Mammography Research Articles

Abstract PO5-18-01: Cancer Detection Rate Meta-Analysis Comparison of Contemporary Dense-Breast Supplemental Screening Modalities

Abstract We performed a meta-analysis of the cancer detection rates from 24 published reports in dense breasts for all contemporary and FDA-approved imaging modalities (DM, DBT, U/S, CEM, MBI, MRI) available for supplemental breast cancer screening. This information is critical to the 40% of women with BIRADS categorized dense breasts (C,D) receiving breast cancer screening. In the paper an analysis of the net lives saved using a benefit-to-risk comparison of the ionizing imaging modalities (DM, DBT and MBI) is also presented and the safety of each technique is described. Note that it is well accepted that carcinogenic risk associated with ionizing radiation doses of < 100 mSv are considered too small to be detected or altogether non-existant. Recently, with FDA's federal MQSA requirements changing to mandate notification of womens' dense-breast status (C,D), awareness has grown substantially about the dismal cancer detection performances of DM, DBT and U/S which degrades substantially with increasing breast density. Additionally, this May 2023, federal legislation was introduced in congress. The Find It Early Act (HR3086), should it become law in 2024, will require that healthcare payors cover costs for supplemental screening of women with dense breasts. Knowing and understanding the arsenal of the highest performing imaging modalities (based on cancer detection rates (CDR), Sensitivity, Specificity, NPV) is critically important for all patients and physicians caring for them. The volume of women qualifying for supplemental breast screening is expected to be managed by existing and growing numbers of all the best performing available technologies and approaches. Since the analysis is based on numerous others’ clinical trials of CDRs evaluating the various modalities in millions of women, this comprehensive analysis presents a level playing field for comparison. The top-three high performing imaging modalities (CEM, MBI, MRI) should be used to increase the number of early-stage cancers found in order to substantially decrease mortality, decrease patient trauma, decrease procedures, and decrease costs per cancer detected, all at overall benefit to the patients, the hospitals, the payors and provide long-term benefits to society. Table. Summary of Relative Cancer Detection Rates (per 1,000 women) in Dense-Breast Supplemental Screening Results of multiple pairwise meta-analyses comparing various modalities (Digital Breast Tomosynthesis; Ultrasound; Contrast Enhanced Mammography; Molecular Breast Imaging; Magnetic Resonance Imaging) to Digital Mammography. “X” represents the second supplemental screening modality compared to DM. “+X” means the combination of DM+X. Two normalizations are compared: “CDR Ratio model” and “Incremental CDR model.” Table. Net Lives Saved by Ionizing Radiation Imaging Modalities per Age Decade Citation Format: Martin Tornai, James Hugg, Bradley Patt, Chin-Tu Chen, Eduardo Santos, Alaattin Erkanli, Samantha Morrison, Matthew Covington. Cancer Detection Rate Meta-Analysis Comparison of Contemporary Dense-Breast Supplemental Screening Modalities [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-18-01.

Abstract PO4-18-09: SMALL: Open Surgery versus Minimally invasive vacuum-Assisted excision for smaLL screen-detected breast cancer – a UK phase III randomised multi-centre trial

