Mammogram Results Research Articles

Evaluation of a mammography screening program within the population-based Vorarlberg Health Monitoring & Prevention Program (VHM&PP)

ObjectivesTo describe the mammography screening program from 1989 to 2005 within a population-based prevention program in Austria and to appraise it according to recommended quality indicators. Material and methodFrom 01.01.1989 all women aged 40 years or older participating in the Vorarlberg Health Monitoring & Prevention Program (VHM&PP) was offered to undergo additionally a “screening mammography”. Passive follow-up has been performed by record linkages with the Vorarlberg cancer registry and mortality statistics for information on outcome variables. Interval cancer rates have been estimated and the survival after breast cancer has been calculated by life table technique by examination period and age groups (40–49 years, 50–69 years). ResultsBetween 1989 and 2005 50,100 women aged 40 to 69 years participated in the program, of which 123,652 mammogram results have been collected. In the target population the participation rate was 65.1%. During median follow-up time 13.5 years and 633,342 person-years overall 665 invasive cancer and 87 ductal carcinoma in situ (11.6%) cases have been identified. Between 1996 and 2004 the detection rates were 239.9 per 100.000 among women aged 40–49 years and 543.2 per 100,000 among women aged 50–69 years. The rates for interval cancers were 160.4 and 277.4 per 100 000 negative screens, respectively. During median follow-up of 13.5 years 165 deaths occurred with no difference in survival between patients with interval and screen detected cancers. ConclusionA mammography screening program has been performed between 1989 and 2005 in Vorarlberg. Till 2005 most quality indicators improved and met the EU-recommendations suggesting that alternative approaches to organized mammography screening based on routine data should be explored.

The Effect of Breast Implants on Mammogram Outcomes

Breast cancer detection in women with implants has been questioned. We sought to evaluate the impact of breast implants on mammographic outcomes. A retrospective review of women undergoing mammography between March 1 and October 30, 2013 was performed. Demographic characteristics and mammogram results were compared between women with and without breast implants. Overall, 4.8 per cent of 1863 women identified during the study period had breast implants. Median age was 59 years (26-93). Women with implants were younger (53.9 vs 59.2 years, P < 0.0001), had lower body mass index (25.4 vs 28.9, P < 0.0001), and were more likely to have dense breast tissue (72.1% vs 56.4%, P = 0.004) than those without. There were no statistically significant differences with regards to Breast Imaging Recording and Data System 0 score (13.3% with implants vs 21.4% without), call back exam (18.9% with vs 24.1% without), time to resolution of abnormal imaging (58.6 days with vs 43.3 without), or cancer detection rate (0% with implants vs 1.0% without). Because implants did not significantly affect mammogram results, women with implants should be reassured that mammography remains useful in detecting cancer. However, future research is required to determine whether lower call back rates and longer time to resolution of imaging findings contribute to delays in diagnosis in patients with implants.

Abstract B78: Outcomes of mammography in the National Breast and Cervical Cancer Early Detection Program

Abstract Background: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) is a nationwide, comprehensive public health program that provides uninsured, underinsured, and underserved women with access to screening and diagnostic services for breast and cervical cancer. The program enrolls asymptomatic women for cancer screening and symptomatic women for diagnostic services. While the NBCCEDP prioritizes screening for breast cancer to women aged 50 to 64 years, requiring that at least 75% of all program-paid mammograms be provided to this priority population, some women aged 40-49 years also receive services. This study describes the results of mammograms provided by the NBCCEDP, by exam indication (screening or diagnostic) and age group. Methods: For women receiving an NBCCEDP-funded mammogram from 2009 through 2012, we calculated age- specific percentages of abnormal findings, and rates of follow-up testing, biopsy, and invasive and in situ breast cancer diagnosis per 1,000 mammograms. Logistic regression was used to estimate the odds for each of these outcomes by exam indication. The odds ratios (ORs) were adjusted for age, race/ethnicity, rural or urban residence, and region. Results: From 2009 2012, 941,649 screening and 175,310 diagnostic mammograms were provided to women in the NBCCEDP. A small proportion (2.7%; 30,434) of mammograms had unknown indications. Most women were white, non-Hispanic (46.7%), Hispanic (24.4%) or Black, non-Hispanic (18.1%). The percentage of abnormal mammograms was higher for diagnostic mammograms (40.1 %) than screening mammograms (15.5 %). Compared with women aged 40-49 years, fewer women aged 50-64 years had abnormal results for screening (13.7% vs. 19.7%; OR=0.65; 95% confidence interval [CI]: 0.64-0.66) and diagnostic mammograms (37.7% vs, 42.7%; OR=0.82, 95% CI: 0.80-0.83). Overall, the follow-up rates for screening and diagnostic mammograms were 163.1 and 699.7 per 1,000 mammograms; biopsy rates were 26.8 and 168.7, respectively. Follow-up testing rates were lower among women aged 50-64 years compared to those aged 40-49 years (screening: 143.9 vs. 207.5; diagnostic: 645.3 vs. 760.9); biopsy rates exhibited a similar pattern (screening: 24.1 vs. 32.9; diagnostic: 167.7 vs. 169.7). The cancer detection rates for diagnostic mammograms were higher than screening mammograms for invasive (53.1 vs 3.2 per 1,000) and in situ (14.5 vs. 2.2 per 1,000) cancers. For screening mammograms, older women had more cancers detected than younger women (invasive: 3.6 vs. 2.2; in situ: 2.3 vs. 2.0). Similarly, for diagnostic mammograms, cancer detection was higher for older women (invasive: 67.8 vs. 36.6; in situ: 17.4 vs. 11.1). Conclusions: Abnormal mammograms and diagnostic follow-up procedures were less frequent in women aged 50–64 years compared to women aged 40–49 years; however, breast cancer detection was higher for women aged 50-64 years, regardless of indication for the mammogram. Some of these differences between age groups were greater for screening mammograms than for diagnostic mammograms. Cancer detection rates were higher for diagnostic mammograms compared with screening mammograms. These findings support the NBCCEDP's priority of serving women aged 50–64 years. Further, it highlights the need to continue to focus on women at higher risk for developing breast cancer. By providing access to both screening and diagnostic mammograms, NBCCEDP offers much-needed services to this high-risk population. More targeted public health efforts are needed to improve access to screening, timely follow-up and treatment for breast cancer for all women in the United States. Citation Format: Arica White, Jacqueline Miller, Janet Royalty, A. Blythe Ryerson, Vicki Benard. Outcomes of mammography in the National Breast and Cervical Cancer Early Detection Program. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B78.

