [OR, 0.7; 95% confidence interval (CI), 0.5-0.99)] and breast cancer screening (OR, 0.6; 95% CI, 0.4-0.96). FI was inversely associated with being up-to-date for colorectal cancer and breast cancer screening. Future studies should combine FI and cancer screening interventions to improve screening rates.

An Examination of Factors That Influence Receipt of Reproductive Health Screenings Among Female Veterans.

As the number of women veterans grows, so does the need to ensure they receive timely health care, including preventive reproductive health screenings such as cervical cancer screenings and mammograms. However, little is known about the rates of reproductive health screenings among veterans and what factors may be related to screening. The objectives of this cross-sectional study were to (1) understand healthcare treatment-seeking experiences among women veterans, (2) determine the rate of adherence to screening guidelines for cervical and breast cancers, and (3) examine potential correlates of adherence to clinical reproductive health screening guidelines. Women veterans completed an electronically administered survey, which assessed personal characteristics, psychological health symptoms, military service history, health insurance status, healthcare-seeking experiences (e.g., barriers to and satisfaction with care), and receipt of cervical and breast cancer screenings. Multivariable logistic regression identified factors associated with adherence to clinical guidelines for cervical and breast cancer screening. Of the 90 women (mean age = 38.78; SD = 12.19) who participated, 64 (71.10%) reported meeting all age-applicable screening guidelines. The most common barriers to obtaining women's healthcare were availability of convenient appointment times, finding time in your schedule to make and go to an appointment, and long wait times for appointments. Multivariable logistic regression revealed veterans without a regular women's health provider were less likely to adhere to guidelines than those with a regular provider (OR = 0.16; 95% CI, 0.04-0.57). Many women veterans are unable to receive reproductive health screenings; continued efforts are needed to determine how to increase adherence in this unique population.

Abstract P1-02-06: Prediction of Prosigna® breast cancer intrinsic subtype by immunohistochemical ER, PR and Ki67 expression

Abstract The present study evaluated whether Prosigna® breast cancer assay intrinsic subtype (IST) can be predicted using a specified cutoff for Ki67 proliferation index and immunohistochemical (IHC) biological subtype estimation, complemented by estrogen receptor (ER) and progesterone receptor (PR) expression in a clinical cohort. Our study included 185 cases of early stage ER-positive, HER2-negative breast cancer treated at the Comprehensive Cancer Center of the Medical University of Vienna between 2014 and 2019. Prosigna® breast cancer assay was performed when recommended by the institutional multidisciplinary tumor board to aid adjuvant therapy decision. Pathological diagnostics was carried out according to current WHO and EU breast cancer screening and diagnostics guidelines. Immunohistochemical assessment of ER, PR, human epidermal growth factor receptor 2 (HER2) and proliferation index by Ki67 was performed using Ventana Benchmark Ultra (Tucson, AR, USA) according to recent ASCO/USCAP guidelines. Univariable logistic regression was used to verify that Ki67 positivity is predictive for IST LumA and LumB tumors according to Prosigna® IST. Probability for luminal B IST was estimated by receiver operating characteristics and Youden index was calculated. Next, multivariable logistic regression was applied to test the hypothesis that additional inclusion of ER and PR receptor expression contain additional information regarding IST. Median age of patients was 56 years. 52 patients (28%) had tumors larger than 2 cm (pT2-pT3). 75 patients (41%) had lymph node metastases. 83 (45%), 98 (53%) and 3 (2%) of tumors were diagnosed as luminal A, luminal B and HER2-enriched subtype by Prosigna®, respectively. 19 (10%), 77 (42%) and 89 (48%) tumors could be allocated in the low, intermediate and high risk groups, respectively. Univariable logistic regression confirmed that higher Ki67 positivity significantly, yet insufficiently predicts luminal B tumor subtype (p<0.0001). There was no justification for an optimal Ki67 cutoff and irrespective of its value, no more than 70% of tumors could correctly be assigned to the IST, according to a Youden-Index of maximum 0.42. The hypothesis that including ER and PR expression improves accuracy could not be confirmed (p=0.14). Although higher Ki67 positivity significantly predicted luminal B tumor subtype, the Prosigna® breast cancer assay provided independent information for adjuvant therapy decision in cases where Ki67 IST estimation alone is not sufficient. Irrespective of the chosen cutoff value, a maximum accuracy of 70% was achieved for correctly predicting IST, including ER and PR expression into our model did not improve accuracy. Therefore, IST determination by the Prosigna® breast cancer assay cannot be replaced by immunohistochemical parameters. Citation Format: Ulrike Heber, Kristina Tendl-Schulz, Stefan Heber, Sabine Danzinger, Rupert Bartsch, Christian F. Singer, Florian Fitzal, Ruth Exner, Michael F. Gnant, Leonhard Müllauer, Zsuzsanna Bago-Horvath. Prediction of Prosigna® breast cancer intrinsic subtype by immunohistochemical ER, PR and Ki67 expression [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-02-06.

Abstract P3-14-09: Breast cancer disparities through an imaging lens: Are black women more likely to have cancer detected on their first mammogram?

