Mammography Screening Program Research Articles

Disparities in Same-Day Diagnostic Imaging in Breast Cancer Screening: Impact of an Immediate-Read Screening Mammography Program Implemented During the COVID-19 Pandemic.

BACKGROUND. The need for second visits between screening mammography and diagnostic imaging contributes to disparities in the time to breast cancer diagnosis. During the COVID-19 pandemic, an immediate-read screening mammography program was implemented to reduce patient visits and decrease time to diagnostic imaging. OBJECTIVE. The purpose of this study was to measure the impact of an immediate-read screening program with focus on disparities in same-day diagnostic imaging after abnormal findings are made at screening mammography. METHODS. In May 2020, an immediate-read screening program was implemented whereby a dedicated breast imaging radiologist interpreted all screening mammograms in real time; patients received results before discharge; and efforts were made to perform any recommended diagnostic imaging during the visit (performed by different radiologists). Screening mammographic examinations performed from June 1, 2019, through October 31, 2019 (preimplementation period), and from June 1, 2020, through October 31, 2020 (postimplementation period), were retrospectively identified. Patient characteristics were recorded from the electronic medical record. Multivariable logistic regression models incorporating patient age, race and ethnicity, language, and insurance type were estimated to identify factors associated with same-day diagnostic imaging. Screening metrics were compared between periods. RESULTS. A total of 8222 preimplementation and 7235 postimplementation screening examinations were included; 521 patients had abnormal screening findings before implementation, and 359 after implementation. Before implementation, 14.8% of patients underwent same-day diagnostic imaging after abnormal screening mammograms. This percentage increased to 60.7% after implementation. Before implementation, patients who identified their race as other than White had significantly lower odds than patients who identified their race as White of undergoing same-day diagnostic imaging after receiving abnormal screening results (adjusted odds ratio, 0.30; 95% CI, 0.10-0.86; p = .03). After implementation, the odds of same-day diagnostic imaging were not significantly different between patients of other races and White patients (adjusted odds ratio, 0.92; 95% CI, 0.50-1.71; p = .80). After implementation, there was no significant difference in race and ethnicity between patients who underwent and those who did not undergo same-day diagnostic imaging after receiving abnormal results of screening mammography (p > .05). The rate of abnormal interpretation was significantly lower after than it was before implementation (5.0% vs 6.3%; p < .001). Cancer detection rate and PPV1 (PPV based on positive findings at screening examination) were not significantly different before and after implementation (p > .05). CONCLUSION. Implementation of the immediate-read screening mammography program reduced prior racial and ethnic disparities in same-day diagnostic imaging after abnormal screening mammograms. CLINICAL IMPACT. An immediate-read screening program provides a new paradigm for improved screening mammography workflow that allows more rapid diagnostic workup with reduced disparities in care.

Prevalence of breast imaging reporting and data system (BIRADS) categories and breast consistencies in Central India -A cross-sectional survey.

Background:For recognizing the initial stages of breast cancer, mammography is regarded as one of the best modalities and plays a crucial part to lessen morbidity and mortality. For collaborative studies and planning of preventive strategies, it is significant to have baseline data. Thus, in this survey, the frequency distribution of breast imaging reporting and data system (BIRADS) classification and breast consistencies was investigated during the mammographic screening program in the Gwalior region, India.Material and Methods:A descriptive, cross-sectional survey was conducted in the Gwalior region, India, in which 1,838 patients were screened with the aid of mammography. The mammography films were evaluated by a single radiologist who determined the BIRADS score, breast composition, and any other abnormal findings. After tabulating the data into MS Excel (MS Office version 2007 developed by Microsoft, Redmond, WA), descriptive analysis and Chi-square test were performed to determine the association between the BIRADS score and breast consistency and setting significance level at (below) 0.05.Results:The most commonly found BIRADS score was score 1 (53.4%), followed by score 2 (20.4%), and score 5 was of the least frequency (1.3%). Similarly, the most common consistency found was fatty (48.2%) and the least common was heterogeneously dense (3.97%). The most BIRADS category of 0 was seen in heterogeneously dense (n = 22; 26%) followed by dense breast compositions (n = 18; 25%). The most common consistency found with known breast malignancy (BIRADS 6) patients was the extremely dense breast (n = 11; 40.7%).Conclusion:In this study, it was observed that about 57.3% of all the cases were categorized as BIRADS 1 and 20.8% as BIRADS 2.

Kuwait National Mammography Screening Program: outcomes of 5 years of screening in Kuwaiti women.