Abstract Background: Mammographic screening programmes reduce breast cancer mortality but detect many small good-prognosis tumours which may not progress. Screen-detected cancers are currently treated with standard surgery and adjuvant therapies, with associated morbidities. There is a need to reduce overtreatment of good prognosis tumours and numerous studies are evaluating omission of radiotherapy in low-risk disease. However, there is little evidence to support surgical de-escalation, although percutaneous minimally invasive treatment approaches have been described. Vacuum-assisted excision (VAE) is in widespread use for management of lesions of uncertain malignant potential and benign lesions. SMALL (ISRCTN 12240119) is designed to determine the feasibility of using this approach to treat small invasive tumours detected within the UK NHS Breast Screening Programme. Methods: SMALL is a phase III multicentre randomised trial comparing standard surgery with VAE for screen-detected cancers. Main eligibility criteria are age ≥47 years, unifocal grade 1 tumours with maximum diameter 15mm, strongly ER/PR+ve and HER2-ve, with negative axillary staging. Patients are randomised 2:1 to VAE or surgery, with no axillary surgery in the VAE arm. Completeness of excision is assessed radiologically, and if excision is incomplete, patients undergo surgery. Adjuvant radiotherapy and endocrine therapy are mandated in the VAE arm but may be omitted following surgery. Co-primary end-points are: 1. Non-inferiority comparison of the requirement for a second procedure following excision 2. Single arm analysis of local recurrence (LR) at 5 years following VAE Recruitment of 800 patients will permit demonstration of 10% non-inferiority of VAE for requirement of a second procedure. This ensures sufficient patients for single arm analysis of LR rates, where expected LR free survival is 99% at 5 years, with an undesirable survival probability after VAE of 97%. To ensure that the trial as a whole only has 5% alpha, the significance level for each co-primary outcome is set at 2.5% with 90% power. The Data Monitoring Committee will monitor LR events to ensure these do not exceed 3% per year. Secondary outcome measures include time to ipsilateral recurrence, overall survival, complications, quality of life and health economic analysis. A novel feature of SMALL is the integration of a QuinteT Recruitment Intervention (QRI), which aims to optimise recruitment to the study. Recruitment challenges are identified by analysing recruiter/patient interviews and audio-recordings of trial discussions, and by review of trial screening logs, eligibility and recruitment data and study documentation. Solutions to address these are developed collaboratively, including individual/group recruiter feedback and recruitment tips documents. Results: SMALL opened in December 2019, but recruitment halted in 2020 for 5 months due to COVID-19. At 6th July 2023, 39 centres are open, with 300 patients randomised from 32 of these, with a randomisation rate of approximately 45%, and a per site recruitment rate of 0.4-0.5 patients/month. Despite the pandemic, SMALL achieved the internal pilot feasibility targets and continues to recruit to the main study, with estimated completion of recruitment in June 2025. Drawing from preliminary QRI findings and insights from patient representatives, a recruitment tips document has been circulated (on providing balanced information about treatments, encouraging recruiters to engage with patient preferences, and explaining randomisation). Individual recruiter feedback has commenced and wider feedback is being delivered across sites via recruitment training workshops. Conclusion: Despite pandemic-related challenges, SMALL has excellent recruitment to date and is expected to have a global impact on treatment of breast cancer within mammographic screening programmes. SMALL is funded by the UK NIHR HTA programme award 17/42/32 Citation Format: Stuart McIntosh, Charlotte Coles, David Dodwell, Kenneth Elder, Jessica Foster, Claire Gaunt, Amanda Kirkham, Iain Lyburn, Sangeetha Paramasivan, Jenna Morgan, Sarah Pinder, Shelley Potter, Tracy Roberts, Nisha Sharma, Hilary Stobart, Elizabeth Southgate, Sian Taylor-Phillips, Matthew Wallis, Daniel Rea. SMALL: Open Surgery versus Minimally invasive vacuum-Assisted excision for smaLL screen-detected breast cancer – a UK phase III randomised multi-centre trial [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-18-09.

Abstract PO5-19-11: A novel portable breast cancer screening method - initial institutional experience

Abstract Background: Breast ultrasound (US) is a remarkable supplementary tool alongside mammography and magnetic resonance imaging (MRI) for the detection of breast lesions. US imaging is a fast, reliable method to identify and localize breast pathology. Innovative technologies that aim to timely identification and prompt diagnosis of suspicious lesions in breast cancer screening remain a clinical need. ATUSA is a B-type rechargeable US, shaped as a wearable device. It uses a linear array of transducers with water acting as a coupling medium that recreates a 3-dimensional image of the scanned breast. The ATUSA portability makes this device a practical breast screening method during a healthcare office visit. We report the initial feasibility of ATUSA to detect breast lesions in an outpatient setting from a trial in progress. Methodology: Interim prospective data from 35 female patients presenting with a mass of equal or greater than 1 cm in size, with a baseline handheld US image and pathology reports that evidenced a cancer diagnosis or a lesion suspicious of malignancy. Breast cancer types included invasive ductal carcinoma (IDC), ductal carcinoma in situ (DCIS) and invasive lobular carcinoma (ILC), invasive mammary carcinoma (IMC) with mixed ductal and lobular features and atypical lobular hyperplasia (ALH). ATUSA and baseline handheld reference US images were cross-referenced from June 2022 to June 2023. Basic demographics, clinical characteristics, mammogram and/or MRI, and pathology reports were included in the analysis. Patients were followed up for a 30-day period to note occurrence of any adverse event (AE). Institutional Review Board (IRB) approved this study (protocol H-42616). Results: The 35 patients had a mean age of 57 years (range: 25 – 79), mean BMI 29.6 kg/m2 (range: 18.1 – 49.3). Mammographic breast density was fibroglandular tissue 15 (42.8%), followed by heterogeneously dense (HD) 13 (3.7%), mixed HD and fibroglandular 1 (2.8%), mildly dense 1 (2.8%), extremely dense 2 (5.7%), and extremely fatty 1 (2.8%). Breast sizes were 1 (2.8 %) A cup, 11 (31.4%) B cups, 1 (2.8%) B – C cups, 5 (14.2%) C cups, 1 (2.8%) C – D cups, 13 (37.1%) D cups, and 3 (8.5%) DD cups. The 35 scanned lesions had a diagnosis (compared with final resected pathology) classified as IDC 18 (51.4 %), DCIS 2 (5.7 %), mixed IDC and DCIS 6 (17.1 %), ILC 3 (8.5 %), IMC with mixed features 2 (5.7 %), IMC with DCIS 1 (2.8 %), ALH 1 (2.8 %), and 2 (5.7 %) benign masses. ATUSA successfully identified 17/35 (48.5 %) lesions from this group as malignant, from which 4 were hard to distinguish due to shadowing artifact and 3 were underestimated in size. A total of 15 (42.8 %) malignant lesions were missed by ATUSA. No AEs related to the ATUSA device were reported. Conclusion: The ATUSA provides the means to produce a good quality US image during a clinic visit or where a facility lacks conventional US imaging. When compared to the handheld US, ATUSA can be safely used in the outpatient setting without the need of trained specialists but requires further development and testing to match conventional breast imaging. Table 1. Basic clinical characteristics & demographics Citation Format: Margarita Riojas-Barrett, Jessica Montalvan, Mary Bajomo, Ivan Marin, Quan Dang Nguyen, Karla A Sepulveda, Elizabeth Bonefas, Alastair Thompson, Stacey Carter. A novel portable breast cancer screening method - initial institutional experience [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-19-11.