Abstract B35: Disparities in follow up after abnormal mammogram for multiple Asian subpopulations

Abstract Introduction: The burden of breast cancer among certain Asian subpopulations is higher than previously estimated, underscoring the need for close scrutiny of Asian disparities across the breast cancer continuum from prevention through survivorship. A critical point in this process, timely and complete follow-up of screening abnormalities, is known to be inadequate among women in minority groups but has not yet been studied among disaggregated Asian populations. The objective of this investigation was to assess and compare the timeliness in follow-up after abnormal mammogram among White and Asian American women in the San Francisco Bay Area. Methods: Using data from the San Francisco Mammography Registry (SFMR), we identified women with an index abnormal screening mammogram result of BIRADS 0/3+ between the years 2000-2010. Our study sample included women who self-report White or Asian race/ ethnicity, ages 30 and older who received screening services at 10 participating SFMR-facilities. We first used chi-square statistics to compare median days to diagnostic follow-up after abnormal mammogram by patient characteristics including race/ethnicity. Cumulative percent plots were constructed to visually display the percentage of racial/ethnic groups with follow-up at multiple time intervals (i.e., 30 days, 60 days). We then conducted hierarchical regression analyses that adjust for the multilevel nature of the data, controlling for within-facility clustering of observations, estimating the associations between follow-up and sociodemographic characteristics including age and education, as well as family history of breast cancer. Subgroup comparisons identified differences in these factors which might explain abnormal mammogram follow-up disparities. Results: The total sample was 54,028 women, 70% White and 30% Asian. Among Asians, 16.2% were Chinese, 6.7% Filipina, 1.8% Japanese, 1.1% Vietnamese, 2.4% Other Asian, and 1.4% Mixed Asian. The mean age of women was 53.4 years, and the majority fell within the range of 40-74 years recommended for screening. The proportion of women who did not receive follow-up within one year after an index abnormal mammogram was 11.1% (n=6023). A higher proportion of Asian women did not receive follow-up compared to Whites (15% vs 10%). Among Asian groups, Filipinas had the highest percentage of women not receiving follow-up (18%) while Japanese women had the lowest (10.4%). In comparing those who received follow-up and those who did not, a higher proportion of women with no follow-up had lower education levels (24% vs 15%). Median time to diagnostic follow-up for White and Asian women combined was 18 days. The median follow-up time was 15 days for Whites and 26 days for Asians. The median follow-up time differed significantly among Asian ethnic groups: Japanese women had the shortest (19 days) followed by Filipinas (28 days). Vietnamese women had the longest (30 days). Hierarchical regression model results with Whites and Asians, accounting for sociodemographic variables and the effect of facility, indicate that women who did not complete high school and Asian women had higher odds of no follow-up after an abnormal mammogram at 30, 60, and 90 days compared to women with a graduate degree and Whites, respectively OR 1.3, CI: 1.16-1.41, and OR 1.2, CI: 1.14-1.27. Race was no longer significant at 60 and 90 days. For regression analyses comparing Whites and Asians by ethnicity, controlling for facility, Chinese, Filipina, Other Asian and Mixed Asian were more likely than White women to not receive follow-up, even after accounting for facilities at 30 days. At 60 days, only Filipinas were significantly more likely to receive no follow-up. At 90 days, Filipina women had slightly higher odds of no follow-up compared to Whites (OR 1.1, CI: 1.02-1.28). Conclusion: We observed disparities in timeliness to follow-up between White and Asian women and among Asian ethnic groups in the first 30-days after an abnormal screening mammogram. Disaggregation of ethnicity can identify subpopulations most in need of breast cancer control, and to provide more specific information on care delivery patterns. Citation Format: Kim Hanh Nguyen, Leah Karliner, Rena Pasick. Disparities in follow up after abnormal mammogram for multiple Asian subpopulations. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B35.