BACKGROUND: Breast cancer is the most common malignancy among women in Kuwait, representing 39.8% of all female cancer cases.OBJECTIVES: Report the data of the Kuwait National Mammography Screening Program (KNMSP) for a 5-year period.DESIGN: Prospective data collection.SETTING: Population-based screening.SUBJECTS AND METHODS: We included mammography screens done for Kuwaiti women (age 40 years and older) who attended the KNMSP from 2014 to 2019 to screen for breast cancer. A full-field digital mammography system was used to acquire the mammographic images in craniocaudal and mediolateral oblique projections. Independent double-blind reading of the mammograms was performed by two radiologists.MAIN OUTCOME MEASURE: Early detection of breast cancer.SAMPLE SIZE: 14 773 asymptomatic women met inclusion criteria (mean [SD] age, 51.8 (8.2).RESULTS: Lesions were detected in 551 women (3.7%). These included 233 malignant lesions (233/551, 42.3%), 57 high-risk lesions (10.3%) and 261 benign lesions (47.4%). The participation rate was 7.8% of the target population of women 40–69 years of age. The majority of breast cancer cases were reported in the age group 45–49 years (23.2%). The KNMSP study recall rate for 5 consecutive years was in a range of 11.9–16.5% (mean, 14.3%). The detection rate of ductal/lobular carcinoma in situ and invasive breast cancer were 2.5 and 13.6 per 1000 screened women, respectively. Invasive ductal carcinoma was the most common type. Only 4314 women followed up within 12–15 months of the first mammography for a retention rate of 29.2%.CONCLUSIONS: Screening mammography improves early detection of breast cancer in women older than 40 years but poor participation is a limitation. We are aiming to increase the participation rate to 70% of the population.LIMITATIONS: Lack of participation by women.CONFLICT OF INTEREST: None.

The Impact of Radiologist Screening Mammogram Reading Volume on Performance in the Ontario Breast Screening Program.

Although some studies have shown increasing radiologists' mammography volumes improves performance, there is a lack of evidence specific to digital mammography and breast screening program performance targets. This study evaluates the relationship between digital screening volume and meeting performance targets. This retrospective cohort study included 493 radiologists in the Ontario Breast Screening Program who interpreted 1,762,173 screening mammograms in participants ages 50-90 between 2014 and 2016. Associations between annual screening volume and meeting performance targets for abnormal call rate, positive predictive value (PPV), invasive cancer detection rate (CDR), sensitivity, and specificity were modeled using mixed-effects multivariate logistic regression. Most radiologists read 500-999 (36.7%) or 1,000-1,999 (31.0%) screens annually, and 18.5% read ≥2,000. Radiologists who read ≥2,000 annually were more likely to meet abnormal call rate (OR = 3.85; 95% CI: 1.17-12.61), PPV (OR = 5.36; 95% CI: 2.53-11.34), invasive CDR (OR = 4.14; 95% CI: 1.50-11.46), and specificity (OR = 4.07; 95% CI: 1.89-8.79) targets versus those who read 100-499 screens. Radiologists reading 1,000-1,999 screens annually were more likely to meet PPV (OR = 2.32; 95% CI: 1.22-4.40), invasive CDR (OR = 3.36; 95% CI: 1.49-7.59) and specificity (OR = 2.00; 95% CI: 1.04-3.84) targets versus those who read 100-499 screens. No significant differences were observed for sensitivity. Annual reading volume requirements of 1,000 in Canada are supported as screening volume above 1,000 was strongly associated with achieving performance targets for nearly all measures. Increasing the minimum volume to 2,000 may further reduce the potential limitations of screening due to false positives, leading to improvements in overall breast screening program quality.

PO-1451 Unintentional effects of societal restrictions during the SARS-CoV-2 pandemic on referral for RT B. Mortensen1

