Screening Mammography In Women Research Articles

Breast cancer screening in women with mental illness: comparative meta-analysis of mammography uptake.

There is a higher mortality rate due to cancer in people with mental illness and previous work suggests suboptimal medical care in this population. It remains unclear if this extends to breast cancer population screening. To conduct a systematic review and meta-analysis to establish if women with a mental health condition are less likely to receive mammography screening compared with those without mental ill health. Major electronic databases were searched from inception until February 2014. We calculated odds ratios (OR) with a random effects meta-analysis comparing mammography screening rates among women with and without a mental illness. Results were stratified according to primary diagnosis including any mental illness, mood disorders, depression, severe mental illness (SMI), distress and anxiety. We identified 24 publications reporting breast cancer screening practices in women with mental illness (n = 715,705). An additional 5 studies investigating screening for those with distress (n = 21,491) but no diagnosis of mental disorder were identified. The pooled meta-analysis showed significantly reduced rates of mammography screening in women with mental illness (OR = 0.71, 95% CI 0.66-0.77), mood disorders (OR = 0.83, 95% CI 0.76-0.90) and particularly SMI (OR = 0.54, 95% CI 0.45-0.65). No disparity was evident among women with distress alone. Rates of mammography screening are lower in women with mental illness, particularly women with SMI, and this is not explained by the presence of emotional distress. Disparities in medical care due to mental illness clearly extend into preventive population screening.

Abstract B81: Access to care barriers and history of mammography screening in Hispanic/Latino women living in the Northeast, United States

Abstract Background: Hispanic/Latinas (H/Ls) are more likely to be diagnosed with later staged breast cancer and to have poorer survival compared with White (W) women. Nationally, mammography screening rates in H/Ls are lower than reported for Whites or African Americans. However, little is known about cancer screening in H/Ls living in the Northeast, US. Given the rapidly changing socio-demographic profile of this area of the country, the goal of this prospective study is to identify predictors of adherence to mammography screening guidelines and associated outcomes over a 2-3 year period. Here, we report the role of access to care on history of adherence to mammography guidelines as reported in the baseline interview. Methods: 1600 community-based Hispanic/Latinas, ages 40-75, seeking care at primary care clinics in 4 cities with the largest Hispanic populations in Connecticut, and with no prior history of breast cancer or biopsy, were enrolled in this study between October, 2009 and March, 2011( 75% participation rate). Study participants provided extensive information on socio-demographic, medical care, psychosocial, health beliefs and acculturation factors in a one hour telephone interview, generally conducted in Spanish (85%). Access to care variables included: insurance (none, some public/private), usual care provider (no/yes), recent (index) primary care appointment conducted in English language only (yes/no), some or all of mammogram paid out of pocket (yes/no), as well as special arrangements (e.g., child care) needed to receive mammogram (yes/no) and lost pay associated with mammography appointments (yes, no). Bivariate analyses and multivariate stepwise logistic regression were performed. Odds ratios (OR) and 95% confidence intervals (CI) are reported. Results: Adjusting for selected socio-demographic (age, education, marital status), acculturation (foreign or Puerto-Rico born), self-assessed English language skill, self-rated health, as well as other access to care variables, participants who reported that their recent primary care appointment was conducted completely in English language were less likely to have received a screening mammogram in the previous year (OR= 1.31, 95% CI 0.96-1.78, marginally significant). Women lacking a usual place for health care (OR= 1.53, 95% CI 1.12-2.08) and women who had to pay for some or all of their mammograms (OR 1.55, 95% CI 1.07-2.25) were significantly less likely to report a screening mammogram in the previous year. Conclusions: Notwithstanding that all participants were recruited from hospital-based or federally funded primary care clinics that serve large H/L populations, access to care barriers were still associated with history of mammography screening in women at increased risk of poor outcomes associated with breast cancer diagnosis. Findings from this investigation will be critical in informing cancer prevention strategies for this under-resourced population. Citation Format: Beth A. Jones, Inginia Genao, Marcella Nunez-Smith, Hosanna Soler-Vilà, Elizabeth B. Claus, Margaret Doyle, Susan Nappi, Alejandra Miranda, Elizabeth Fernandez, Juliana Quintero. Access to care barriers and history of mammography screening in Hispanic/Latino women living in the Northeast, United States. [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 B81. doi:10.1158/1538-7755.DISP13-B81

Randomized trial of DVD, telephone, and usual care for increasing mammography adherence.