Conversations about Abnormal Mammograms on Distress and Timely Follow-up Across Ethnicity.

Communication with healthcare providers, family, and friends is associated with increased mammography use. Less is known about the abnormal mammogram experience, especially in terms of the interval between screening and follow-up appointments (time to follow-up) and psychological distress. The impact of communication may vary across ethnicity, depending on cultural emphases placed on interpersonal relationships. The current study's objectives were to (a) explore the role of family/friend and provider communication with regard to time to follow-up and distress and (b) examine if family/friend and provider communication moderates associations between ethnicity and these outcomes. A convenience-based sample of 41 Latina and 41 non-Latina White (NLW) women who had received an abnormal mammogram result was recruited from Washington State. Women who discussed results with providers had a shorter time to follow-up, although this was not significant when including health insurance. A significant interaction between conversations with family/friends and ethnicity was found: Latinas who did not have conversations with family/friends had particularly elevated psychological distress relative to NLW women and slightly more than other Latinas. This exploratory study suggests health communication with providers and family/friends is important for timely receipt of follow-up care and reduced distress among women who receive an abnormal mammogram result, which has implications for cancer education intervention development and adaptation. Larger, population-based research is necessary to confirm these findings.

Abstract 5165: Cancer associated macrophage-like cells as a blood-based biomarker for the screening of solid tumors

Abstract Background: Blood-based biopsies can be used as a non-invasive method to recover both Circulating Tumor Cells (CTCs) and Circulating Cancer Associated Macrophage-Like cells (CAMLs) from the blood of cancer patients. CAMLs are a newly-defined circulating immune cell type, described as a subtype of circulating stromal cells, known to engulf tumor cells/debris. CAMLs are identified by their large size, 30-300 microns, and aberrant nuclear structure. We studied the peripheral blood of cancer patients to ascertain the prevalence, specificity and sensitivity of CAMLs in relation to their disease status at presentation, including a variety of benign and malignant diseases. We supply evidence that this previously unidentified circulating cell can be used as a screening tool to detect solid tumors in numerous malignancy subtypes in all disease stages. Methods: CellSieveTM microfilters were used to isolate CAMLs from 7.5 mL of whole peripheral blood. The pore size of CellSieveTM is 7 microns, capable of isolating both CTCs and CAMLs based on size. Collected cells were fixed, permeabilized, and stained with DAPI and antibodies against cytokeratin 8, 18 and 19, CD14, and CD45. CAMLs were defined as enlarged, multinuclear cells with diffuse cytoplasmic cytokeratin staining, and/or CD14+, and/or CD45+. CTCs were defined as filamentous cytokeratin cells that are CD45-. Study 1: Blinded peripheral blood samples from 61 cancer patients were tested, including Stage I-IV breast, pancreatic, lung and prostate cancers, and newly diagnosed, untreated patients. Non-blinded blood samples from 30 healthy volunteers served as controls. Study 2: Double blinded peripheral blood samples from 20 patients with abnormal mammogram results were drawn at time of tissue biopsy and screened. After analysis, unblinding showed a distribution of malignant breast disease (n = 10), benign (n = 8), or atypical hyperplasia (AH) (n = 2). Results: Study 1: CAMLs were found in 94% patients with Stage III/IV cancers, 87% with Stage I/II cancers, and 89% of all patients, regardless of cancer type. Specifically, CAMLs were found in 77% of prostate, 100% of pancreatic, 80% of lung, and 100% of breast patient samples. CAMLs were not found in healthy control samples (sensitivity: 84-96%, Specificity: 100%, PPV: 100%, NPV: 88-97%). Study 2: CAMLs were found in 8 patients with malignant disease, 2 with benign disease, and 2 with AH (sensitivity: 80%, Specificity: 75%, PPV: 80%, NPV: 75%) Conclusions: We present evidence that CAMLs can be used as a non-invasive blood based biopsy, to detect the anatomical presence of solid malignancies and potentially pre-malignant lesions. The presence of CAMLs in newly diagnosed patient samples suggests their use as a blood biomarker for early stage cancer screening in a broad population. Preliminary data from a double blind breast cancer study suggests that CAMLs may differentiate between benign and malignant breast diseases. Citation Format: Daniel Adams, Katherine Alpaugh, Massimo Cristofanilli, Stuart Martin, Saranya Chumsri, Raymond C. Bergen, Susan Tsai, Martin Edelman, Peixuan Zhu, Shuhong Li, Olga V. Makarova, Platte T. Amstutz, Cha-Mei Tang, Jeffrey R. Marks. Cancer associated macrophage-like cells as a blood-based biomarker for the screening of solid tumors. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 5165. doi:10.1158/1538-7445.AM2015-5165

