Mammographic Screening For Breast Cancer Research Articles

Women’s Awareness of Mammographic Screening for Breast Cancer in Togo

Breast cancer represents a real public health problem due to its increasing frequency, its seriousness and its psycho-social implications. The aims of this study were to determine the level of awareness of women on the performance of mammography in the diagnosis and screening for breast cancer. This was a cross-sectional study over a period of 4 months (from October 1, 2016 to January 31, 2017) in Togo. It consisted in completing a questionnaire distributed to women above 30 years of age. The mean age of the women was 42 years. 88.8% of them had heard of breast cancer. There was a link between age, occupation, level of education and awareness of breast cancer. Only 20.8% of women had heard of mammography, with a link between awareness of mammography and age, occupation, and level of education. A link was noted between awareness of breast cancer and awareness of mammography. Information on mammographic breast cancer screening is inadequate in Togo.

Determinants of mammography screening in Tehranian women in 2018 based on the health belief model: A cross-sectional study.

BACKGROUND:Breast cancer is the most common type of cancer among women. Mammography is the most sensitive and important method for screening and early diagnosis of breast cancer. Considering the importance of using mammography in breast cancer screening, this study was performed to evaluate mammographic determinants.MATERIALS AND METHODS:In the cross-sectional study, we surveyed 985 women over 40 years in Tehran concerning demographic characteristics: age, socioeconomic status, a problem in the breast, alcohol use, drug use, and health belief model. Logistic regression was used to identify determinant factors associated with mammography performance.RESULTS:The results of this study showed that 42.1% (95% confidence interval [CI]: 38, 45) participant performed mammography at least once during their lifetime. Age (odds ratio [OR] = 4.252; 95% CI = 2.041–8.857); housing situation (OR = 1.706; 95% CI = 1.178–2.469); having breast problems (OR = 5.224; 95% CI = 3.501–7.795); socioeconomic status (OR = 1.855; 95% CI = 1.035–3.325); family income level (OR = 1.998; 95% CI = 1.028–3.884); alcohol consumption (OR = 2.676; 95% CI = 1.344–5.328); smoking (OR = 2.824; 95% CI = 1.418–5.623); self-efficacy (OR = 1.935; 95% CI = 1.242–3.015); perceived barriers (OR = 2.017; 95% CI = 1.348–3.019); self-care (OR = 4.901; 95% CI = 3.152–7.620); perceived susceptibility (OR = 1.971; 95% CI = 1.271–3.057) and perceived severity (OR = 1.830; 95% CI = 1.170–2.860) were mammography behaviors determinants.CONCLUSION:The findings indicated that the rate of mammography screening among Tehranian women is low and highlights the need for developing a comprehensive national breast cancer control program, which should be considered as the priority for health-care providers. Furthermore, the identification of these factors can help to design an appropriate educational intervention that focuses on the benefits of mammography screening.

Relationship between compression breast thickness (CBT) and breast density by mammography in breast cancer screening

Relationship between compression breast thickness (CBT) and breast density by mammography in breast cancer screening

Breast Thermograms Asymmetry Analysis using Gabor filters

Women are far more likely than males to acquire breast cancer, and current research indicates that this is entirely avoidable. It is also to blame for higher death rates among younger women compared to older women in nearly all developing nations. Medical imaging modalities are continuously in need of development. A variety of medical techniques have been employed to detect breast cancer in women. The most recent studies support mammography for breast cancer screening, although its sensitivity and specificity remain suboptimal, particularly in individuals with thick breast tissue, such as young women. As a result, alternative modalities, such as thermography, are required. Digital Infrared Thermal Imaging (DITI), as it is known, detects and records temperature changes on the skin’s surface. Thermography is well-known for its non-invasive, painless, cost-effective, and high recovery rates, as well as its potential to identify breast cancer at an early stage. Gabor filters are used to extract the textural characteristics of the left and right breasts. Using a support vector machine, the thermograms are then classified as normal or malignant based on textural asymmetry between the breasts (SVM). The accuracy achieved by combining Gabor features with an SVM classifier is around 84.5 percent. The early diagnosis of cancer with thermography enhances the patient’s chances of survival significantly since it may detect the disease in its early stages.