The purpose of this study was to test an intervention to increase mammography screening in women 51-75 years of age who had not received a mammogram in the last 15 months. A total of 1681 women were randomized to (1) a mailed tailored interactive DVD, (2) a computer-tailored telephone counseling, or (3) usual care. Women with income below US$75,000 who were in the interactive DVD group had significantly more mammograms than women in usual care. Women with income above US$75,000 had significantly fewer mammograms than women with income less than US$75,000 regardless of group. Further investigation is needed to understand why women with income above US$75,000 did not show the same benefit of the intervention.

Commentary on the Canadian National Breast Screening study.

In the setting of the 25-year follow-up of the Canadian National Breast Screening Study, the Society of Surgical Oncology continues to endorse mammographic screening for women beginning at 40 years of age, while acknowledging that mammography has both risks and benefits. Further investigation is warranted to develop better screening methods and to determine optimal screening schedules for women based on their risk of future breast cancer and their imaging characteristics.

Accuracy of screening mammography in women with a history of lobular carcinoma in situ or atypical hyperplasia of the breast.

Women with lobular carcinoma in situ (LCIS), atypical lobular hyperplasia (ALH), atypical ductal hyperplasia (ADH), or atypical hyperplasia (AH) are at increased breast cancer (BC) risk. We investigated the accuracy and outcomes of mammography screening in women with histology-proven LCIS, ALH, ADH, or AH history who had screening through Breast Cancer Surveillance Consortium-affiliated mammography facilities. Screens from two cohorts, defined by LCIS/ALH or ADH/AH history, were compared to two cohorts without such history mammogram-matched for age-group, breast density, family history, screen-year, and mammography registry. Overall 359 BCs (277 invasive BC) occurred within 1 year from screening among 52,380 screens. In the LCIS/ALH cohort [versus comparator screens] cancer incidence rates, cancer detection rates (CDR), and interval cancer rates (ICR) were significantly higher (all P < 0.001); although ICR was 4.4/1,000 screens [versus 0.9/1,000; P < 0.001] the proportion that were interval cancers did not differ between compared cohorts (P = 0.43); screening sensitivity was 76.1 % [versus 82.3 %; P = 0.43], however, specificity was significantly lower at 85.1 % [versus 90.7 %; P < 0.0001]. In the ADH/AH cohort [versus comparator] cancer rates and CDR were significantly higher (P < 0.001); although ICR was 2.6/1,000 screens [versus 0.9/1,000; P = 0.002] the proportion that were interval cancers did not differ between cohorts (P = 0.74); screening sensitivity was 81.0 % [versus 82.6 %; P = 0.74] and specificity was lower at 86.2 % [versus 90.2 %; P < 0.0001]. Mammography screening sensitivity in LCIS/ALH and ADH/AH cohorts did not significantly differ from that of matched screens, however, specificity was lower, and ICRs were higher (reflecting underlying cancer rates). Adjunct screening may be of value in these women if it reduces ICR without substantially reducing specificity.

ACOG Committee Opinion no. 593: Management of women with dense breasts diagnosed by mammography.

Women with dense breasts have a modestly increased risk of breast cancer and experience reduced sensitivity of mammography to detect breast cancer. However, evidence is lacking to advocate for additional testing until there are clinically validated data that indicate improved screening outcomes. Currently, screening mammography remains the most useful tool for breast cancer detection and has consistently demonstrated a reduction in breast cancer mortality. The American College of Obstetricians and Gynecologists does not recommend routine use of alternative or adjunctive tests to screening mammography in women with dense breasts who are asymptomatic and have no additional risk factors. The American College of Obstetricians and Gynecologists recommends that health care providers comply with state laws that may require disclosure to women of their breast density as recorded in a mammogram report.