Purpose or Objective: During the SARS-CoV-2 (COVID-19) pandemic, the Danish Healthcare system has remained fully open for all acute or life-threatening conditions. However Skovlund et al. 2020 has shown 33% fewer cancer cases in Denmark during the first three months of the national lockdown, initiated on March the 11th, compared to the previous five years. The purpose of this study is to analyse and quantify this over the first year of the pandemic in respect to changes in referral for radiotherapy (RT) for curative treatment for early breast cancer (BC) in one Danish radiotherapy centre. Materials and Methods: The monthly number of referrals for curative RT for BC ranging from April 2020 to February 2021 was analysed and compared to the previous 25 months to test for statistically significant changes. Results: The median monthly number of referrals for curative RT for BC for the 25 months prior to the lockdown was 51 with a standard deviation of 6.8. For the 11 months following the lockdown, the median monthly number of referrals for curative RT for BC was 41 with a standard deviation of 9.3 (decline of 19.6%). This was found statistically significant using Mann-Whitney U-test with a p<0.001 (one-tailed). (Figure Presented) Analysis from the Danish Health Authorities (February 2021) ranging from week 2 to week 52 of 2020 showed a decline in mammography starting in March with the onset of the COVID-19 pandemic in Denmark. After lifting the societal restriction, the activity showed a tendency towards only partial normalisation. The median decline of the 43 weeks following the first 9 weeks of 2020 in the hospital’s catchment area corresponded to 18.2%.. (Figure Presented) Dividing the curative BC referrals into two subgroups: a) local-only RT or b) loco-regional RT showed that the decline in referrals where mainly driven by the first group. Median monthly referrals dropped from 34 to 24 and from 20 to 18 respectively with declines of 29.4% and 10.0%. Monthly referrals in both subgroups where found to correlate with the total number of referrals before the lockdown (Pearson Correlation Coefficient – both with p<0.001), while only the first subgroup correlated after the lockdown (p<0.001 and p≈0.065 respectively). Conclusion: Although no acute nor life-threatening activities in the Danish Healthcare system during the COVID-19 pandemic have been closed nor reduced in activity, significant declines in patients diagnosed with cancer have been reported. Analysis of local referrals for one radiotherapy centre for curative RT for BC supports this, with a suggested decline of around 20% cumulative for the 11 months period following the COVID-19 pandemic onset in Denmark. Further analysis suggests that this decline was mainly driven by the subgroup of patients referred for local-only RT of the conserved breast. This might indicate that patient behaviour during the societal restriction have had unintended effects in early diagnosis of BC by voluntarily participations in national mammography screening program.

English

BACKGROUND Breast cancer is the most common cancer in women worldwide and has surpassed cervical cancer in India. As a result of regular mammography screening programs and public awareness, early-stage breast cancer with better prognosis has occurred. Immunohistochemistry (IHC) is now a common practice in tumour evaluation which are of importance in diagnosis as well as for deciding the treatment and of prediction of prognosis in breast cancer. The present study was undertaken in view of correlating the histopathology of the tumour and IHC profile with respect to oestrogen receptor (ER), progesterone receptor (PR) and HER2 / neu. METHODS The study is a cross-sectional prospective analysis of patients with primary carcinoma of breast who are undergoing surgery over a period of 2 years from September 2017 to August 2019. All specimens were processed and stained with haematoxylin and eosin and immunohistochemistry was done for oestrogen and progesterone receptors and HER 2neu. RESULTS A total of 20 cases of breast carcinoma specimens were studied, whose age ranged from 24 - 72 years of age. All the 20 cases occurred in females. Infiltrating duct carcinoma was the most histological subtype noted in this study comprising 85 % (17 / 20) of cases. In the study 50 % (10/20) of the cases showed ER / PR positivity with negative HER2 / neu while 15 % (3/15) of cases were negative for ER / PR and HER2 / neu and only one case showed positivity for all three markers. 10 cases (50 %) had lymph node metastases in this study. CONCLUSIONS Breast cancer is the most commonly diagnosed malignancy in Indian women and is also the leading cause of cancer death in women worldwide. Assessment of receptor (ER, PR and HER – 2 / neu) status along with histopathological grading and staging will guide the clinicians to impart a correct treatment protocols to the patients. It will also be of great help in assessing the prognosis. KEYWORDS Breast Cancer, Histopathology, Immunohistochemistry

Breast Density and Risk of Interval Cancers: The Effect of Annual Versus Biennial Screening Mammography Policies in Canada

Regular screening mammography reduces breast cancer mortality. However, in women with dense breasts, the performance of screening mammography is reduced, which is reflected in higher interval cancer rates (ICR). In Canada, population-based screening mammography programs generally screen women biennially; however, some provinces and territories offer annual mammography for women with dense breast tissue routinely and/or on recommendation of the radiologist. This study compared the ICRs in those breast screening programs with a policy of annual vs. those with biennial screening for women with dense breasts. Among 148,575 women with dense breasts screened between 2008 to 2010, there were 288 invasive interval breast cancers; screening programs with policies offering annual screening for women with dense breasts had fewer interval cancers 63/70,814 (ICR 0.89/1000, 95% CI: 0.67-1.11) compared with those with policies of usual biennial screening 225/77,761 (ICR 1.45 /1000 (annualized), 95% CI: 1.19-1.72) i.e. 63% higher (p = 0.0016). In screening programs where radiologists’ screening recommendations were able to be analyzed, a total of 76,103 women were screened, with 87 interval cancers; the ICR was lower for recommended annual (65/69,650, ICR 0.93/1000, 95% CI: 0.71, 1.16) versus recommended biennial screening (22/6,453, ICR 1.70/1000 (annualized), 95%CI: 0.70, 2.71)(p = 0.0605). Screening program policies of annual as compared with biennial screening in women with dense breasts had the greatest impact on reducing interval cancer rates. We review our results in the context of current dense breast notification in Canada.

