History Of Breast Cancer Screening Research Articles

Residual Risk of Breast Cancer After Bariatric Surgery

Excess adiposity confers higher risk of breast cancer for women. For women who have lost substantial weight, it is unclear whether previous obesity confers residual increased baseline risk of breast cancer compared with peers without obesity. To determine whether there is a residual risk of breast cancer due to prior obesity among patients who undergo bariatric surgery. Retrospective matched cohort study of 69 260 women with index date between January 1, 2010, and December 31, 2016. Patients were followed up for 5 years after bariatric surgery or index date. Population-based clinical and administrative data from multiple databases in Ontario, Canada, were used to match a cohort of women who underwent bariatric surgery for obesity (baseline body mass index [BMI] ≥35 with comorbid conditions or BMI ≥40) to women without a history of bariatric surgery according to age and breast cancer screening history. Nonsurgical controls were divided into 4 BMI categories (<25, 25-29, 30-34, and ≥35). Data were analyzed on October 21, 2021. Weight loss via bariatric surgery. Residual hazard of breast cancer after washout periods of 1, 2, and 5 years. Comparisons were made between the surgical and nonsurgical cohorts overall and within each of the BMI subgroups. In total, 69 260 women were included in the analysis, with 13 852 women in each of the 5 study cohorts. The mean (SD) age was 45.1 (10.9) years. In the postsurgical cohort vs the overall nonsurgical cohort (n = 55 408), there was an increased hazard for incident breast cancer in the nonsurgical group after washout periods of 1 year (hazard ratio [HR], 1.40 [95% CI, 1.18-1.67]), 2 years (HR, 1.31 [95% CI, 1.12-1.53]), and 5 years (HR, 1.38 [95% CI, 1.21-1.58]). When the postsurgical cohort was compared with the nonsurgical cohort with BMI less than 25, the hazard of incident breast cancer was not significantly different regardless of the washout period, whereas there was a reduced hazard for incident breast cancer among postsurgical patients compared with nonsurgical patients in all high BMI categories (BMI ≥25). Findings suggest that bariatric surgery was associated with a reduced risk of developing breast cancer for women with prior obesity equivalent to that of a woman with a BMI less than 25 and a lower risk when compared with all groups with BMI greater than or equal to 25.

Determinants of breast cancer screening mammography uptake: Results from Jordan population and family health survey.

Screening for breast cancer utilizing mammography is associated with reduced advanced cancer diagnosis and reduced breast cancer mortality. We aimed to assess the lifetime history of breast cancer screening utilization for Jordanian women aged 40 and 49 years and determinants of this utilization. This paper reports the analyzed data from the seventh cycle of the Jordan Population and Family Health Survey (JPFHS). For this study, the analysis was confined to 4486 women aged between 40 and 49 years at the time of data collection who reported their nationality as Jordanian. We used multivariate logistic regression analysis to assess whether any socio-demographic variables could predict greater breast cancer screening utilization. Only 14% of all respondents aged 40-49 years reported ever having a mammogram. Results of multivariate logistic regression showed that area of residence, husband's level of education, younger age, and living in a wealthy status were strong predictors of lifetime history of breast cancer screening. This study elucidates that breast cancer screening mammography among Jordanian women has remained opportunistic and underutilized despite the efforts of national entities to promote screening and early detection of breast cancer. There is a geographic and social disparity in the utilization of mammography screening among Jordanian women.

Abstract A123: Providing breast cancer screening in vulnerable communities: The impact of a mobile cancer screening van

Abstract Background: Mobile cancer screening vans (MCSV) are a promising approach to providing preventive cancer screenings to those in need. In 2021, the Sidney Kimmel Cancer Center (SKCC) at Jefferson launched an MCSV to cover its 7-county catchment area. The primary focus of the screening van is to provide breast cancer screenings, although other cancer screenings as well as connections to resources are periodically offered. Community organizations agree to host the MCSV at their site; up to 14 women can be screened for breast cancer at each event. Screening registration information as well as clinical outcomes from the mammogram are captured in the electronic health record (EMR). Here, we describe the impact of the MCSV during its first 8 months of operation. Methods: Data was pulled from the EMR for all women who received breast cancer screening on the MCSV between September 30, 2021 and May 31, 2022. Patient demographic information included age, gender, race and ethnicity, primary language spoken, insurance status, zip code of residence and breast cancer screening history. Clinical outcomes included screening result, need for follow-up and diagnosis of cancer, if relevant. Means and frequencies were calculated for each variable. Bivariate analyses investigated associations between patient demographics and previous screening history or screening exam results. Results: In partnership with community organizations, we have held 47 screening events and screened a total of 377 women in the previous 8 months. Of the 377 women screened, 175 (46%) were African American, 90 (24%) were Caucasian, and 61 (16%) were Hispanic. 279 (74%) of the women had health insurance while 98 (26%) were uninsured. Seventy (19%) women needed additional imaging or follow-up and one woman has been diagnosed with stage 1b invasive ductal carcinoma of the breast. The only significant difference among those screened was that those without health insurance were less likely to have a previous mammogram (X2 =4.002, p,.05).Conclusion: The SKCC MCSV is reaching a diverse population, based on race and ethnicity, and a population in need, based on insurance status. While we did not observe racial nor ethnic differences among those screened on the van in relation to screening results or previous screening, those without insurance are more likely to receive their first screening with the MCSV, another important marker that the van is reaching those in need. Citation Format: Christina L. Yurick, Nicola Cianci, Katie Bradley, Khaldoun Hamade, Christine Bonaccorso, Amy Leader. Providing breast cancer screening in vulnerable communities: The impact of a mobile cancer screening van [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A123.