Updated Guidelines for Management of High Blood Pressure

Updated Guidelines for Management of High Blood Pressure

Abstract P1-09-08: Breast cancer (BC) outcomes after implementation of “Seguro popular” at the National Institute of Medical Sciences and Nutrition, Salvador Zubiran (INCMNSZ) in Mexico

Abstract Background: In Mexico 60% of newly diagnosed BC patients present with locally advanced disease. In the United States, 88-95% of patients present with early stage disease, however in Mexico, only 10% of patients are diagnosed at this stage. The Seguro Popular (SP), a national insurance scheme for Mexico's poor and uninsured population, was implemented for BC in 2007. The SP covers diagnostics, local and systemic treatment for BC patients. The INCMNSZ is a third level hospital where patients receive diagnosis and treatment for non-malignant diseases, and also routinely conducts BC annual mammography screening for women ≥ 50 years old. We aimed to evaluate BC outcomes in our patients following the implementation of SP at our institution. Methods: From January 2011 to May 2013, we prospectively evaluated a cohort of 93 patients with BC included in the SP program at the INCMNSZ. A retrospective cohort of 99 patients without SP access who received neoadjuvant chemotherapy from January 2007 to December 2009 was used for comparative analysis. Complete pathologic response (pCR) was defined as complete absence of invasive tumor in breast and axillary nodes. We used Fisher's exact test to compare pCR between groups. Results: A total of 93 patients were diagnosed with BC and included in the SP program. 10 patients were excluded from the analysis- (5 were lost to follow-up and 5 had missing data. Median age was 52 (46-59) years and 37 patients (45%) were premenopausal at diagnosis), median follow up 11.8 months. 20 patients (24%) had stage I, 36 (43%) stage II, 7 (8%) stage III, and 20 (24%) stage IV. 55 (66%) patients had hormone receptor (HR) positive (ER + and/or PR+), 15 (18%) HER2+ and 13 (16%) had triple negative (TN) tumors. Thirty-two (39%) patients received neoadjuvant chemotherapy. 27% of patients achieved pCR (17% in HR positive, 20% in TN and 50% in HER2+ tumors) compared to 15% in the non SP cohort (11% in HR positive, 22% in TN and 14% in HER2+ tumors). HER2+ tumors from the SP cohort reached significantly higher pCR rates than in the non SP cohort (p = 0.029). Discussion: Our results confirmed that about half of our patients were diagnosed with early stage BC, which highlights the importance of a screening program at our institution. Increased pCRs in the HER2+ subgroup may reflect wider access to trastuzumab after implementation of SP. Although we acknowledge a short period of follow-up in our cohort, our results in pCR are comparable to those previously reported in the literature. We believe the SP had a positive impact on access to care and outcomes in our patients. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-09-08.

Screening Mammography for Women in Their 40s: A Retrospective Study of the Potential Impact of the U.S. Preventive Service Task Force's 2009 Breast Cancer Screening Recommendations