Cost-effectiveness evaluation of mammography screening program in Taiwan: Adjusting different distributions of age and calendar year for real world data

We estimated loss-of-life expectancy (LE) and lifetime medical expenditures (LME) stratified by stages to evaluate the cost-effectiveness of breast cancer (BC) screening in Taiwan. We interlinked four national databases- Cancer Registry, Mortality Registry, National Health Insurance Claim, and Mammography Screening. A cohort of 123,221 BC was identified during 2002-2015 and followed until December 31, 2017. We estimated LE and loss-of-LE by rolling extrapolation algorithm using age-, sex-, and calendar-year-matched referents simulated from vital statistics. LME was estimated by multiplying monthly cost with survival probability and adjusted for annual discount rate. We calculated incremental cost-effectiveness ratio (ICER) by comparing the loss-of-LE of those detected by screening versus non-screening after accounting for administration fees and radiation-related excess BC. The LEs of stages I, II, III, and IV were 31.4, 27.2, 20.0, and 5.2 years, respectively, while the loss-of-LEs were 1.2, 4.9, 11.7, and 25.0 years with corresponding LMEs of US$ 73,791, 79,496, 89,962, and 66,981, respectively. The difference in LE between stages I and IV was 26.2 years while that of loss-of-LE was 23.8 years, which implies that a potential lead time bias may exist if diagnosis at younger ages for earlier stages were not adjusted for. The ICER of mammography seemed cost-saving after the coverage exceeded half a million. Mammography could detect BC early and be cost-saving after adjustment for different distributions of age and calendar year of diagnosis. Future studies exploring healthcare expenditure and impaired quality of life for false-positive cases are warranted.

The role of self-evaluation and education of radiographers involved in a breast cancer screening program at Clinical Hospital Center Rijeka

IntroductionEarly breast cancer detection can be achieved by enforcing the quality of mammography screening program. Hence, proper breast positioning is necessary. Systematic education of radiographers on mammographic positioning is a prerequisite for obtaining high-quality mammograms. The aim of this study is to demonstrate the importance of self-evaluation and education of radiographers involved in a breast cancer screening program. MethodsThe First School of Mammographic Positioning was organized in 2018 at Clinical Hospital Center (CHC) Rijeka and 24 radiographers included in the screening program attended. Four months after the School, an analysis and comparison of randomly selected mammograms was performed. Retrospective analysis was performed, and two sets of collected data were gathered from the period before and after the education. The quality criteria for evaluation were set and the mammograms were independently analyzed by two radiographers with experience in mammography. The chi-square test was used to perform statistical analysis. ResultsResults showed a statistically significant difference in the quality of mammograms before and after training for all criteria (p < 0.05). ConclusionSelf-evaluation and education of radiographers at the CHC Rijeka have led to a significant progress in image quality. Implications for practiceResults of this work imply that there is a strong need to formalize breast imaging education and the need to implement systematic education at the national level in Croatia.

Nurses’ knowledge of breast screening and the implications for advising women with dense breast tissue: a literature review

Breast cancer is the second highest cause of female death in the UK. Early detection of breast cancer has been advanced through the mammography screening programme, however this is not always effective for women with dense breast tissue. There is little published research discussing alternative screening approaches for women with dense breast tissue. This article reports findings of a literature review that appraised the evidence on nurses’ knowledge of breast cancer and the implications when advising women with dense breast tissue. Nurses’ knowledge of breast cancer, risk factors, appropriate screening methods and treatment can influence women’s breast cancer awareness, uptake of screening and ultimately morbidity and mortality.