Clinical outcomes of mammography in the National Breast and Cervical Cancer Early Detection Program, 2009-2012.

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) enrolls asymptomatic women for cancer screening and symptomatic women for diagnostic services. This study describes the results of mammograms provided by the NBCCEDP, by examination indication (screening or diagnostic), and by age group. For the first NBCCEDP-funded mammogram received during 2009-2012, we calculated age-specific percentages of abnormal findings, rates of follow-up testing, and invasive and in situ breast cancer diagnoses per 1,000 mammograms. Logistic regression was used to estimate the odds for each of these outcomes by examination indication. The NBCCEDP provided 941,649 screening, 175,310 diagnostic, and 30,434 unknown indication mammograms to 1,147,393 women. The percentage with abnormal mammograms was higher for diagnostic mammograms (40.1 %) than for screening mammograms (15.5 %). Compared with women aged 40-49 years, fewer women aged 50-64 years had abnormal results for screening (13.7 vs. 19.7 %) and diagnostic mammograms (37.7 vs. 42.7 %). Follow-up rates per 1,000 mammograms were lower among women aged 50-64 compared to those aged 40-49 (screening: 143.9 vs. 207.5; diagnostic: 645.3 vs. 760.9); biopsy rates exhibited a similar pattern (screening: 24.1 vs. 32.9; diagnostic: 167.7 vs. 169.7). For screening mammograms, older women had more cancers detected than younger women (invasive: 3.6 vs. 2.2; in situ: 2.3 vs. 2.0). Similarly, for diagnostic mammograms, cancer detection was higher for older women (invasive: 67.8 vs. 36.6; in situ: 17.4 vs. 11.1). Abnormal mammograms and diagnostic follow-up procedures were less frequent in women aged 50-64 years compared to women aged 40-49 years, while breast cancer detection was higher, regardless of indication for the mammogram. Some of these differences between age groups were greater for screening mammograms than for diagnostic mammograms. Cancer detection rates were higher for diagnostic mammograms compared with screening mammograms. These findings support the NBCCEDP's priority of serving women aged 50-64 years and providing both screening and diagnostic mammograms.

An integrated breast cancer risk assessment and management model based on fuzzy cognitive maps

BackgroundThere is a growing demand for women to be classified into different risk groups of developing breast cancer (BC). The focus of the reported work is on the development of an integrated risk prediction model using a two-level fuzzy cognitive map (FCM) model. The proposed model combines the results of the initial screening mammogram of the given woman with her demographic risk factors to predict the post-screening risk of developing BC. MethodsThe level-1 FCM models the demographic risk profile. A nonlinear Hebbian learning algorithm is used to train this model and thus to help on predicting the BC risk grade based on demographic risk factors identified by domain experts. The risk grades estimated by the proposed model are validated using two standard BC risk assessment models viz. Gail and Tyrer–Cuzick. The level-2 FCM models the features of the screening mammogram concerning normal, benign and malignant cases. The data driven Hebbian learning algorithm (DDNHL) is used to train this model in order to predict the BC risk grade based on these mammographic image features. An overall risk grade is calculated by combining the outcomes of these two FCMs. ResultsThe main limitation of the Gail model of underestimating the risk level of women with strong family history is overcome by the proposed model. IBIS is a hard computing tool based on the Tyrer–Cuzick model that is comprehensive enough in covering a wide range of demographic risk factors including family history, but it generates results in terms of numeric risk score based on predefined formulae. Thus the outcome is difficult to interpret by naive users. Besides these models are based only on the demographic details and do not take into account the findings of the screening mammogram. The proposed integrated model overcomes the above described limitations of the existing models and predicts the risk level in terms of qualitative grades. The predictions of the proposed NHL-FCM model comply with the Tyrer–Cuzick model for 36 out of 40 patient cases. With respect to tumor grading, the overall classification accuracy of DDNHL-FCM using 70 real mammogram screening images is 94.3%. The testing accuracy of the proposed model using 10-fold cross validation technique outperforms other standard machine learning based inference engines. ConclusionIn the perspective of clinical oncologists, this is a comprehensive front-end medical decision support system that assists them in efficiently assessing the expected post-screening BC risk level of the given individual and hence prescribing individualized preventive interventions and more intensive surveillance for high risk women.