Abstract PO3-27-09: A Multidisciplinary Telehealth Approach to Breast Cancer Prevention in a Veteran Population

Abstract INTRODUCTION An estimated 13% of women will be diagnosed with breast cancer at some point in their lifetime. There are non-modifiable and modifiable risk factors including family history, genetics, obesity, and estrogen exposure. Interventions that reduce breast cancer risk and/or mortality include screening, chemoprevention, and lifestyle modification. A recent national survey shows that there are significant gaps in providing breast cancer prevention care for female Veterans. We describe the creation of a multi-disciplinary telehealth clinic aimed at reducing breast cancer risk in a high-risk female Veteran population. METHODS The breast cancer prevention clinic (BCPC) team consists of a medical oncologist, geneticist, genetic counselor, dietician, psychologist, and nurse navigator. High risk women are identified through a combination of screening questionnaires at annual mammography and genetics or primary care provider (PCP) evaluation, then referred to the clinic. Criteria for referral include age >=35, Gail 5 year risk >= 1.7%, Tyrer-Cuzick 10 year risk >= 5%, or history of thoracic radiation. At the BCPC telehealth visit, the medical oncologist makes individualized recommendations about chemoprevention by discussing the risks and possible complications of therapy. Use of screening magnetic resonance imaging (MRI) is also recommended to women with lifetime Tyrer-Cuzick score > 20%. Within the same visit, patients meet with a dietician to discuss nutrition modification, and a psychologist to address psychosocial barriers to lifestyle change. Those who start chemoprevention attend a 3 month follow-up with a nurse navigator to discuss tolerability and side effects. Subsequently, the patient’s PCP becomes responsible for management of chemoprevention and annual breast MRI. RESULTS Between January and December 2022, 33 patients were seen in BCPC. Patients had an average age of 52 years (range 42-70), Gail 5-year score of 2.53%, Tyrer-Cuzick 10-year score of 6.65%, and Tyrer-Cuzick lifetime score of 21.5%. Thirteen patients (39.4%) started chemoprevention, the majority of which were selective estrogen receptor modulators (SERM). Nine reported starting the medication at the 3 month follow-up appointment. The most reported side effect was hot flashes in 67%, although only the majority had mild symptoms. Three reported weight gain and one reported vaginal dryness. None reported worsening arthralgia or fatigue. Despite the low incidence of severe symptoms, only 3 continued to fill the medication at the time of chart review in August 2023. Twenty (60.6%) patients did not initiate chemoprevention. Four (20%) did not qualify due to cardiovascular or thrombotic risk factors, and three (15%) did not qualify due to concurrent use of hormone replacement therapy. Two (10%) elected not to start chemoprevention because they were planning for risk reducing mastectomies. Eleven (55%) did not initiate chemoprevention due to patient preferences and concern for side effects. Twenty-eight patients were recommended to obtain breast MRI in addition to mammogram for yearly screening. At time of chart review, 15 had at least one screening breast MRI ordered by PCP after BCPC visit, with 10 MRIs performed. CONCLUSIONS The unique interdisciplinary model of our breast cancer prevention clinic allows for a comprehensive and personalized evaluation for high-risk female Veterans on interventions to reduce their breast cancer risk. However, the current model does not ensure long-term compliance with these interventions. Studies have shown that more frequent/short-term follow up may improve compliance with endocrine therapies. Future directions include clinic expansion and providing additional follow-up with the multidisciplinary team to promote continued adherence to BCPC interventions. Citation Format: Hanqing Shang, Sarah Ansari, Shweta Dhar, Mahdieh Irranejadparizi, Stacey Edwards, Jessica Honkomp, Meagan Siehr, Bethany Aiena, Mary Nikityn, Diana Bearden, Deleene Menefee, Sita Bushan. A Multidisciplinary Telehealth Approach to Breast Cancer Prevention in a Veteran Population [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-27-09.