Population-based mammography screening attendance in Sweden 2017–2018: A cross-sectional register study to assess the impact of sociodemographic factors

Sweden has a population-based mammography screening programme for women aged 40–74. The objective of this study was to examine the association between mammography screening attendance and sociodemographic factors in 15 of Sweden's 21 health care regions. Register-based information was collected on all mammography screening invitations and attendance during 2017 and 2018, and linked to individual-level sociodemographic data from Statistics Sweden. Odds ratios (ORs) and 95% confidence intervals (CIs) for attendance were computed by sociodemographic factor. The study sample included 1.5 million women, aged 40–75, with an overall screening attendance of 81.3%. The lowest odds of attending were found for women living without a partner (OR = 0.52, 95% CI: 0.52–0.53), low-income women (OR = 0.57, 95% CI: 0.56–0.57), and non-Nordic women born in Europe (OR = 0.60, 95% CI: 0.59–0.61). Other groups with lower odds of attending were women whose main source of income was social assistance or benefits (OR = 0.62, 95% CI: 0.62–0.63), those not owning their home (OR = 0.66, 95% CI: 0.66–0.67), and those with low level of education (OR = 0.72, 95% CI: 0.71–0.73). Having multiple of these sociodemographic characteristics further lowered the odds of attending. Although overall mammography screening attendance in Sweden is high, sociodemographic inequalities exist, and efforts should be made to address these. Particular attention should be given to low-income women who live without a partner.

Reducing racial disparities in time to breast cancer diagnosis: Impact of immediate screening mammogram reads during the COVID pandemic.

6508 Background: During the COVID-19 pandemic, barriers to access screening mammography along with goals to reduce visits supported immediate reading of screening mammograms. Typically, screening mammograms are reported after patients have left the facility. If imaging is abnormal, then an additional visit is needed for diagnostic imaging, introducing delays and potential disparities .Thus, we implemented an immediate-read screening mammography program and measured its impact on racial/ethnic disparities in time to diagnostic imaging after an abnormal screening mammogram. Methods: Responding to the COVID-19 pandemic, we implemented an immediate read screening program in late May 2020. Patients were provided imaging results before discharge and if the exam was abnormal, efforts were made to perform diagnostic imaging during that visit. We identified consecutive screening mammograms performed weekdays 8:00am-4:30pm and Saturdays 9:00am-4:00pm pre-implementation (6/1/19-10/31/19) and post-implementation (6/1/2020-10/31/2020). Exams left unread while awaiting comparison studies, due to technical factors, or for more than 10 days were excluded. Patient demographics and time from screening exam completion to report finalized were obtained from the electronic medical record. Cancer detection rate (CDR), abnormal interpretation rate (AIR), and positive predictive value (PPV) were calculated. Multivariable linear and logistic regression models were used to compare time from screening exam to report, same-day diagnostic imaging, and screening performance metrics pre- and post-implementation overall and by patient subgroups. Results: After 963 exams met exclusion criteria, a total of 8,222 pre- and 7,235 post-implementation exams were included. Median time to report finalization decreased from 61minutes (interquartile range [IQR]:24, 152) to 4 minutes (IQR:2, 7) for pre- and post-implementation periods (p &lt; 0.001). During the pre-implementation period, non-white patients had lower odds of having same-day diagnostic imaging after an abnormal screening exam (age-adjusted odds ratio: 0.28; 95% CI: 0.10, 0.78 p = 0.015). There was no evidence of this disparity post-implementation. AIR was higher in the pre- versus post-implementation period (6.3% versus 5.0%; p &lt; 0.001). There was no evidence of a difference in CDR (5.8 versus 4.2 cancers/1,000 exams) and PPV (9.2% versus 8.4%) for pre- versus post-implementation periods. Conclusions: An immediate read screening mammography program reduces racial/ethnic disparities in time to diagnostic imaging after an abnormal screening mammogram, thus promoting equity in access to care.[Table: see text]

Adverse consequences of the COVID-19 pandemic on breast cancer stage distribution and breast cancer disparities.