Performance of Digital Breast Tomosynthesis, Synthetic Mammography, and Digital Mammography in Breast Cancer Screening: A Systematic Review and Meta-Analysis.

Our objective was to perform a systematic review and meta-analysis comparing the breast cancer detection rate (CDR), invasive CDR, recall rate, and positive predictive value 1 (PPV1) of digital mammography (DM) alone, combined digital breast tomosynthesis (DBT) and DM, combined DBT and synthetic 2-dimensional mammography (S2D), and DBT alone. MEDLINE and Embase were searched until April 2020 to identify comparative design studies reporting on patients undergoing routine breast cancer screening. Random effects model proportional meta-analyses estimated CDR, invasive CDR, recall rate, and PPV1. Meta-regression modeling was used to compare imaging modalities. All statistical tests were 2-sided. Forty-two studies reporting on 2 606296 patients (13 003 breast cancer cases) were included. CDR was highest in combined DBT and DM (6.36 per 1000 screened, 95% confidence interval [CI] = 5.62 to 7.14, P < .001), and combined DBT and S2D (7.40 per 1000 screened, 95% CI = 6.49 to 8.37, P < .001) compared with DM alone (4.68 per 1000 screened, 95% CI = 4.28 to 5.11). Invasive CDR was highest in combined DBT and DM (4.53 per 1000 screened, 95% CI = 3.97 to 5.12, P = .003) and combined DBT and S2D (5.68 per 1000 screened, 95% CI = 4.43 to 7.09, P < .001) compared with DM alone (3.42 per 1000 screened, 95% CI = 3.02 to 3.83). Recall rate was lowest in combined DBT and S2D (42.3 per 1000 screened, 95% CI = 37.4 to 60.4, P<.001). PPV1 was highest in combined DBT and DM (10.0%, 95% CI = 8.0% to 12.0%, P = .004), and combined DBT and S2D (16.0%, 95% CI = 10.0% to 23.0%, P < .001), whereas no difference was detected for DBT alone (7.0%, 95% CI = 6.0% to 8.0%, P = .75) compared with DM alone (7.0%, 95.0% CI = 5.0% to 8.0%). Our findings provide evidence on key performance metrics for DM, DBT alone, combined DBT and DM, and combined DBT and S2D, which may inform optimal application of these modalities for breast cancer screening.

Mammography and breast tomosynthesis simulator for virtual clinical trials

Computer modeling and simulations are increasingly being used to predict the clinical performance of x-ray imaging devices in silico, and to generate synthetic patient images for training and testing of machine learning algorithms. We present a detailed description of the computational models implemented in the open source GPU-accelerated Monte Carlo x-ray imaging simulation code MC-GPU. This code, originally developed to simulate radiography and computed tomography, has been extended to replicate a commercial full-field digital mammography and digital breast tomosynthesis (DBT) device. The code was recently used to image 3000 virtual breast models with the aim of reproducing in silico a clinical trial used in support of the regulatory approval of DBT as a replacement of mammography for breast cancer screening. The updated code implements a more realistic x-ray source model (extended 3D focal spot, tomosynthesis acquisition trajectory, tube motion blurring) and an improved detector model (direct-conversion Selenium detector with depth-of-interaction effects, fluorescence tracking, electronic noise and anti-scatter grid). The software uses a high resolution voxelized geometry model to represent the breast anatomy. To reduce the GPU memory requirements, the code stores the voxels in memory within a binary tree structure. The binary tree is an efficient compression mechanism because many voxels with the same composition are combined in common tree branches while preserving random access to the phantom composition at any location. A delta scattering ray-tracing algorithm which does not require computing ray-voxel interfaces is used to minimize memory access. Multiple software verification and validation steps intended to establish the credibility of the implemented computational models are reported. The software verification was done using a digital quality control phantom and an ideal pinhole camera. The validation was performed reproducing standard bench testing experiments used in clinical practice and comparing with experimental measurements. A sensitivity study intended to assess the robustness of the simulated results to variations in some of the input parameters was performed using an in silico clinical trial pipeline with simulated lesions and mathematical observers. We show that MC-GPU is able to simulate x-ray projections that incorporate many of the sources of variability found in clinical images, and that the simulated results are robust to some uncertainty in the input parameters. Limitations of the implemented computational models are discussed. Program summaryProgram title: MCGPU_VICTRECPC Library link to program files:https://doi.org/10.17632/k5x2bsf27m.1Licensing provisions: CC0 1.0Programming language: C (with NVIDIA CUDA extensions)Nature of problem: The health risks associated with ionizing radiation impose a limit to the amount of clinical testing that can be done with x-ray imaging devices. In addition, radiation dose cannot be directly measured inside the body. For these reasons, a computational replica of an x-ray imaging device that simulates radiographic images of synthetic anatomical phantoms is of great value for device evaluation. The simulated radiographs and dosimetric estimates can be used for system design and optimization, task-based evaluation of image quality, machine learning software training, and in silico imaging trials.Solution method: Computational models of a mammography x-ray source and detector have been implemented. X-ray transport through matter is simulated using Monte Carlo methods customized for parallel execution in multiple Graphics Processing Units. The input patient anatomy is represented by voxels, which are efficiently stored in the video memory using a new binary tree structure compression mechanism.