Abstract PO2-28-10: Analysis of whole breast ultrasound image sequence reading time with a new FDA approved automated whole breast ultrasound tomography system for supplemental screening in women with dense breasts

Abstract Purpose: Ultrasound technology as a supplement to mammography for screening women with dense breasts increases cancer detection. However, automated whole breast ultrasound technologies have been shown to substantially increase radiologist reading time. We conducted a reading validation program to assess how quickly and accurately radiologists could interpret images from a new automated whole breast ultrasound prior to launching a prospective case collection registry. Methods: The study analyzed 500 reading times of bilateral screening breast ultrasounds obtained from SoftVue Automated Whole Breast Ultrasound (SV) (Delphinus Medical) in women with dense breasts. For this proctored reading validation program, 20 bilateral screening ultrasound cases were selected. Thecases included a mix of normal, cysts, benign masses, cancers, and implants. 25 MSQA-trained radiologists with varying experience from 9 institutions across the United States each read the 20 cases. The same hanging protocol was used, beginning with sequences of Wafer and Sound Speed to identify an area of interest, Reflection to determine if the area persists, and then Stiffness Fusion for further confirmation and characterization. The primary outcome was reading time per bilateral ultrasound. Reading times were compared using linear mixed effects models for findings in neither, one, or both breasts and for subgroups of cancer and benign findings. Mean reading time was 3.3± 1.76 minutes (n=498, median 2.9min) per case. Cases that were negative in both breasts tended to have faster read times (2.7min, sd=1.32) compared to those with findings in one breast (3.2min, sd=1.57) or findings in both breasts (3.8min, sd=2.14). Mean read times for cases with clinical findings were within a minute of the mean time for normal cases across all case types. Conclusion Breast image sequences of Wafer, Sound Speed, Reflection, and Stiffness Fusion from SV ultrasound tomography facilitate bilateral ultrasound mean reading times of less than 4 minutes per case. Clinical Significance: SV, used as an adjunct to mammography in screening women with dense breasts, offers the benefits of increased cancer detection with supplemental ultrasound with little increase in radiologist reading time. Table 1: Analysis of Bilateral SV Read Time Across Types of Case Clinical Findings Citation Format: Mary Yamashita, Taylor Mahoney, Patrick Walker, Linda Hovanessian Larsen. Analysis of whole breast ultrasound image sequence reading time with a new FDA approved automated whole breast ultrasound tomography system for supplemental screening in women with dense breasts [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-28-10.

Predicting Prognosis of Phyllodes Tumors Using a Mammography- and Magnetic Resonance Imaging-Based Radiomics Model: A Preliminary Study

PurposeTo investigate whether a radiomics model based on mammography (MG) and magnetic resonance imaging (MRI) can be used to predict disease-free survival (DFS) after phyllodes tumor (PT) surgery. MethodAbout 131 PT patients who underwent MG and MRI before surgery between January 2010 and December 2020 were retrospectively enrolled, including 15 patients with recurrence and metastasis and 116 without recurrence. 884 and 3138 radiomic features were extracted from MG and MR images, respectively. Then, multiple radiomics models were established to predict the recurrence risk of the patients by applying a support vector machine classifier. The area under the ROC curve (AUC) was calculated to evaluate model performance. After dividing the patients into high- and low-risk groups based on the predicted radiomics scores, survival analysis was conducted to compare differences between the groups. ResultsIn total, 3 MG-related and 5 MRI-related radiomic models were established; the prediction performance of the T1WI feature fusion model was the best, with an AUC value of 0.93. After combining the features of MG and MRI, the AUC increased to 0.95. Furthermore, the MG, MRI and all-image radiomic models had statistically significant differences in survival between the high- and low-risk groups (P < .001). All-image radiomics model showed higher survival performance than the MG and MRI radiomics models alone. ConclusionsRadiomics features based on preoperative MG and MR images can predict DFS after PT surgery, and the prediction score of the image radiomics model can be used as a potential indicator of recurrence risk.

Follow-up results of BI-RADS 3 lesions on magnetic resonance imaging: a retrospective study