10555 Background: The COVID-19 surge in March 2020 resulted in a hiatus placed on screening mammography programs in support of shelter-in-place mandates and diversion of medical resources to pandemic management. The COVID-related economic recession and ongoing social distancing policies continued to influence screening practices after the hiatus was lifted. We evaluated the effect of the hiatus on breast cancer stage distribution on the diverse patient population of a health care system in New York City, the first pandemic epicenter in the United States. Methods: Breast cancer patients diagnosed January 1, 2019 to December 31, 2020 were analyzed, with comparisons of stage distribution and mammography screen-detection for three intervals: Pre-Hiatus, During Hiatus (March 15, 2020 to June 15, 2020), and Post-Hiatus. Results were stratified by African American (AA), White American (WA), Asian (As) and Hispanic/Latina (Hisp) self-reported racial/ethnic identity. Results: A total of 894 patients were identified; of these, 549 WA, 100 AA, 104 As, and 93 Hisp comprised the final race/ethnicity-stratified study population. Overall, 588 patients were diagnosed Pre-Hiatus, 61 During-Hiatus, and 245 Post-Hiatus. Nearly two-thirds (65.5%) of the Pre-Hiatus cases were screen-detected versus 49.2% During-Hiatus and 54.7% Post-Hiatus (p = 0.002). Frequency of tumors diagnosed &lt; 1 cm declined from 41.9% Pre-Hiatus to 31.7% Post-Hiatus (p = 0.035). WA patients were more likely to have screen-detected disease compared to AA in the Pre-Hiatus period (69.1% vs. 56.1%; p = 0.05) but non-significantly more likely to have screen-detected disease compared to As and Hisp patients (66.2% vs. 56.9%; p = 0.08). In the Post-Hiatus period, the frequency of screen-detected disease was highest among WA patients (63.0%) compared to all other racial/ethnic groups (AA; 48.1%, As-33.3%, and Hisp-40%; p = 0.007). Similar patterns were observed for frequency of tumors diagnosed ≤1cm Pre-Hiatus (WA-44.3% vs AA-26%, p = 0.02; and vs. As-41.3%, Hisp-48%; p = 0.09), and Post-Hiatus (WA-37.7% vs. AA-18.2%, As-30.8%, Hisp-23.5%; p = 0.25). Conclusions: The 3-month pandemic-related mammography screening hiatus resulted in a more advanced stage distribution for New York City breast cancer patients, and worsened pre-existing race/ethnicity-associated disparities, especially for AA pts.

Screening of women with aesthetic prostheses in dedicated sessions of a population-based breast cancer screening programme

BackgroundWomen with aesthetic prostheses must be included in the target population of mammography screening programmes. Breast implants are radiopaque and partially obscure the breast tissue. This can be avoided with the use of the Eklund technique, which causes an increased radiation exposure. In this study, augmented women undergoing a dedicated protocol within a population-based screening programme were compared according to selected indicators with the standard screening population. Essential dosimetric parameters and their time trend were also assessed.Materials and methodsThe study was conducted in a screening centre in Milan in the years 2009–2016. The screening protocol for women with breast implants included a double-read mammography with the Eklund views, ultrasound and clinical breast examination.ResultsA total of 28,794 women were enrolled, including 588 (2%) women with breast implants and 28,206 (98%) undergoing the standard screening protocol. The invasive assessment rate was 9.0‰ for women with breast implants vs. 15‰ in the standard cohort. The surgical referral rate was 2.2% vs. 0.9%. The detection rate was similar in the two groups (4.0 and 4.5‰, respectively). There were significant differences in the average glandular dose according to the mammography equipment. The use of the Eklund views increased over time.ConclusionsScreening of augmented women according to a specific protocol in the contexts of population-based programmes is feasible. Observed differences in screening indicators relative to the standard screening population require further research. The increasing use of Eklund views probably results from quality assurance measures associated with screening programmes.

168P Danish women favour hypothetical breast cancer screening with harms, but no benefits

Aimed at reducing breast cancer mortality, mammography screening programs have been implemented in many countries. However, the extent and balance between benefits and harms of such screening programs remain contested. Therefore, transparent and balanced information on benefits and harms is recommended as basis for informed decision-making. Previous studies found that informed decision-making was challenged by overly positive attitudes towards cancer screening. In particular, that an objective decision might be challenged by strong emotions, and worry, fear and anxiety of having breast cancer. Thus, we hypothesized that a large proportion of women would be willing to participate in screening regardless of the presented information. We aimed to estimate the prevalence of Danish women’s willingness to participate in a hypothetical mammography screening with no health benefits, only harms. We invited a random sample of 768 healthy women in the non-screening population aged 44-49 in the Central Denmark Region to an online survey. After presentation of a hypothetical screening, the survey captured screening attitudes, breast cancer worry, perceived likelihood of breast cancer, assessment of the hypothetical screening test and information on breast cancer history and health literacy. Data were subsequently linked to register data on sociodemographic factors. A total of 323 (42.1%, 95% CI: 38.5-45.6) women filled in the questionnaire. Hereof, 247/300 (82.3%, 77.5-86.5) were willing to participate in the hypothetical mammography screening with no benefits, only harms. Women were generally very certain about their decision to participate, 63.2% (56.8-69.2) and 52.8% (38.6-66.7) in the participation and non-participation group, respectively. Yet, more than two-thirds in both groups seemed to understand the presented information and responded that the screening did not reduce breast cancer mortality. A high percentage of women in this study were willing to participate in the hypothetical screening with harms, but no health benefits. Surprisingly, most women understood that the screening did not reduce breast cancer mortality. This indicates that Danish women are unduly positive about mammography screening.