Abstract PO-265: Perceived barriers and facilitators for breast cancer screening influences among African American women ages 40-75

Abstract Introduction: Breast cancer is the most commonly diagnosed cancer in women in the United States. Breast cancer screening mammography helps detect cancer earlier, improving treatment success. Similar to other screening exams, making the decision to get screened for breast cancer involves evaluating the risks and benefits of the procedure which can vary by age. While the assessment for breast cancer screening is often personal, few screening decision aids have been created with ethically and racially diverse women for use in a variety of settings, including low-resource settings. We aim to characterize the primary influences among African American women when making a decision about breast cancer screening mammography and how these influences may differ based on age in order to better engage this demographic to inform decision aid development. Methods: Focus groups were performed to elicit the views and opinions of African American women ages 40 to 75 on the topic of breast cancer screenings. Using the Andersen Behavioral Model of Health Services Use, a qualitative analysis of the focus groups transcripts was performed using a deductive coding approach. The Andersen Model included predisposing factors (e.g. age, knowledge, beliefs, fears and fatalism), enabling factors (e.g. health insurance and health utilization), and need factors (e.g. physician recommendation and family/personal history). Sociodemographic information was collected, and quantitative data were summarized using descriptive statistics. Results: This study included 51 African American women ages 40 -75 (ages 40-49 n=23, ages 50-75 n=28). In the 40-49 age cohort, 82.3% (n=19) has had at least one mammography and 69.6% (n=16) had high health literacy. In the 50-75 age cohort, 100% of women had at least one mammography and 71.4% (n=20) had high health literacy. For all of the women in the study, the major influences for breast cancer screening include physician recommendation, family/personal medical history as well as health utilization (e.g. wanting to be proactive about their health). Participants indicated that topic of autonomy was also important as they prioritized caring for themselves and making a personal decision. However, for women ages 50- 75, customer service was also a major influence for breast cancer screening (e.g. how they were treated while accessing medical services for breast cancer screening). Conclusions: The primary influences for breast cancer screening among African American women age 40-75 can vary with age. A better understanding of these influences can help inform decision aids to meet the needs of ethnically and racially diverse women across various ages eligible for breast cancer screening mammography. Citation Format: Kamilah S. Abdur-Rashid, Ashley J. Housten, Graham A. Colditz. Perceived barriers and facilitators for breast cancer screening influences among African American women ages 40-75 [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-265.

Is Ultrasound an Accurate Alternative for Mammography in Breast Cancer Screening in an Asian Population? A Meta-Analysis.