The categorization of Breast Imaging Reporting and Data System (BI-RADS) 3 lesions is not as clear in magnetic resonance imaging (MRI) as it is in mammography (MG). With the increasing number of MRI scans currently being conducted globally, incidentally detected lesions falling into the probably benign category are frequently being observed. In this study, our aim was to investigate the imaging characteristics and follow-up results of BI-RADS 3 lesions detected by MRI and to determine their malignancy rates. Breast MRI scans performed between January 2010 and January 2020 and classified as BI-RADS 3 lesions were retrospectively analyzed. The study included 216 lesions with known biopsy or surgical excision results or with at least one year of radiological follow-up. We assessed the patients' age, the presence of breast cancer, the follow-up interval, and the imaging findings at the beginning and during the follow-up. Lesions that remained stable, disappeared, or decreased in size and had a benign histopathological diagnosis were classified as benign. Lesions with the histopathological diagnosis of malignancy, identified by either biopsy or surgical excision, were classified as malignant. We determined the malignancy rate based on the histopathology and follow-up results. Considering the follow-up results of all cases, 8% of lesions were excised, 0.5% decreased in size, 1.4% became enlarged, 17.1% disappeared, and 73% remained stable. The malignancy rate was 2.8%. A significant relationship was found between lesion shape and malignancy, as progression to malignancy was more likely in round lesions than in other types. An irregular margin, heterogeneous enhancement, and kinetic curve (type 2) features were significant for lesion upgrade to malignancy. The malignancy rate in BI-RADS 3 lesions detected by MRI is low and falls within the accepted cancer rate for MG and sonography. Changes in size, morphology, and enhancement pattern should be considered in terms of malignancy development during follow-up. The follow-up intervals should be determined on a case-by-case basis.

The influence of breast screening on breast cancer incidence in England: observational study based on cancer registries and bulletins of the NHS Breast Screening Programme.

To assess the amount of breast cancer overdiagnosis associated with the National Health Service Breast Screening Programme (NHSBSP) that started in 1988 in England. First, numbers of breast cancers in women eligible for breast screening not attending screening were estimated for the period 1995-2019, which were extrapolated to all women. A second method was based on ratios of incidence rates of breast cancers in women aged 50-69 to women aged 70 years or more in 1971-1985. The ratio was used for estimating expected numbers of cancers in 1988-2019, and 1995-2019. From 1995 to 2019, 506,607 non-invasive and invasive breast cancers were diagnosed among women aged 50-64 years (1995-2001) and 50-70 years (2002-2019). A first method estimated that 95,297 cancers were in excess to the number of cancers that would be expected had the NHSBSP not existed. 42,567 screen-detected non-invasive and micro-invasive cancers represented 45.8% of the total excess cancer. 18.8% of all cancers diagnosed among women invited to screening, 25.1% of cancers found in women attending screening, and 35.1% of cancers detected by screening would represent overdiagnosis. A second method estimated that, 18.0% of all cancers diagnosed in 1988-2019, and 18.2% of all cancers diagnosed in 1995-2019 among women invited to screening would represent overdiagnosis. The two independent methods obtained similar estimates of overdiagnosis. The NHS Breast Screening Programme in England is associated with substantial amount of overdiagnosis.

Automated breast ultrasound in breast cancer screening of mammographically dense breasts: added values

BackgroundFull-field digital mammography (FFDM) is the primary screening method for breast cancer, yet the number of cancers that can be missed with mammography is considerable, notably in female with dense breast. In this study, we compared the diagnostic yield and the clinical significance of FFDM for breast cancer detection in female with dense breasts versus its performance when complemented by automated breast ultrasound (ABUS).ResultsThis retrospective study was performed during the period between January 2022 and December 2022 including 500 females with dense breast (ACR C&D), who underwent screening using FFDM and ABUS. The images were retrospectively interpreted, and statistical assessments were done comparing the FFDM results alone and after complemented with ABUS. Significance was considered at a p value less than 0.05. The use of FFDM with supplemental ABUS has reduced the numbers of recall and showed improved breast cancer detection with increased positive predictive value (from 74.5 to 83.5%). In comparison, using FFDM alone and associated with ABUS, there was moderate agreement with a kappa test of 0.51; p < 0.001.ConclusionABUS can be a useful and powerful diagnostic imaging tool when adjunct to FFDM for screening of dense breast. In this study, ABUS showed less false-negative results and improved the sensitivity of cancer detection.

Imaging the dense breast.

The sensitivity of mammography reduces as breast density increases, which impacts breast screening and locoregional staging in breast cancer. Supplementary imaging with other modalities can offer improved cancer detection, but this often comes at the cost of more false positives. Magnetic resonance imaging and contrast-enhanced mammography, which assess tumour enhancement following contrast administration, are more sensitive than digital breast tomosynthesis and ultrasound, which predominantly rely on the assessment of tumour morphology.

A comparative analysis of risk factor associations with interval and screen-detected breast cancers: A large UK prospective study.