The politicians\u2019 perspectives on participation in mammographic screening: an interview-based study from a region in Sweden

BackgroundBreast cancer is the most common cancer type among women globally. To facilitate early detection, all 40–74-year-old female residents of Sweden are invited to participate in a population-based mammographic screening programme. Approximately 20% of all invited women decline the offer, and if this is due to systematic differences that can be adjusted, it can indicate inequity in healthcare. Assessment of and being updated about the health and healthcare of the residents are largely the responsibilities of the self-governed regions in Sweden. The understanding of the residents’ health serves as a basis for decision making and priority setting. This study aims to describe how politicians representing a region in Sweden perceive women’s participation in mammographic screening and the politicians’ own possibility to promote such participation.MethodsQualitative thematic analysis was conducted on the data obtained from individual semi-structured interviews held in 2019. The interviewees comprised ten politicians (six women and four men, 38–71 years old) representing a sub-committee focusing on public health and healthcare issues.ResultsTwo main themes have been identified: 1) expected actions and 2) expected conditions for acting, including a total of four sub-themes. According to the politicians, the expected actions, such as obtaining information and being updated about matters regarding mammographic screening, concern both the women invited to the screening and the politicians themselves. Additionally, for both the individual and the healthcare organisation, here represented by the politicians, expected actions entail a shared commitment to maintain health. The expected conditions for acting refer to the politician’s awareness of the factors influencing the women’s decision to undergo or refuse the screening and having the resources to enable taking actions to facilitate participation.ConclusionsExpected actions and expected conditions for acting are tightly connected and entail some form of prioritisation by the politicians. Setting the priorities can be based on information about the purpose of the screening and an understanding of social determinants’ impacts on women’s decision to refrain from mammographic screening, as well as available resources.

Developing and validating an individualized breast cancer risk prediction model for women attending breast cancer screening.

Several studies have proposed personalized strategies based on women's individual breast cancer risk to improve the effectiveness of breast cancer screening. We designed and internally validated an individualized risk prediction model for women eligible for mammography screening. Retrospective cohort study of 121,969 women aged 50 to 69 years, screened at the long-standing population-based screening program in Spain between 1995 and 2015 and followed up until 2017. We used partly conditional Cox proportional hazards regression to estimate the adjusted hazard ratios (aHR) and individual risks for age, family history of breast cancer, previous benign breast disease, and previous mammographic features. We internally validated our model with the expected-to-observed ratio and the area under the receiver operating characteristic curve. During a mean follow-up of 7.5 years, 2,058 women were diagnosed with breast cancer. All three risk factors were strongly associated with breast cancer risk, with the highest risk being found among women with family history of breast cancer (aHR: 1.67), a proliferative benign breast disease (aHR: 3.02) and previous calcifications (aHR: 2.52). The model was well calibrated overall (expected-to-observed ratio ranging from 0.99 at 2 years to 1.02 at 20 years) but slightly overestimated the risk in women with proliferative benign breast disease. The area under the receiver operating characteristic curve ranged from 58.7% to 64.7%, depending of the time horizon selected. We developed a risk prediction model to estimate the short- and long-term risk of breast cancer in women eligible for mammography screening using information routinely reported at screening participation. The model could help to guiding individualized screening strategies aimed at improving the risk-benefit balance of mammography screening programs.

Digital breast tomosynthesis in a population based mammographic screening program: Breast compression and early performance measures

PurposeWe aimed to determine if compression force or pressure could be associated with early performance measures for women screened with digital breast tomosynthesis (DBT) in BreastScreen Norway. Early performance measures included rates of consensus, recall, and screen-detected breast cancer. MethodData on compression force and pressure, compressed breast thickness and breast characteristics were extracted from an automated software for density assessment of DBT screening examinations for 25,286 women. For descriptive analyses, force (Newton, N) and pressure (kilopascal, kPa) were categorized into quartiles. Analyses were stratified by mammographic view, craniocaudal (CC) and mediolateral oblique (MLO). Logistic regression with restricted cubic splines was used to investigate the association between force and pressure as continuous exposures and early performance measures adjusted for age, compressed breast thickness and fibroglandular volume. ResultsMean age of the screened women was 60.7 (SD = 5.2) years. Mean compression force was 90.8 (SD = 14.2) N for CC and 106.3 (SD = 20.6) N for MLO, and pressure was 11.3 (SD = 3.6) kPa for CC and 8.7 (SD = 2.0) kPa for MLO. The highest rates of screen-detected cancer were observed for low force (1.04 % for <82.5 N for CC and 1.07 % for <92.0 N for MLO) and low pressure (1.07 % for <7.2 kPa for MLO). No association was found between force or pressure as continuous exposures and early performance measures in adjusted regression analyses. ConclusionsWe found the highest rates of screen-detected cancer for low force and pressure, but no significant association between continuous values of force or pressure and early performance measures in DBT. The findings might indicate that the levels of force and pressure in DBT are of lower significance for screening performance than reported in standard digital mammography.