Outcome of breast cancer screening: a Lebanese single institution experience.

Since 2002, from October till December of each year, the Lebanese Ministry of Public Health conducts a mammogram based breast cancer screening campaign in the whole country for women over 40 years of age. These mammograms are performed free of charge in governmental hospitals or for reduced fees in private hospitals. The aim of this study is to analyze the direct impact of this campaign on cancer detection and subsequent treatment. Radiologic records of women screened with a mammogram during the campaign period from October till December 2012 at Saint Joseph Hospital, Baouchrieh, Beirut, were reviewed. RESULTS of mammograms were reported using the ACR score. Women with ACR score ≥4 were tracked and investigated. 900 screening mammograms were performed; median age was 55.2 years (range:31-81 years). Some 826 (91.8%) had an ACR score of ≤2; 66 (7.3%) an ACR =3 and only 8 (0.89%) an ACR=4. Thus, less than 1% (8/900) of all screened women were considered at high risk and needed a close follow-up. Among these 8 women, 4 underwent surgery for an early breast cancer, one had synchronous metastatic breast cancer and two were lost to follow-up. To coclude, Among 900-screened women for BC, less than 1 % (8 out of 900) were at high risk of hiding a BC (ACR=4), half of them benefited from early therapy (4 women out of 900) and one was a false positive. Larger studies on national level should be accomplished to have a complete data on breast cancer screening in Lebanon. The results of these studies can affect the Lebanese health policy regarding BC.

Abstract B86: “The doctor supported me by telling me exactly what she was doing”: Health care experiences of African American women following an abnormal mammogram

Abstract Purpose. The diagnostic and therapeutic delays African American women experience following an abnormal mammogram are well-documented and may partially contribute to racial disparities in late stage diagnosis and survival. Previous literature has suggested inadequate provider-patient communication may contribute to delayed care and subsequent attitudes and behaviors regarding breast cancer care. Nevertheless, little research has characterized the specific communication needs African American women have following an abnormal mammogram experience. Objective. We describe themes regarding positive and challenging healthcare experiences following an abnormal mammogram result among a small sample of African American women. Methods. Through multiple clinics and community advocates, we recruited a convenience sample of 30 African American women who had received an abnormal mammogram within the previous four years. Qualitative, semi-structured interviews focused on challenging and positive aspects of healthcare interactions following the abnormal mammogram experience (e.g., “What were some ways you felt the doctor and staff supported you?”). Data were analyzed using principles of grounded theory. Results. Several salient themes concerning health communication emerged from our exploratory study. African American women often emphasized their confidence in their ability to act on health information during the abnormal mammogram experience (“When you do the follow-up, you get to ask”). Staff responses to proactive approaches were negative and positive for different women. Negative social interactions with staff included perceived disrespect (“I was actually disappointed with the receptionist…she had a little attitude”) and healthcare distrust concerning withheld information (“I would call them on the phone and…fuss at them about different things that I had found out that were not true or that were available that they did not tell me.”). African American women with positive experiences noted direct communication (“They didn't try to hide anything. They were out front.”; “I feel the doctor supported me by telling me exactly what she was doing.”) and detailed information (“They told me what they were going to do. They told me how to prepare.”). Additionally, women noted the importance of personalism. Women who were less satisfied with follow-up care noted lack of empathy (“They were robots…They're like a tape recording. It's not individualized or personal.”). Conversely, satisfied women mentioned familiarity with patients (“Well they knew my history, so that really made me feel comfortable”) and empathy (“I have doctors who care. They are concerned about this, so they want me to follow-up”; “They talked to you, comforted you.”). Conclusions: Our findings parallel a broader body of literature concerning inadequate patient-provider interactions and culturally specific communication needs of African American populations. The current study further suggests the importance of providing African Americans an active role during care, including direct, professional, and comprehensive communicative styles. Interpersonal support and “whole patient” approaches are also highly valued for this patient population. Emergent themes from this study have direct implications for clinicians and future interventions to increase early breast cancer detection for African American women. Citation Format: Yamile Molina, Sarah H. Hohl, Bridgette Hempstead, Jacci Thompson-Dodd, Rachel C. Malen, Beti Thompson, Rachel M. Ceballos. “The doctor supported me by telling me exactly what she was doing”: Health care experiences of African American women following an abnormal mammogram. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B86. doi:10.1158/1538-7755.DISP13-B86

Abstract B89: Timeliness in follow-up after abnormal mammography screening among Asian groups