The associations of certain factors, such as age and menopausal hormone therapy, with breast cancer risk are known to differ for interval and screen-detected cancers. However, the extent to which associations of other established breast cancer risk factors differ by mode of detection is unclear. We investigated associations of a wide range of risk factors using data from a large UK cohort with linkage to the National Health Service Breast Screening Programme, cancer registration, and other health records. We used Cox regression to estimate adjusted relative risks (RRs) and 95% confidence intervals (CIs) for associations between risk factors and breast cancer risk. A total of 9421 screen-detected and 5166 interval cancers were diagnosed in 517,555 women who were followed for an average of 9.72 years. We observed the following differences in risk factor associations by mode of detection: greater body mass index (BMI) was associated with a smaller increased risk of interval (RR per 5 unit increase 1.07, 95% CI 1.03-1.11) than screen-detected cancer (RR 1.27, 1.23-1.30); having a first-degree family history was associated with a greater increased risk of interval (RR 1.81, 1.68-1.95) than screen-detected cancer (RR 1.52, 1.43-1.61); and having had previous breast surgery was associated with a greater increased risk of interval (RR 1.85, 1.72-1.99) than screen-detected cancer (RR 1.34, 1.26-1.42). As these differences in associations were relatively unchanged after adjustment for tumour grade, and are in line with the effects of these factors on mammographic density, they are likely to reflect the effects of these risk factors on screening sensitivity.

The impact of AI implementation in mammographic screening: redefining dense breast screening practices.

The impact of AI implementation in mammographic screening: redefining dense breast screening practices.

The Impact of Mammographic, Radiologist, and Patient Factors on the Likelihood of Probably Benign (BI-RADS 3) Assessment at Diagnostic Mammography.

To evaluate the association of mammographic, radiologist, and patient factors on BI-RADS 3 assessment at diagnostic mammography in patients recalled from screening mammography. This Institutional Review Board-approved retrospective study of consecutive unique diagnostic mammography examinations in asymptomatic patients recalled from screening mammography March 5, 2014, to December 31, 2019, was conducted in a single large United States health care institution. Mammographic features (mass, calcification, distortion, asymmetry), breast density, prior examination, and BI-RADS assessment were extracted from reports by natural language processing. Patient age, race, and ethnicity were extracted from the electronic health record. Radiologist years in practice, recall rate, and number of interpreted diagnostic mammograms were calculated. A mixed effect logistic regression model evaluated factors associated with likelihood of BI-RADS 3 compared with other BI-RADS assessments. A total of 12 080 diagnostic mammography examinations were performed during the study period, yielding 2010 (16.6%) BI-RADS 3 and 10 070 (83.4%) other BI-RADS assessments. Asymmetry (odds ratio [OR] = 6.49, P <.001) and calcification (OR = 5.59, P <.001) were associated with increased likelihood of BI-RADS 3 assessment; distortion (OR = 0.20, P <.001), dense breast parenchyma (OR = 0.82, P <.001), prior examination (OR = 0.63, P = .01), and increasing patient age (OR = 0.99, P <.001) were associated with decreased likelihood. Mass, patient race or ethnicity, and radiologist factors were not significantly associated with BI-RADS 3 assessment. Malignancy rate for BI-RADS 3 lesions was 1.6%. Asymmetry and calcifications had an increased likelihood of BI-RADS 3 assessment at diagnostic evaluation with low likelihood of malignancy, while radiologist features had no association.

Breast cancer screening motivation and behaviours of women aged over 75 years: a scoping review

BackgroundThis scoping review aimed to identify and present the evidence describing key motivations for breast cancer screening among women aged ≥ 75 years. Few of the internationally available guidelines recommend continued biennial screening for this age group. Some suggest ongoing screening is unnecessary or should be determined on individual health status and life expectancy. Recent research has shown that despite recommendations regarding screening, older women continue to hold positive attitudes to breast screening and participate when the opportunity is available.MethodsAll original research articles that address motivation, intention and/or participation in screening for breast cancer among women aged ≥ 75 years were considered for inclusion. These included articles reporting on women who use public and private breast cancer screening services and those who do not use screening services (i.e., non-screeners).The Joanna Briggs Institute (JBI) methodology for scoping reviews was used to guide this review. A comprehensive search strategy was developed with the assistance of a specialist librarian to access selected databases including: the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Web of Science and PsychInfo. The review was restricted to original research studies published since 2009, available in English and focusing on high-income countries (as defined by the World Bank). Title and abstract screening, followed by an assessment of full-text studies against the inclusion criteria was completed by at least two reviewers. Data relating to key motivations, screening intention and behaviour were extracted, and a thematic analysis of study findings undertaken.ResultsA total of fourteen (14) studies were included in the review. Thematic analysis resulted in identification of three themes from included studies highlighting that decisions about screening were influenced by: knowledge of the benefits and harms of screening and their relationship to age; underlying attitudes to the importance of cancer screening in women's lives; and use of decision aids to improve knowledge and guide decision-making.ConclusionThe results of this review provide a comprehensive overview of current knowledge regarding the motivations and screening behaviour of older women about breast cancer screening which may inform policy development.