The objective of our study was to review screening mammography examinations performed at our institution from 2007 through 2010 with the primary endpoint of determining the incidence of breast cancer and associated histologic and prognostic features in women in their 40s. Patients who presented for screening mammography who ultimately (i.e., after additional imaging, including diagnostic mammographic views and ultrasound) received a BI-RADS assessment of a category 4 or 5 for a suspicious abnormality were followed retrospectively through completion of care and were analyzed with respect to pathology results after biopsy, treatment, and family history. During the study period, 43,351 screening mammography examinations were performed; 1227 biopsies were recommended on the basis of those studies and yielded 205 breast cancers (cancer detection rate of 4.7 per 1000 screening examinations). These screening examinations included 14,528 (33.5%) screening examinations of patients in their 40s; 413 biopsies were recommended and yielded 39 breast cancers (39/205 = 19%) (cancer detection rate of 2.7 per 1000 screening examinations). More than 50% (21/39) of the cancers in women in their 40s were invasive. Only 8% (3/39) of the women in their 40s with screening-detected breast cancer had a first-degree relative with breast cancer. From 2007 through 2010, patients in their 40s accounted for one third of the population undergoing screening mammography and for nearly 20% of the screening-detected breast cancers--more than half of which were invasive. This information should be a useful contribution to counseling women in this age group when discussing whether or not to pursue regular screening mammography.

The impact of screening mammography in women age 40-49 as a function of tumor biology.

113 Background: Mammographic screening for women 40-49 years of age remains controversial based on results from earlier large scale, controlled mammography trials. Methods: From 2002-2006, 871 women aged 40-49 were diagnosed with breast cancer at Intermountain. The charts of all patients without a record of a screening mammogram at Intermountain (n= 436) were reviewed to confirm that they had not had a screening mammogram in the prior two years at any facility (Interval Cancers) and their survival was compared to 435 women who had their cancer diagnosed on a screening exam (Screen Detected). All patients were followed for at least 5 years via the tumor registry. Results: Stage distribution for Screen Detected/Interval cancers was 25.3/6.4% stage 0, 36.8/24.8% stage I, 24.6/35.6% stage II, 6.9/20.4% stage III and 0.5/3.4% stage IV. Overall, 67 patients (7.7%) did not have complete staging data. Overall survival was significantly better (p&lt;.0001) for 40-49 year old women with Screen Detected compared to those with Interval cancers. 702 (79.6%) had ER/PR status recorded (83.5% ER/PR positive). Women with DCIS or LCIS did not have tissue sent for markers. 679 patients (76.9%) had HER2 status recorded (78.8% HER2 neg). Of the patients with both HER2 and ER/PR status recorded 10.4% were “triple negative.” Survival following screening mammography was significantly enhanced for women who were ER/PR positive (p&lt;0.0001), HER2 negative (p=0.0065), or HER2 positive (p=0.0013). Survival was not improved by screening mammography for women who were ER/PR negative (p=0.3818) or for women who were triple negative (p=0.416). Conclusions: A minority of women age 40-49 who develop breast cancer (13%) have biologic features suggestive of aggressive disease and, after 5 years of follow up, they are not benefitted by screening mammography. The remaining 87% are clearly benefitted by screening mammography. Our results suggest that the discrepancies noted in the screening mammography trials in 40-49 year old women may have resulted from population variations in the proportion of women with unfavorable biology. Based in part on these results, we continue to recommend regular screening in the 40-49 year old cohort.

Abstract C06: Temporal changes in characteristics of women receiving screening mammograms at a community-based breast cancer screening center