Abstract Background: Treatment of breast cancer at the earliest possible stage results from a combination of screening for non-palpable abnormalities and timely and appropriate follow-up of abnormal test results. Studies have addressed Black-White differences in follow-up of abnormal mammograms but little is known about other groups including Asian Americans, a population composed of distinct ethnic sub-groups with substantial heterogeneity in risk factors that correspond with important to differences in breast cancer rates. In this study we aimed to assess completion and timeliness of diagnostic follow-up after an abnormal mammogram between White and Asian women and among disaggregated Asian ethnic subgroups. Methods: Using data from the San Francisco Mammography Registry, we identified women with an index abnormal screening mammogram result of BIRADS 0/3+ between the years 2000-2010. Our study sample included women who self-report White or Asian race/ ethnicity, ages 40 and older. Our outcomes were: 1) proportion of women without diagnostic follow-up within a year of their index mammogram, and 2) median days to diagnostic follow-up. Results: We identified 54028 White and Asian women between 2000 and 2010 in the SFMR data. Seventy percent of women were White and 30% were Asians. Among Asians, 16.2% were Chinese, 6.7% Filipina, 1.8% Japanese, 1.1% Vietnamese, 2.4% Other Asian, and 1.4% Mixed Asian. The majority of women were between the ages of 40-59 (67%). A total of 6023 (11.1%) of women did not receive follow-up within one year after an index abnormal mammogram. A higher proportion of Asian women did not receive follow-up compared to Whites (15% vs 10%). Among Asian groups, Filipinas had the highest percentage of women not receiving follow-up (18%) while Japanese women had the lowest (10.4%). In comparisons of individuals who received follow-up to those who did not, a higher proportion of women with no follow-up had lower education levels (24% vs 15%). Median time to diagnostic follow-up for White and Asian women combined was 18 days. The median follow-up time was 15 days for Whites, and 26 days for Asians. Among Asians, the median follow-up time differed significantly among ethnic groups: Japanese women had the lowest (19 days) and Vietnamese women the longest (30 days) followed by Filipinas (28 days). Conclusion: We observed disparities in timeliness to follow-up between White and Asian women and among Asian ethnic groups. Disaggregation of ethnicity can identify subpopulations most in need of breast cancer control, and to provide more specific information on breast cancer patterns. Citation Format: Kim H. Nguyen, Leah Karliner, Rena J. Pasick. Timeliness in follow-up after abnormal mammography screening among Asian groups. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B89. doi:10.1158/1538-7755.DISP13-B89

Medical Advocacy and Supportive Environments for African-Americans Following Abnormal Mammograms.

African-American women experience disproportionately adverse outcomes relative to non-Latina White women after an abnormal mammogram result. Research has suggested medical advocacy and staff support may improve outcomes among this population. The purpose of the study was to understand reasons African-American women believe medical advocacy to be important and examine if and how staff can encourage and be supportive of medical advocacy. A convenience-based sample of 30-74-year-old women who self-identified as African-American/Black/of African descent and who had received an abnormal mammogram result was recruited from community-based organizations, mobile mammography services, and the local department of health. This qualitative study included semi-structured interviews. Patients perceived medical advocacy to be particularly important for African-Americans, given mistrust and discrimination present in medical settings and their own familiarity with their bodies and symptoms. Respondents emphasized that staff can encourage medical advocacy through offering information in general in a clear, informative, and empathic style. Cultural competency interventions that train staff how to foster medical advocacy may be a strategy to improve racial disparities following an abnormal mammogram.

Psychological distress, social withdrawal, and coping following receipt of an abnormal mammogram among different ethnicities: a mediation model.

To explore ethnic differences in psychological distress and social withdrawal after receiving an abnormal mammogram result and to assess if coping strategies mediate ethnic differences. Descriptive correlational. Two urban mobile mammography units and a rural community hospital in the state of Washington. 41 Latina and 41 non-Latina Caucasian (NLC) women who had received an abnormal mammogram result. Women completed standard sociodemographic questions, Impact of Event Scale-Revised, the social dimension of the Psychological Consequences Questionnaire, and the Brief COPE. Ethnicity, psychological distress, social withdrawal, and coping. Latinas experienced greater psychological distress and social withdrawal compared to NLC counterparts. Denial as a coping strategy mediated ethnic differences in psychological distress. Religious coping mediated ethnic differences in social withdrawal. Larger population-based studies are necessary to understand how ethnic differences in coping strategies can influence psychological outcomes. This is an important finding that warrants additional study among women who are and are not diagnosed with breast cancer following an abnormal mammogram. Nurses may be able to work with Latina patients to diminish denial coping and consequent distress. Nurses may be particularly effective, given cultural values concerning strong interpersonal relationships and respect for authority figures.

Developing a comprehensive database management system for organization and evaluation of mammography datasets.