Abstract Introduction Black women are more likely to be diagnosed with early-onset breast cancer, have triple negative disease, carry pathogenic variants in BRCA2, and are 41% more likely to die from the disease. The American College of Radiology recommends risk assessment for all Black women by age 30. Still, it remains unclear whether this population may benefit from earlier screening mammography. We evaluated women treated for breast cancer between ages 40 and 45 to determine the frequency of cancer detection on first mammogram for Black patients versus other racial/ethnic groups. We also analyzed risk factors associated with first mammogram-detected cancers. Methods Demographic, mammographic, and clinico-pathologic data were obtained from 724 women ages 40-45 who underwent oncologic surgery for breast cancer at our institution between 2010 and 2019. We defined first mammogram cancers as those with tissue diagnoses within three months of first mammogram. A logistic regression model was applied to assess the association of collected variables with cancer detection on baseline mammogram by racial/ethnic group. Results In the overall cohort of 724 patients, the mean age at breast cancer diagnosis was similar across ethnic groups (42.8 years, p=0.624). Black women were more likely to have a BMI greater than 30 (p=<0.001), to be current smokers (p=0.033), to have a variant of unknown significance on germline genetic testing (p=0.049), and present with Stage 2 or Stage 3 disease. Black women were also significantly more likely to have breast cancer detected on their first mammogram (38/80, 47.5%) compared to White women (153/611, 25.0%) and Asian women (7/21, 33.0%) (p = <0.001). One hundred ninety eight patients (27.3% of overall cohort) were diagnosed with breast cancer on their first mammogram. The mean age at diagnosis was similar across ethnicities within this subgroup (42.2 years, p=0.136). The only risk factor of statistical significance detected differentially in Black women among both the overall cohort and the subgroup of first mammogram cancer diagnoses was a BMI greater than 30. Black women with cancers detected on first mammogram presented more often with later stage disease, though this trend did not reach statistical significance (p=0.07). Conclusion Breast cancer screening guidelines for women age 40-45 vary. Unless a woman is evaluated based on family history and pedigree suggestive of hereditary cancer or familial clustering, there are no screening guidelines for women under age 40. Women identified with BRCA mutations, for example, would initiate high-risk screening at the age of 25, and even those with family history of early onset disease in the absence of a genetic mutation would initiate high risk screening to include contrast-enhanced MRI ten years earlier than the first affected relative. Our data suggests that Black women between age 40 and 45 are more likely to have cancer detected on their first mammogram. Early risk stratification and assessment, education and counseling on risk mitigation, and possibly initiation of earlier screening (even in the absence of family history) may be warranted in this group. First Mammogram Cancers by RaceAllAsianBlackWhitep-valueN=712N=21N=80N=611Cancer on first mammogram, N (%):198 (27.8%) 7 (33.3%) 38 (47.5%) 153 (25.0%) <0.001 Citation Format: Avia Wilkerson, Megan Obi, Camila Ortega Estrella, Chao Tu, Holly Pederson, Zahraa Al-Hilli. Breast cancer disparities through an imaging lens: Are black women more likely to have cancer detected on their first mammogram? [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-14-09.

Nurse Practitioners’ Awareness of Existing Barriers Regarding Breast and Cervical Cancer Screening Among African American Women

Background and Significance: Despite availability of adequate screening protocols, African American (AA) women face increased incidence of breast and cervical cancer due to specific barriers to care. Nurse practitioners (NP) are perfectly positioned to identify and mitigate these specific barriers. Study Purpose and Aim: The purpose of this study was to explore NPs’ awareness of existing barriers regarding breast and cervical cancer screening among AA women. The aim of the study was to promote NP awareness and understanding of existing barriers to care and the need for evidence-based breast and cervical cancer screening protocols tailored to the needs of AA women. Methodology: A qualitative descriptive design was utilized with use of individual semi-structured interviews. Guided by an essentialist/ realist framework, Braun and Clarke’s reflective thematic analysis method was used to analyze data with an inductive approach and use of semantic or explicit data driven codes. Findings: One overarching theme, I’m Not Sure of Anything in Particular with African American Women as Far as Breast and Cervical Cancer Go, and three key themes, Multiple Screening Guidelines: Whatever It’s Called, It’s a Little Bit Too Late...Less Likely to Get Screening Done, and It All Just Comes Down to Awareness, were generated as a result of the analysis of data. Strengths and Limitations: Strengths of this study included use of semi-structured individual interviews which yielded rich data that provided valuable insight into an under-researched area of NP practice concerning cancer screening in AA women. Limitations included study implementation during the Covid-19 pandemic, the data collection time frame, a small sample size, use of convenience sampling, and potential for participant bias. Conclusion and Recommendations: The disparity that currently exists within healthcare for AA women regarding breast and cervical cancer screening is alarming with a critical need to be addressed and mitigated. Improved outcomes of breast and cervical cancer screening for AA women may be achieved through NP and patient education, the creation of culturally sensitive and appropriate standardized breast and cervical cancer screening recommendations and guidelines, and increased provider diversity to promote representation.