Screening is associated with lower mastectomy rates in eastern Switzerland beyond stage effects

BackgroundA recent study found an influence of organized mammography screening programmes (MSPs) on geographical and temporal variation of mastectomy rates. We aimed to quantify the effect on the example of one of the cantonal programmes in Switzerland.MethodsWe used incidence data for the years 2010–2017 from the cancer registry of Eastern Switzerland. We included women with invasive-non-metastatic breast cancer (BC) in the screening age group 50–69-year-olds in the canton of St.Gallen. We compared mastectomy rates among cancer patients detected through the organised screening programme (MSP) vs. otherwise detected by stage.ResultsMSP-detected patients in St.Gallen presented with lower stages. 95% of MSP-detected had stages I-II vs 76% of Non-MSP-detected. Within all non-metastatic stage, tumour size and nodal status groups, MSP-detected patients had lower mastectomy rates, overall 10% vs 24% in 50–69-year-old non-participants. Their odds of receiving a mastectomy are about half of the Non-MSP-detected (OR = 0.48, p = 0.002).ConclusionsOur study showed that MSPs have a positive effect on lowering mastectomy rates. Screening participants are significantly less likely to receive a mastectomy compared to non-participants, which must be attributed to additional factors than just lower stages. Lower mastectomy rates lead to a higher quality of life for many patients.

Abstract IA-21: AI in an imaging center: Challenges and opportunities

Abstract There is significant and well-founded enthusiasm for the promise of AI to improve healthcare outcomes across diverse clinical applications in oncology. However, careful analyses of the impact of AI tools in actual “real world” clinical settings are sparse in this relatively early phase of scientific discovery. The rigor applied to deep learning model development (training, testing, external validation) must be matched with equal rigor in assessing patient outcomes after implementation of deep learning tools in actual clinical settings. We can learn from our past endeavors in computer-assisted image interpretation. Tools for computer aided detection were approved by the FDA in 1998 to help radiologists find breast cancers on mammograms. However, after widespread clinical implementation (based on promising results in reader studies and reimbursement approvals), clinical trials to assess the impact of CAD on diagnostic accuracy of mammography revealed the tools did not improve human performance in findings cancers, and in many cases increased false positive readings by humans using CAD assistance. Due to severely limited healthcare resources during pandemics, and to protect patients and healthcare workers, state governments and the COVID-19 Pandemic Breast Cancer Consortium urged providers to focus cancer screening efforts on those patients at higher risk. These mandates were and continue to be necessary responses to support fair allocation of scarce resources to maximize benefits for all patients across the full spectrum of healthcare needs and acknowledge the shift in risk-benefit ratios for screening in average risk women. After screening mammography programs were closed due to the COVID-19 pandemic, we implemented an AI image-only risk model strategy at MGH to invite women at higher risk to return to screening for breast cancer. The AI model identified the top 60% of patients at risk, who were diagnosed with 90% of cancers, while the top 60% of at-risk patients based on traditional models harbored less than 50% of cancers. Our AI image-only risk model performed best in identifying women with current breast cancer, followed by strategies which used five-year traditional risk models and included all women with a personal history of breast cancer in invitations to screen. Lifetime risk models performed extremely poorly. Operating at the traditional “high risk” threshold of &amp;gt;20% lifetime risk, these models identified fewer than 10% of patients with cancer in the total population screened. AI-based risk models may support accurate and equitable risk-based screening. It may be possible with early intervention to reduce the widening disparities and later stage breast cancer diagnoses we are experiencing with COVID and mitigate the risk of delayed diagnoses and increased mortality from breast cancer during and after pandemics. Strategies for careful and rigorous assessment of clinical implementation are essential for AI to have the impact in health desired by all. Citation Format: Constance Lehman. AI in an imaging center: Challenges and opportunities [abstract]. In: Proceedings of the AACR Virtual Special Conference on Artificial Intelligence, Diagnosis, and Imaging; 2021 Jan 13-14. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(5_Suppl):Abstract nr IA-21.