We aimed to design and develop a comprehensive mammography database system (CMDB) to collect clinical datasets for outcome assessment and development of decision support tools. A Health Insurance Portability and Accountability Act (HIPAA) compliant CMDB was created to store multi-relational datasets of demographic risk factors and mammogram results using the Breast Imaging Reporting and Data System (BI-RADS) lexicon. The CMDB collected both biopsy pathology outcomes, in a breast pathology lexicon compiled by extending BI-RADS, and our institutional breast cancer registry. The audit results derived from the CMDB were in accordance with Mammography Quality Standards Act (MQSA) audits and national benchmarks. The CMDB has managed the challenges of multi-level organization demanded by the complexity of mammography practice and lexicon development in pathology. We foresee that the CMDB will be useful for efficient quality assurance audits and development of decision support tools to improve breast cancer diagnosis. Our procedure of developing the CMDB provides a framework to build a detailed data repository for breast imaging quality control and research, which has the potential to augment existing resources.

Breast screening revisited

Breast screening is the medical screening of asymptomatic, apparently healthy women for breast lump in an attempt to achieve an earlier diagnosis. The assumption is that the early detection will improve outcomes. In western countries, breast screening programs have led to a significant reduction in mortality and improved prognosis of patients with breast cancer. However in India, although the number of breast cancer are on the rise there is no such organized program. This article emphasizes on the importance of breast screening and protocol to be followed in our country where it can have significant impact on the prognosis.

Role of Breast Ultrasound and Mammography in Evaluating Patients Presenting with Focal Breast Pain in the Absence of a Palpable Lump

To determine if ultrasound and/or mammography is helpful in detecting breast cancers in patients presenting with focal breast pain. Patients who presented between February 2008 and April 2011 with focal breast pain without a lump were included in the study. The mammographic and US findings were retrospectively reviewed. BIRADS 0, 4, and 5 were considered positive on mammogram while BIRADS 4 and 5 were considered positive on US. The efficacy of mammogram-alone, ultrasound-alone, and in combination to detect breast cancer was evaluated. The performance of mammography for detecting any mass lesions that were present on subsequent US was also evaluated. A total of 257 patients were evaluated with US and 206 (80.1%) of these also had mammograms prior to the US. Cancer incidence was 1.2% (n = 3). The sensitivity, specificity, PPV, and NPV of mammogram-alone and US-alone for detection of breast cancer in these patients were 100%, 87.6%, 10.7%, 100% and 100%, 92.5%, 13.6%, and 100%, respectively, while for combined mammogram and US was 100%, 83.7%, 8.3%, and 100%. The sensitivity, specificity, PPV, and NPV of mammogram for identifying an underlying suspicious mass lesion that was subsequently detected by US was 58%, 91%, 39%, and 95%. The NPV of a BIRADS 1 mammogram for any underlying mass lesion was 75%. Addition of an ultrasound to a mammogram did not detect additional cancers; likely due to low cancer incidence in these patients. However, US detected underlying mass lesions in 25% cases with a BIRADS 1 mammogram result.

Time to definitive diagnosis of breast cancer in Latina and non-Hispanic white women: the six cities study.

Time delay after an abnormal screening mammogram may have a critical impact on tumor size, stage at diagnosis, treatment, prognosis, and survival of subsequent breast cancer. This study was undertaken to evaluate disparities between Latina and non-Hispanic white (NHW) women in time to definitive diagnosis of breast cancer after an abnormal screening mammogram, as well as factors contributing to such disparities.As part of the activities of the National Cancer Institute (NCI)-funded Redes En Acción research network, clinical records of 186 Latinas and 74 NHWs who received abnormal screening mammogram results were reviewed to determine the time to obtain a definitive diagnosis. Data was obtained from participating clinics in six U.S. cities and included demographics, clinical history, and mammogram characteristics. Kaplan-Meier estimates and Cox proportional hazards models were used to test differences in median time to definitive diagnosis by ethnicity after adjusting for clinic site, demographics, and clinical characteristics.Time-to-event analysis showed that Latinas took 2.2 times longer to reach 50% definitively diagnosed with breast cancer relative to NHWs, and three times longer to reach 80% diagnosed (p=0.001). Latinas’ median time to definitive diagnosis was 60 days compared to 27 for NHWs, a 59% gap in diagnosis rates (adjusted Hazard Ratio [aHR] = 1.59, 95% CI = 1.09, 2.31; p=0.015). BI-RADS-4/5 women’s diagnosis rate was more than twice that of BI-RADS-3 (aHR = 2.11, 95% CI = 1.18, 3.78; p=0.011).Disparities in time between receipt of abnormal screening result and definitive diagnosis adversely affect Latinas compared to NHWs, and remain significant after adjusting for demographic and clinical variables. With cancer now the leading cause of mortality among Latinos, a greater need exists for ethnically and culturally appropriate interventions like patient navigation to facilitate Latinas’ successful entry into, and progression through, the cancer care system.