Abstract The American Cancer Society recommends annual mammography screening for women over 40 years old, however, screening uptake is lower among African American, Hispanic, and Asian Americans than Whites. Socioeconomic factors such as income, lack of insurance, low education level, and immigrant status are also associated with lower mammography screening rates. Among uninsured/under-insured and medically underserved populations, community clinics are important providers for breast cancer screening services. The Capital Breast Care Center (CBCC) of the Georgetown-Lombardi Comprehensive Cancer Center was established in 2004 to deliver breast and cervical cancer screening to all women in the District of Columbia (D.C.) metropolitan region regardless of ability to pay. We examined the characteristics of women presenting to CBCC for screening mammograms from 2010-2012 and investigated temporal changes in selected demographic and socioeconomic characteristics during this period. Data was abstracted from the electronic medical records at CBCC and analyzed. Patient characteristics were described in frequencies and the statistical significance was determined using chi-square tests. From 2010 to 2012, 4,604 women were screened at CBCC. Patient volume increased each year, with a greater number of returning patients than each previous year. In 2010, 1428 women were seen, 46% of whom were new. In 2011 and 2012, 1581 and 1594 patients were seen, with 43% and 38% as new patients, respectively. About 40% of the women screened at CBCC each year were below the age of 50. The age distribution of the women remained relatively constant over the 3 year study period. African-American and Hispanic women accounted for about 90% of those screened at CBCC over the 3 year period. However, between 2010 and 2012, the racial/ethnic composition of the screenees shifted with a 9% decrease in the number of African-Americans and an increase of 6% among Latinas (P&amp;lt;0.0001). A small increase in the number of Asian-American women was also noted (2%). Corresponding changes in the primary language spoken by the patients were also observed with the proportion of native English speakers decreasing and native Spanish speakers increasing by 6% from 2010 to 2012 (P &amp;lt; 0.01). More than half of the women seen at CBCC were uninsured. The proportion of uninsured women screened at CBCC increased by 13% from 2010 (46%) to 2012 (59%), with corresponding declines in the proportion of screenees with private insurance (-3.52%), Medicaid (-5.49%), and Medicare (-1.98%) (P&amp;lt;0.0001). 73% of the women screened between 2010 and 2012 had completed high school or higher education. Temporal changes in education levels of the participants were not evident in our data. Reasons for the temporal changes in racial/ethnic composition and native language of the women seen at CBCC could be related to the demographic changes in the Washington D.C. metropolitan area and/or a demographic shift in the age distribution of Latinas thereby resulting in a greater percentage of them being eligible for mammograms. In addition, over the past three years, CBCC outreach efforts have increased in the Latino community with hiring of Spanish-speaking health educators and patient navigators. Results from our study underscore the importance of community-based clinics in increasing cancer screening uptake in un-/under-served communities. Citation Format: Holly S. Greenwald, Chiranjeev Dash, Bridget Oppong, Tesha Coleman, Vivian Watkins, Lucile L. Adams-Campbell. Temporal changes in characteristics of women receiving screening mammograms at a community-based breast cancer screening center. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr C06.

Mammography screening among women 40-49 years old, before and after USPSTF guideline changes.

113 Background: The age at which to start breast cancer screening is controversial. The US Preventive Task Force (USPSTF) recommended against routine mammography screening in women 40-49 years old in November 2009 (the 2002 report had recommended screening), and instead suggested that women consult their physicians. We examined the frequency of screening among 40-49yo, and characteristics of the screened. Methods: We examined mammography screening among 85,650 women who were continuously enrolled in a prepaid integrated delivery system and who were between 40-45yo in 2006. We excluded women with any cancer diagnosis (2005-2009). Using logistic regression, we examined the association between screening in 2010 and several traits, e.g., mammogram cost-sharing, screening behavior before 2010, comorbidity score, race/ethnicity, and neighborhood socio-economic status indictors. In 2010, 75% of women had free mammograms; for the others, the median cost-sharing amount was $10. Results: Nearly all subjects (92%) received at least one mammogram between 2006-10: 14% received one; 37% received two; 33% received three; 6% received four; and 1% received 5+ mammograms. The unadjusted percent screened during each year increased slightly from 2006-2009 (38% to 47%) before dropping in 2010 (45%). Among women screened before the guideline changes, 47% received a mammogram in 2010. After adjustment, subjects who had any cost-sharing (OR=0.96 vs. free screening, 95%CI: 0.93-0.99) or who lived in lower SES neighborhoods (OR=0.94 vs. higher SES, 95%CI: 0.90-0.97) were less likely to receive a screening mammogram in 2010. Subjects with frequent earlier screening (e.g., OR=4.44 for four mammograms vs. none, 95%CI:3.99-4.94) and who were Asian (OR=1.05 vs. White, 95%CI: 1.01-1.09) were more likely to receive a 2010 mammogram; Black and Hispanic subjects had similar odds as Whites. Conclusions: In this integrated system, mammography screening among women 40-49 years old decreased slightly after the 2009 USPSTF recommendation against routine screening. Better alignment of insurance benefits with screening guidelines could improve adherence with recommendations.