S3656 Primary Diagnosis of Metastatic Breast Cancer via Esophagogastroduodenoscopy With Gastric Biopsies

Introduction: Gastric metastases are a rare manifestation of breast cancer and previous case reports suggest they typically occur in patients with a long standing history of breast cancer. We present a case of a patient whose primary diagnosis of breast cancer was made via gastric biopsies taken during esophagogastroduodenoscopy (EGD) after the patient presented to the hospital with symptoms of persistent nausea and vomiting. Case Description/Methods: The patient is a 58-year-old female with a reported history of alcohol use disorder who presented to the emergency department with intractable nausea and vomiting. On arrival, the patient’s vitals were stable and labs were only significant for a mildly elevated creatinine of 1.40, which normalized with IV fluids. Computed tomography (CT) of the abdomen and pelvis showed diffuse gastric wall thickening. Following the results of the CT, an EGD was performed which revealed diffuse gastritis with friable mucosa and concern for malignancy or ischemia. Gastric biopsies were suggestive of adenocarcinoma with likely primary being breast cancer. Immunohistochemical staining was positive for CDK7, GATA3, mammaglobin, and 80-90% estrogen receptor. Following consideration of both the pathologic appearance and immunohistochemical staining, the diagnosis was made of metastatic lobular carcinoma. Due to the patient's poor support system and functional status, the patient elected to pursue hospice, and therefore further workup was not performed (Figure 1). Discussion: Breast cancer is the second most common malignancy in women in the United States, with metastasis of breast cancer classically spreading to lungs, liver, bone, soft tissue, and adrenal glands. Metastasis to the gastrointestinal (GI) tract is rare, with lobular breast cancer having higher predilection over ductal carcinoma. The average time for breast cancer to metastasize to GI tract has been previously reported as many years after primary diagnosis. Here we present a case of breast cancer where the primary diagnosis was made after EGD assisted gastric biopsies. After extensive literature review, there is sparse information on early gastric metastasis of breast cancer. While our patient's previous history of breast cancer screening is unknown, she had no prior knowledge of her breast cancer diagnosis. This case signifies the importance of endoscopic evaluation and gastric biopsies in patients with nonspecific symptoms, especially with abnormal imaging findings suggestive of gastritis.Figure 1.: Endoscopic appearance of the gastric mucosa.

Bariatric Surgery and Breast Cancer Incidence: a Population-Based, Matched Cohort Study.

Obesity is associated with increased breast cancer risk in women. Bariatric surgery induces substantial weight loss. However, the effects of such weight loss on subsequent breast cancer risk in women with obesity are poorly understood. To examine breast cancer incidence and related outcomes in women with obesity undergoing bariatric surgery. This was a population-based matched cohort study of breast surgery outcomes utilizing linked clinical databases in Ontario, Canada. Women with obesity who underwent bariatric surgery were 1:1 matched using a propensity score to non-surgical controls for age and breast cancer screening history. The main outcomes were incidence of breast cancer after lag periods of 1, 2, and 5years. Additional outcomes included tumor hormone receptor status, cancer stage, and treatments undertaken. Time-varying Cox proportional hazard models accounting for screening during follow-up were used to model cancer incidence. A total of 12,724 women per group were included, average age 45.09. After a 1-year lag, breast cancer incidence occurred in 1.09% and 0.79% of the control and surgery groups, respectively (adjusted hazard ratio, 0.81 [95%CI 0.69-0.95]; p = 0.01). This association was maintained after lag periods of 2 and 5years. Women in the surgical cohort diagnosed with breast cancer were more likely to have low-grade tumors and less likely to have high-grade tumors (overall p < 0.01). No association was found for tumor hormone receptor status, although the surgical group was more likely to have her2neu-negative tumors (p = 0.01). Bariatric surgery was associated with a lower incidence of breast cancer and lower tumor grade in women with obesity. Further evaluation of outcomes, including mortality, is required.