Menstrual and reproductive factors associated with risk of breast cancer among Indian women: a cross sectional study from National Family Health Survey, 2019-21

BackgroundThe breast cancer is common cancer in women globally. The risk of breast cancer is strongly associated with women’s menstrual and reproductive factors that have been established in different countries. Therefore present study was aim to explore the association between menstrual and reproductive factors and the risk of breast cancer screening in Indian women.MethodsThe present study data has been used fifth round of the National Family Health Survey (NFHS-V) with 724,115 women in aged 15–49 in 2019-21. The self-reported ever screened of breast cancer for women aged 30–49 was the main outcome variable of the study. Logistic regression models were used to estimate odds ratios and 95% confidence intervals for breast cancer by menstrual and reproductive factors adjusted for potential confounders.ResultsLate menarche (OR = 2.20, 95% CI: 1.48–3.28), irregular menstrual cycle (OR = 1.29, 95% CI: 1.08–3.53)), delay age at first birth (OR = 1.93, 95% CI: 1.11–3.04) and contraceptive pill used (OR = 1.11, 95% CI: 0.74–2.10) were significantly associated to increases the uptake of screening breast cancer. While, a higher number of birth (OR = 0.52, 95% CI: 0.10–1.03), and long duration of breast-feeding practice (OR = 0.75, 95% CI: 0.63–0.91) were reduced to participate for screening breast cancer.ConclusionThe results of the study confirm the role of menstrual and reproductive factors in breast cancer in Indian women. Therefore, our findings are imperative for developing breast cancer prevention strategies and better preparedness. Creating awareness and providing knowledge on cancer could be key strategies for the reduction of breast cancer in Indian reproductive age group women.

Knowledge, Attitude and Practice Regarding Breast Cancer and Screening Among Female Health Workers at Birat Medical College Teaching Hospital .

Introduction: In Nepal, breast cancer is the second most common cancer amongst women. Objectives: The objective of this study is to analyze the knowledge, attitudes and practices of health care female professional regarding breast cancer and screening. Methodology: A cross sectional study was done among the female healthcare workers in the department of Medical Oncology from 1st November 2021 to 1st December 2021. Purposive sampling technique was applied for sampling. After consent , questionnaire set regarding the research was provided to the female care professionals. The interview was conducted under the supervision of matron of nursing department. The collected data were analyzed with the help of SPSS Statistic software. Results: One hundred seven female healthcare professionals participated the study during the study time period. The mean age of them was 25.25 years (20-45 years).55% of them had high level of knowledge regarding risk factors of breast cancer .88% of them had high level of knowledge regarding symptoms of breast cancer .75% of them had good knowledge regarding breast cancer treatment modalities. 69% of them were aware that screening helps in prevention of breast cancer amongst which 61% participants agreed for screening themselves for breast cancer . 72% of them were involved in self breast examination .A total of 4.6% of them were unaware of mammograms and 93.4% had never undergone mammogram. Conclusion : Present study demonstrated a good knowledge regarding breast cancer but poor practice regarding breast cancer screening methods among the female health care workers at Birat Medical College Teaching Hospital.

Factors Affecting Breast Cancer Screening Behavior Among Women in Saudi Arabia: A Retrospective Cross-Sectional Study.

Background Early detection of breast cancer is crucial for effective treatment and minimizing mortality, requiring effective screening methods like self-examination, clinical examination, and mammography. However, not all women in Saudi Arabia comply with these examinations, and studies examining its practice and barriers of low uptake are scant. The aim of this study is to investigate factors influencing breast cancer screening behavior among women in Saudi Arabia. Methods This cross-sectional study involving 806 women from October to November 2022 used an online questionnaire for the data collection process, including questions about demographic characteristics, awareness assessment, breast cancer screening behavior, symptoms, risk factors, and screening programs. Factors affecting the screening behavior were analyzed using the logistic regression model with adjusted odds ratio (AOR) and 95% confidence interval (CI). Results Among the 806 women who participated in the study, 479 (59.4%) were under 40 years old, and half of them were urban residents (n = 394, 48.9%). Only 134 subjects (16.6%) had a history of breast screening. Social media (n = 519, 64.5%) was the predominant source of screening information. The primary obstacles to breast cancer screening were the absence of tumor symptoms (n = 333, 41.3%), insufficient knowledge about early detection (n = 249, 31%), lack of time (n = 245, 30%), fear of discovering a tumor (n = 187, 23%), and lack of awareness about screening centers (n = 155, 19%).In regression analysis, predictive factors for breast cancer screening behavior were as follows: age over 40 years old (AOR: 2.56; 95% CI: 1.70-3.87), residents of big cities (AOR: 3.57; 95% CI: 1.02-12.56), positive family history of breast cancer (AOR: 2.53; 95% CI: 1.50-4.28), proximity to the screening center (AOR: 2.56; 95% CI: 1.22-5.39), and using contraceptive pills for more than five years (AOR: 1.78; 95% CI: 1.04-3.04), and were statistically significant (all p-values < 0.05). Conclusions In this study, the most perceived barriers to BSE were the absence of tumor symptoms, followed by insufficient knowledge about early detection, lack of time, fear of discovering a tumor, and lack of awareness about screening centers. Additionally, the predictive factors for breast cancer screening behavior were as follows: age over 40 years old, residents of big cities, positive family history of breast cancer, proximity to the screening center, and using contraceptive pills for more than five years. Given the identified factors affecting breast self-examination behavior in this study, public education initiatives are crucial for raising awareness, facilitating self-examination, and ultimately improving health outcomes and reducing breast cancer treatment costs in society.