Factors Influencing Time to Diagnosis After Abnormal Mammography in Diverse Women

Abnormal mammograms are common, and the risk of false positives is high. We surveyed women in order to understand the factors influencing the efficiency of the evaluation of an abnormal mammogram. Women aged 40-80 years, identified from lists with Breast Imaging Reporting and Data System (BIRADS) classifications of 0, 3, 4, or 5, were surveyed. Telephone surveys asked about the process of evaluation, and medical records were reviewed for tests and timing of evaluation. In this study, 970 women were surveyed, and 951 had chart reviews. Overall, 36% were college graduates, 68% were members of a group model health plan, 18% were Latinas, 25% were African Americans, 15% were Asian, and 43% were white. Of the 352 women who underwent biopsies, 151 were diagnosed with cancer (93 invasive). Median time to diagnosis was 183 days for BIRADS 3 compared to 29 days for BIRADS 4/5 and 27 days for BIRADS 0. At 60 days, 84% of BIRADS 4/5 women had a diagnosis. Being African American (hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.49-0.97, p=0.03), income < $10,000 (HR 0.55, 95% CI 0.31-0.98, p<0.04), perceived discrimination (HR 0.22, 95% CI 0.09-0.52, p<0.001), not fully understanding the results of the index mammogram (HR 0.49, 95% CI 0.32-0.75, p=0.001), and being notified by letter (HR 0.66, 95% CI 0.48-0.90, p=0.01) or telephone (HR 0.62, 95% CI 0.42-0.92, p=0.02) rather than in person were all associated with significant delays in diagnosis. Evaluation of BIRADS 0, 4, or 5 abnormal mammograms was completed in most women within the recommended 60 days. Even within effective systems, correctible communication factors may adversely affect time to diagnosis.

How do Breast Imaging Centers Communicate Results to Women with Limited English Proficiency and Other Barriers to Care?

Research suggests that women with Limited English Proficiency (LEP) and ethnic minority women are at increased risk of being inadequately informed of their mammogram result. The purpose of this study is to explore breast imaging centers' communication practices and assess how these centers accommodate women with low literacy and LEP. A 35-question survey was distributed to a national association of more than 700 breast health centers. Descriptive analysis of the overall sample and Fisher's exact or Chi squared testing to distinguish differences between subgroups were performed. Respondents from 206 centers completed questionnaires. 29% of respondents stated that more than a quarter of their patients were black, 27% of respondents stated that more than a quarter of their patients were Hispanic/Latina, and 13% of respondents stated that more than a quarter of their patients had LEP. Overall, 18% of respondents reported they do not routinely telephone patients with results, 15% do not have multilingual staff or translators available to answer questions, and 69% send result letters in English only. Of note, 69% use patient navigators. Centers reported systemic strengths and barriers to clear communication of mammography results. Our findings are consistent with past investigations identifying a general need to improve the communication of breast imaging results and suggesting that result notification letters alone are inadequate in ensuring that every woman understands her personal results and follow-up plan.

A phase I safety and efficacy study of the mammary aspirate specimen cytology test device for collection of spe-cimens for exfoliative cytopathology of the breast ducts

Background: The ability to identify asymptomatic women at high risk for breast cancer using known pre-malignant changes in exfoliative cytopathology of nipple aspirate fluid is of clinical importance. Exfoliative cytopathology of Nipple Aspirate Fluid (NAF) has been shown to be an important adjunct to the currently accepted standard of medical care, i.e. mammography, coupled with physical examination, for the diagnosis of breast cancer. This is especially important for the subset of women aged 18-50 who are not identified as “high risk”, and therefore, for whom mammography is not routinely recommended. The objective of this study was to determine if a new, patented Class II medical device, the Mammary Aspirate Specimen Cytology Test (MASCT) System, designed to collect NAF for subsequent cytological examination is safe and effective. Methods: The MASCT medical device is a modified breast pump and was used to obtain bilateral specimens from 34 healthy, non-pregnant, female subjects for cytopathological examination. A conventional breast disease work-up was performed (medical history/risk factor collection, clinical breast examination and mammogram) and NAF specimens collected. Specimen weight was measured and a cytopathological examination was performed. Vital signs measurements, clinical laboratory analysis, and adverse event reporting were performed. Results: Based on cytopathological evaluation and/or measurable weight changes on the specimen collection membrane filter, all breasts evaluated (100%) yielded nipple aspirate fluid. Specimen weights ranged from in 60 breasts (representing 30 subjects) being evaluated cytologically. Fifty-eight of sixty breasts evaluated cytopathologically (97%) were reported as cytology Class I, and 2 of 60 (3%) were reported as cytology Class IIa. Cytopathological findings correlated well with mammogram and clinical breast exam results. No adverse events, including pain from the collection procedure, were reported. Conclusion: Based on this clinical study, we conclude that the Mammary Aspiration Specimen Cytology Test device is safe and effective for the collection of mammary aspirate specimens for laboratory cytopatho-logical testing.