Perceived Breast Cancer Risk among Female Undergraduate Students in Ghana: A Cross-Sectional Study.

Background While breast cancer accounts for the highest mortality among women across the globe, little is known about its perceived risks among them. We examined the perceived risk of breast cancer among undergraduate female university students in Ghana. Methods This was a cross-sectional survey of 358 undergraduate female students at the University of Health and Allied Sciences, Ghana. Descriptive and inferential statistics comprising frequencies, percentages, chi-square, and binary logistic regression analyses were used in analysing the data collected. All analyses were done using STATA Version 13.1. Results Seventy-three percent were aware of breast cancer and 45.2% out of this did not perceive themselves to be at risk of breast cancer. Academic year (p=0.02), school (p=0.01), knowledge of someone with breast cancer (p < 0.001), family history of breast cancer (p < 0.001), current use of oral pills/injectable contraception (p=0.03), history of breast cancer screening (p < 0.001), and intention to perform breast self-examination (p < 0.001) were the risk factors of breast cancer risk perception. Students without a family history of breast cancer were 90% less likely to perceive breast cancer risk (AOR = 0.10, 95% CI = 0.04–0.29) compared with those having a family history of breast cancer. Students who had never screened for breast cancer were also 62% less likely to perceive that they were at risk of breast cancer (AOR = 0.10, 95% CI = 0.04–0.29) compared with those who had ever screened for breast cancer. Conclusion This study showed that female university students tend to estimate their breast cancer risk based on their experience of breast cancer. Students who have ever screened for breast cancer and those with the intention to perform breast self-examination in the future are more likely to perceive themselves as being at risk and thus take action to avoid getting breast cancer.

Evaluation of Patterns in Access to Breast Cancer Care and Breast Cancer Presentation in a Safety Net Patient Population.

While prior studies have shown the apparent health disparities in breast cancer diagnosis and treatment, there is a gap in knowledge with respect to access to breast cancer care among minority women. We performed a retrospective analysis of patients with newly diagnosed breast cancer from 2014 to 2016 to evaluate how patients presented and accessed cancer care services in our urban safety net hospital. Patient demographics, cancer stage, history of breast cancer screening, and process of referral to cancer care were collected and analyzed. Of the 202 patients identified, 61 (30%) patients were younger than the age of 50 and 75 (63%) were of racial minority background. Only 39% of patients with a new breast cancer were diagnosed on screening mammogram. Women younger than the age of 50 (P < .001) and minority women (P < .001) were significantly less likely to have had any prior screening mammograms. Furthermore, in patients who met the screening guideline age, more than half did not have prior screening mammograms. Future research should explore how to improve breast cancer screening rates within our county patient population and the potential need for revision of screening guidelines for minority patients.

Survey on the Consciousness of Japanese Women Regarding Dense Breasts on Mammography

Patients with dense breasts on mammography have a higher risk of developing breast cancer and missing a tumor mass than those with non-dense breasts. Whether examinees who have dense breasts should be notified is currently under consideration in Japan; however, there is concern about the low level of understanding regarding dense breasts. A questionnaire survey on the degree of comprehension regarding dense breasts was conducted among 409 general women of >20 years of age in Hachinohe city in October 2017 and 2018. The results showed that the degree of comprehension was extremely low, as only 35 people (8.5%) responded with, “I know the meaning”; however, 32 of them (91.5%) stated that they would like to be notified in they had dense breasts. In addition, the degree of comprehension regarding dense breasts was significantly greater among those who had a breast cancer screening history (OR = 6.4; 95% CI = 2.0 - 19.8; P = 0.001) and a self-examination history than among those with no such history (OR = 2.5; 95% CI = 1.1 - 5.8; P = 0.03). However, the degree of comprehension did not differ between participants of years of age or between participants with and without a breast cancer sufferer among their close blood relatives. The present findings to reflect a low understanding of dense breasts on mammography screening and suggest that the degree of comprehension is influenced by the presence or absence of a consultation history and a self-examination history.

PII: S0899-7071(17)30263-2

It is important to understand the history of breast cancer screening to better understand the continuing effort to reduce access to screening. Since the randomized, controlled trials have shown a statistically significant mortality reduction for women ages 40-74, the appropriate threshold for initiating screening is age 40 with no data to support the use of the age of 50 as a threshold for screening. All women are at risk for developing breast cancer and all women should have access to screening.