Screening mammography in older women: the balance between appropriate use and overuse

263 ISSN 1758-1923 10.2217/BMT.13.24 © 2013 Future Medicine Ltd Breast Cancer Manage. (2013) 2(4), 263–265 The incidence of female breast cancer gen‐ erally increases with age, with a median age of 61 years at the time of diagnosis. Women aged 65 years and older comprise approximately 35% of incident breast can‐ cer cases and 57% of breast cancer deaths [1]. The likelihood of death from breast cancer increases with advanced stage and larger tumor size at diagnosis. An impor‐ tant strategy to reduce such deaths is to screen asymptomatic women with mam‐ mography in order to detect and treat breast cancer in its preclinical stage and improve survival. However, ubiquitous mammographic screening among older women may not confer the expected ben‐ efit, but instead may result in unintended harms. For example, there is at least a 4‐year lag between screen‐detected breast cancer and onset of clinical symptoms for women aged 65–74 years [2]. Mammo‐ graphy trials found no survival difference between screened and unscreened women before 7 years of follow‐up for women aged 65–74 years [3]. In older women with lim‐ ited life expectancy, the delayed screening benefit does not have sufficient time to emerge because of competing risks. In fact, such women may be exposed to immediate physical and psychological harms caused by false‐positive results, invasive diagnostic tests, and overdiagnosis and overtreatment of breast cancer that otherwise would not have been diagnosed and treated in their lifetime [4,5]. High‐quality screening mam‐ mography services need to strike a balance between appropriate use and overuse; that is, they must screen older women who have a long enough life expectancy to benefit and avoid screening those with limited life expectancy. Both underuse and overuse of screen‐ ing mammography are evident among older women. Current cancer screening guidelines generally set age limits in their recommendations. For example, the US Preventive Services Task Force recom‐ mends regular screening mammography for women aged 50–74 years and individu‐ alized screening decisions for those aged 75 years and older [6]. It was estimated that, among women aged 75–90 years, approxi‐ mately 80% had an estimated life expec‐ tancy of 7 or more years and 60% had a life expectancy of 10 or more years [7,8]. With the rapid growth of the aging population, the proportion of such healthy, very old persons is expected to increase accordingly.

Contrast enhanced mammography: Techniques, current results, and potential indications

The application of x-rays for breast imaging followed some 18 years after the discovery of x-rays by Conrad Wilhelm Röntgen, 1 Pisano E.D. Gatsonis C. Hendrick E. et al. Diagnostic performance of digital versus film mammography for breast cancer screening. N Eng J Med. 2005; 353: 1773-1783 Crossref PubMed Scopus (1540) Google Scholar followed by several generations of technical improvements. Significant improvements in mammography were made around the turn of the millennium, when digital mammography systems were introduced. Although the diagnostic accuracy of digital full-field mammography is, in general, considered good, it is still dependent on breast density. 1 Pisano E.D. Gatsonis C. Hendrick E. et al. Diagnostic performance of digital versus film mammography for breast cancer screening. N Eng J Med. 2005; 353: 1773-1783 Crossref PubMed Scopus (1540) Google Scholar , 2 Carney P.A. Miglioretti D.L. Yankaskas B.C. et al. Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Ann Intern Med. 2003; 138: 168-175 Crossref PubMed Scopus (897) Google Scholar Carney et al. 2 Carney P.A. Miglioretti D.L. Yankaskas B.C. et al. Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Ann Intern Med. 2003; 138: 168-175 Crossref PubMed Scopus (897) Google Scholar showed that sensitivity of screening mammography in women with extremely dense breasts was 62.9%, versus 87% in women with fatty involution. Specificity was 89.1% in women with extremely dense breasts, versus 96.9% in women with fatty involution. 2 Carney P.A. Miglioretti D.L. Yankaskas B.C. et al. Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Ann Intern Med. 2003; 138: 168-175 Crossref PubMed Scopus (897) Google Scholar