Association between the social vulnerability index and breast, cervical, and colorectal cancer screening rates in Rhode Island.

Cancer screening is effective in reducing the burden of breast, cervical, and colorectal cancers, but not all communities have appropriate access to these services. In this study, we aimed to identify under-resourced communities by assessing the association between the Social Vulnerability Index (SVI) with screening rates for breast, cervical, and colorectal cancers in ZIP-code tabulation areas (ZCTAs) in Rhode Island. This study leveraged deidentified health insurance claims data from HealthFacts RI, the state's all-payer claims database, to calculate screening rates for breast, cervical, and colorectal cancers using Healthcare Effectiveness Data and Information Set measures. We used spatial autoregressive Tobit models to assess the association between the SVI, its four domains, and its 15 component variables with screening rates in 2019, accounting for spatial dependencies. In 2019, 73.2, 65.0, and 66.1% of eligible individuals were screened for breast, cervical, and colorectal cancer, respectively. For every 1-unit increase in the SVI, screening rates for breast and colorectal cancer were lower by 0.07% (95% CI 0.01-0.08%) and 0.08% (95% CI 0.02-0.15%), respectively. With higher scores on the SVI's socioeconomic domain, screening rates for all three types of cancers were lower. The SVI, especially its socioeconomic domain, is a useful tool for identifying areas that are under-served by current efforts to expand access to screening for breast, cervical, and colorectal cancer. These areas should be prioritized for new place-based partnerships that address barriers to screening at the individual and community level.

Cancer Stage Compared With Mortality as End Points in Randomized Clinical Trials of Cancer Screening

Randomized clinical trials of cancer screening typically use cancer-specific mortality as the primary end point. The incidence of stage III-IV cancer is a potential alternative end point that may accelerate completion of randomized clinical trials of cancer screening. To compare cancer-specific mortality with stage III-IV cancer as end points in randomized clinical trials of cancer screening. This meta-analysis included 41 randomized clinical trials of cancer screening conducted in Europe, North America, and Asia published through February 19, 2024. Data extracted included numbers of participants, cancer diagnoses, and cancer deaths in the intervention and comparison groups. For each clinical trial, the effect of screening was calculated as the percentage reduction between the intervention and comparison groups in the incidence of participants with cancer-specific mortality and stage III-IV cancer. Randomization to a cancer screening test or to a comparison group in a clinical trial of cancer screening. End points of cancer-specific mortality and incidence of stage III-IV cancer were compared using Pearson correlation coefficients with 95% CIs, linear regression, and fixed-effects meta-analysis. The included randomized clinical trials tested benefits of screening for breast (n = 6), colorectal (n = 11), lung (n = 12), ovarian (n = 4), prostate (n = 4), and other cancers (n = 4). Correlation between reductions in cancer-specific mortality and stage III-IV cancer varied by cancer type (I2 = 65%; P = .02). Correlation was highest for trials that screened for ovarian (Pearson ρ = 0.99 [95% CI, 0.51-1.00]) and lung (Pearson ρ = 0.92 [95% CI, 0.72-0.98]) cancers, moderate for breast cancer (Pearson ρ = 0.70 [95% CI, -0.26 to 0.96]), and weak for colorectal (Pearson ρ = 0.39 [95% CI, -0.27 to 0.80]) and prostate (Pearson ρ = -0.69 [95% CI, -0.99 to 0.81]) cancers. Slopes from linear regression were estimated as 1.15 for ovarian cancer, 0.75 for lung cancer, 0.40 for colorectal cancer, 0.28 for breast cancer, and -3.58 for prostate cancer, suggesting that a given magnitude of reduction in incidence of stage III-IV cancer produced different magnitudes of change in incidence of cancer-specific mortality (P for heterogeneity = .004). In randomized clinical trials of cancer screening, incidence of late-stage cancer may be a suitable alternative end point to cancer-specific mortality for some cancer types, but is not suitable for others. These results have implications for clinical trials of multicancer screening tests.

HSR24-157: Standalone Performance Evaluation of an Artificial Intelligence Breast Cancer Detection Tool on Consecutively Collected Biopsy Proven Breast Cancer and Screening Negative Tomosynthesis Cases.

HSR24-157: Standalone Performance Evaluation of an Artificial Intelligence Breast Cancer Detection Tool on Consecutively Collected Biopsy Proven Breast Cancer and Screening Negative Tomosynthesis Cases.