Structural equation modeling for implementation intentions, cancer worry, and stages of mammography adoption

This study aimed to develop a structural model for mammography adoption in Japanese middle-aged women by using constructs from the transtheoretical model (TTM), the theory of planned behavior (TPB), implementation intentions, and cancer worry. Questionnaires based on items including TTM, TPB, implementation intentions, cancer worry-related variables, and demographic variables were distributed to 1000 adult women aged 40 to 59 years, with 641 subjects being used in the final analysis (response rate = 64.1%). Regarding the stage of adoption, 79 participants (12.3%) were at the precontemplation stage, 30 (4.7%) were at the relapse stage, 142 (22.2%) were at the contemplation stage, 88 (13.7%) were at the action stage, and 302 (47.1%) were at the maintenance stage. Our model, derived from structural equation modeling, revealed that the stage of mammography adoption was significantly affected by goal intentions, implementation intentions, perceived barriers, history of breast cancer screening, and relative risk. A logistic regression analysis revealed that goal intentions and implementation intentions significantly predicted mammography uptake within 1 year. This study developed an integrated model constructed from TTM, TPB, implementation intentions, and cancer worry to account for mammography adoption in Japan, and also confirmed the predictive validity of the model.

Abstract B85: Chinese American women's beliefs in mammogram.

Abstract Objectives: From the Theory of Planned Action (TPA), a woman's intention to have a mammogram can be determined by three factors: the woman's attitudes toward breast cancer screening, the social normative influence of the people who are important in her life, and her perception of the ease with having a mammogram. These determinants are from corresponding sets of beliefs. TPA posits that individual behavior is driven by behavioral intention. Thus, a woman's beliefs in mammogram will influence her intention toward screening, and eventually to carry out the behavior. The purpose of this study is to explore beliefs in mammogram among Chinese American women and to examine how these beliefs influence screening intention. Methods: A total of 212 participants were recruited from a homemaker program at a Chinese community-based organization located in the Midwest. Participants were asked to fill out a questionnaire on their beliefs in mammogram prior to an educational program on breast cancer screening. The questionnaire was developed by modifying Rakowski's Decisional Balance Scale on Mammography, which included six positive statements and six negative statements. A belief score was calculated by adding all 12 scores from each item. A higher belief score indicated that the participant has more positive beliefs. Screening behaviors were measured by asking participants whether they had a mammogram in the past 10 years, and whether they planned to have a mammogram in the next 1 to 2 years. Results: Sixty-two percent of the participants reported that they had a mammogram in the past 10 years and nearly 78% intended to have a mammogram within the next 1-2 years. Participants who were younger (p = .045) and who had more years of education (p = .039) were more likely to plan to have a mammogram in the next 1-2 years. The belief score was significantly associated with participants' history of breast cancer screening (p &amp;lt; .0005), yearly family income (p = .03) and years of education (p = .01). Both belief score and having a mammogram in the past significantly predicted the intention to have a mammogram in the next 1-2 years, and accounted for 25% (Cox &amp; Snell) to 38% (Nagelkerke) of the variances. Even after considering for years of education and age, both predictors remained significant (p &amp;lt; .0005). Conclusion: Our study finds that Chinese American women's beliefs in mammogram not only had a significant impact on their past breast cancer screening but also their intention to have a mammogram in the future. Chinese American women who had more positive beliefs in mammogram were more likely to have a mammogram in the past 10 years and plan to have a mammogram in the next 1 – 2 years. Having a mammogram in the past and having more positive beliefs in mammogram significantly predicted the intention to have a mammogram, even after controlling for years of education and age. Citation Format: Helen Vallina, Karen Kim. Chinese American women's beliefs in mammogram. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B85.

The evidence base for breast cancer screening

The history of breast cancer screening is littered with controversy. With 10 trials spanning 4 decades, we have a substantial body of evidence, but with different aims and flaws. Combined analysis of the intention-to-treat results gives an overall relative reduction in breast cancer mortality of 19% (95% CI 12%–26%), which, if adjusted for non-attendance gives an approximate 25% relative reduction for those who attend screening. However, given that 4% of all-cause mortality is due to breast cancer deaths, this translates into a less than 1% reduction in all-cause mortality. An emerging issue in interpretation is the improvements in treatment since these trials recruited women. Modern systemic therapy would have improved survival (models suggest between 12% and 21%) in both screened and non-screened groups, which would result in a lesser difference in absolute risk reduction from screening but probably a similar, or slightly smaller, relative risk reduction. However benefits and harms, particularly over-diagnosis, need to balanced and differ by age-groups. The informed views of recipients of screening are needed to guide current and future policy on screening.

Progress in health economics evaluation of breast cancer screening

Breast cancer is the most frequent malignancy in women with a steadily rising incidence,and it has been a major public health problem of millions of women.Screening is the primary means of secondary prevention of breast cancer,and it should be economical,simple,effective and feasible.In this article,we review domestic and wordwide breast cancer screening history,and the effectiveness of screening measurements such as mammography,clinical breast examination,ultrasonography and MRI,as well as health economics evaluations of screening programs for general and high-risk populations.These methods are useful for us to explore a appropriate screening program in China.