Mammographic surveillance in women aged 35–39 at enhanced familial risk of breast cancer (FH02)

Although there have been encouraging recent studies showing a potential benefit from annual mammography in women aged 40-49 years of age with an elevated breast cancer risk due to family history there is little evidence of efficacy in women aged <40 years of age. A prospective study (FH02) has been developed to assess the efficacy of mammography screening in women aged 35-39 years of age with a lifetime breast cancer risk of ≥ 17 % who are not receiving MRI screening. Retrospective analyses from five centres with robust recall systems identified 47 breast cancers (n = 12 in situ) with an interval cancer rate of 15/47 (32%). Invasive tumour size, lymph node status and current vital status were all significantly better than in two control groups of unscreened women (including those with a family history) recruited to the POSH study. Further evaluation of the prospective arm of FH02 is required to assess the potential added value of digital mammography and the cancer incidence rates in moderate and high risk women in order to inform cost effectiveness analyses.

Effects of different information brochures on women’s decision-making regarding mammography screening: study protocol for a randomized controlled questionnaire study

BackgroundIn order to give informed consent for mammography screening, women need to be told the relevant facts; however, screening information often remains vague because of the worry that detailed information might deter women from participating in recommended screening programs. Since September 2010, German women aged 50 to 69 invited for mammography screening have received a new, comprehensive information brochure that frankly discusses the potential benefit and harm of mammography screening. In contrast, the brochure that was in use before September 2010 contained little relevant information.The aim of this study is to compare the impact of the two different brochures on the intention of women to undergo mammography screening, and to broaden our understanding of the effect that factual information has on the women’s decision-making.MethodsThis is a controlled questionnaire study comparing knowledge, views and hypothetical preferences of women aged 48–49 years after receiving the old versus the new information brochure. German GP’s in the region of North Rhine-Westfalia will be asked by mail and telephone to participate in the study. Eligible women will be recruited via their general practitioners (GPs) and randomized to groups A ('new brochure’) and B ('old brochure’), with an intended recruitment of 173 participants per group. The study is powered to detect a 15% higher or lower intention to undergo mammography screening in women informed by the new brochure.DiscussionThis study will contribute to our understanding of the decision-making of women invited to mammography screening. From both ethical and public health perspectives, it is important to know whether frank, factual information leads to a change in the intention of women to participate in a recommended breast cancer screening program.Trial registrationDRKS00004271

Beliefs about optimal age and screening frequency predict breast screening adherence in a prospective study of female relatives from the Ontario Site of the Breast Cancer Family Registry

BackgroundAlthough few studies have linked cognitive variables with adherence to mammography screening in women with family histories of breast and/or ovarian cancer, research studies suggest cognitive phenomena can be powerful adherence predictors.MethodsThis prospective study included 858 women aged 30 to 71 years from the Ontario site of the Breast Cancer Family Registry with at least one first-degree relative diagnosed with breast and/or ovarian cancer. Data on beliefs about breast cancer screening and use of mammography were obtained from annual telephone interviews spanning three consecutive years. Self-reported mammogram dates were confirmed with medical imaging reports. Associations between beliefs about breast cancer screening and adherence with annual mammography were estimated using polytomous logistic regression models corrected for familial correlation. Models compared adherers (N = 329) with late-screeners (N = 382) and never-screeners (N = 147).ResultsWomen who believed mammography screening should occur annually were more likely to adhere to annual screening recommendations than women who believed it should happen less often (OR: 5.02; 95% CI: 2.97-8.49 for adherers versus late-screeners; OR: 6.82; 95% CI: 3.29-14.16 for adherers versus never-screeners). Women who believed mammography screening should start at or before age 50 (rather than after) (OR: 9.72; 95% CI: 3.26-29.02) were significantly more likely to adhere when compared with never-screeners.ConclusionsStudy results suggest that women with a family history of breast cancer should be strongly communicated recommendations about initial age of screening and screening intervals as related beliefs significantly predict adequate adherence.

Neglecting to Screen Women Between the Ages of 40 and 49 Years With Mammography: What Is the Impact on Breast Cancer Diagnosis?

The purpose of this study was to compare breast cancer stage at diagnosis in two groups of women between 40 and 49 years old: women undergoing screening mammography and women with a symptom needing diagnostic workup. This comparison is indicative of the impact of forgoing screening in this age group, as recommended by the United States Preventive Services Task Force. A retrospective chart review was used to collect the results of imaging-guided core needle biopsies performed in women between the ages of 40 and 49 years from January 1, 2008, to December 31, 2009. In patients diagnosed with breast cancer or a high-risk lesion, the reason for presentation, pathology, tumor size, stage, and receptor characteristics were recorded. The chi-square test was used for statistical analysis. Of 108 primary breast cancers, 71 were detected in the screened group and 37 in the unscreened group. The screened group was significantly more likely to be diagnosed with ductal carcinoma in situ than the unscreened group (22 vs 1, chi-square = 11.6, p = 0.001). Furthermore, screened patients with invasive carcinoma were significantly more likely to be diagnosed at earlier stages (chi-square = 5.02, p = 0.025). The size of invasive breast cancer in the screened group was significantly smaller as well (chi-square = 9.3, p = 0.002). Of the high-risk lesions, atypical ductal hyperplasia (n = 29) and lobular carcinoma in situ (n = 8) were most frequently seen. Breast cancer patients undergoing screening mammography were diagnosed at earlier stages with smaller tumors. Screening also allows detection of high-risk lesions, which may prompt chemoprevention and lower subsequent breast cancer risk. We continue to support screening mammography in women between the ages of 40 and 49 years.

The Psychological Impact of a False-Positive Screening Mammogram in Barcelona

The purpose of this study was to ascertain the psychological impact of mammographic screening for women who receive negative results and for those who need additional non-invasive and invasive complementary investigations to exclude breast cancer (false positives). One hundred fifty women who attended a breast cancer screening programme in Barcelona, aged 50-69 years, were included in this study: 50 with negative results and 100 with false positive mammograms (50 underwent non-invasive and 50 underwent invasive complementary investigations). Participants worried little until they underwent mammography, but worries increased when a telephone call notified the women of the need for further testing. A substantial proportion of women requiring further assessment reported that they were at least somewhat worried about having breast cancer throughout the screening process (P < 0.0001). Nevertheless, levels of anxiety and depression, measured by the Hospital Anxiety and Depression Scale, showed no statistically significant differences among the three groups. In conclusion, although the women showed no psychological morbidity, there is a substantial psychological response in those with an abnormal screening mammogram.

Annual Mammography Screening: Is it Necessary?

Recent recommendations from the U.S. Preventative Services Task Force suggest that screening mammography for women should be biennial starting at age 50 years and continue to age 74 years. With these recommendations in mind, we proposed a study to evaluate women at our institution in whom breast cancer is diagnosed within 1 year of a previously benign mammogram. A retrospective chart review was performed over a 4-year period. Only patients who had both diagnostic mammograms and previous mammograms performed at our institution and a pathologic diagnosis of breast cancer were included. Benign mammograms were defined as either Breast Imaging Reporting And Data System 1 or 2. Analysis of the time elapse between benign mammogram and subsequent mammogram indicative of the diagnosis of breast cancer was performed. A total of 205 patients were included. The average age was 64 years. From our results, 48 patients, 23 per cent of the total, had a documented benign mammogram at 12 months or less before a breast cancer diagnosis. One hundred forty-three (70%) patients had a benign mammogram at 18 months or less prior. This study raises concern that 2 years between screening mammograms may delay diagnosis and possible treatment options for many women.