In Asian countries, ultrasound has been proposed as a possible alternative for mammography in breast cancer screening because of its superiority in dense breasts, accessibility and low costs. This research aimed to meta-analyze the evidence for the diagnostic performance of ultrasound compared to mammography for breast cancer screening in Asian women. PubMed, Web of Science, and China National Knowledge Infrastructure databases were searched for studies that concurrently compared mammography and ultrasound in 2000–2019. Data extraction and risk of bias were performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) statement. The primary outcome was the sensitivity and specificity. Bivariate random models were used to generate pooled estimates of diagnostic parameters and 95% confidence intervals (95% CI). In total, 4424 studies were identified of which six studies met the inclusion criteria with a sample size of 124,425 women. The pooled mean prevalence of the included studies was 3.7‰ (range: 1.2–5.7‰). The pooled sensitivity of mammography was significantly higher than that of ultrasound (0.81 [95% CI 0.71–0.88] versus 0.65 [95% CI 0.58–0.72], p = 0.03), but no significant differences were found in specificity (0.98 [95% CI: 0.94–1.00] versus 0.99 [95% CI: 0.97–1.00], p = 0.65). In conclusion, based on the currently available data on sensitivity alone, there is no indication that ultrasound can replace mammography in breast cancer screening in Asian women.

Awareness of Self-Examination, Screening, and Risk Factors for Breast Cancer Among Women Awaiting Care at the Outpatient Clinic of a Mastology Unit

This study aimed to evaluate the awareness and practice of breast self-examination (BSE) and the awareness of screening and risk factors for breast cancer among patients from a mastology clinic and to associate such findings with sociodemographic factors of that population. A total of 202 randomly selected patients from the outpatient clinic of the Mastology Unit of São Paulo School of Medicine were interviewed. A structured questionnaire was used and included questions regarding sociodemographic variables, questions to assess the knowledge and practice of BSE, and knowledge of mammographic screening and risk factors for breast cancer. The vast majority of patients were aware of the existence of BSE (93.1%). BSE was performed by most patients (64.9%), although only 20.3% performed it adequately. Only 21.8% of respondents showed awareness of the best screening method for breast cancer. Furthermore, 17.3% of patients showed adequate awareness of risk factors for breast cancer. The analysis of sociodemographic variables showed that older, postmenopausal, and less-educated women showed better practice of BSE. Overall, the patients had no adequate awareness of BSE, mammographic screening, and risk factors for breast cancer, and the majority failed to practice BSE adequately, particularly the group of patients with the higher level of education. These data show that educational measures regarding the practice of BSE and, especially, mammograms should be emphasized, regardless of education level or family income of the patient.

Awareness of Mammographic Screening Amongst Females Visiting Breast Clinic at a Tertiary Care Hospital of Karachi

Objective: To assess the awareness of mammographic screening among women visiting the breast clinic at a tertiary care facility in Karachi. Study Design and Setting: This cross-sectional study was conducted at Jinnah Post Graduate Medical Centre Karachi over one month period from 1-10-2019 to 31-10-2019. Methodology: After receiving ethical approval, relevant information from patients coming to the breast clinic over the study period, regarding age, level of education, family history, diagnosis and awareness regarding mammographic screening was recorded on specially designed proformas and was statistically analyzed on SPSS 23. P value &lt;/= to 0.05 was considered as statistically significant. Results: Out of the 100 participants included in the study 68 patients had malignant lesions, 18 had a benign diagnosis while 14 patients were undiagnosed. Only 42 had at least some knowledge of mammographic screening of breast cancers and only 15 patients actually had a screening mammogram performed. Of those aware of the screening majority were informed regarding the procedure by health care professionals or through media sources. Only 4 out of 17 participants with a positive history of breast cancer in the family had the screening done. 12 patients diagnosed with malignant breast lesions were under the age of 40 years. Conclusion: Awareness of mammographic screening for breast cancer among females in our setup is still unsatisfactory and calls for improvements in the awareness programs for breast cancer screening. An early age at diagnosis for malignant breast lesions should prompt the concerned to revise the recommended lower age limit for commencing mammographic screening

Breast cancer screening in urban Beijing, 2014-2019

Objective: To analyze the current status of breast cancer screening among females in Urban Beijing Cancer Screening Program, 2014-2019. Methods: Based on an on-going cancer screening program launched by the National Urban Cancer Screening Program, women residences aged 40 to 69 were recruited from 80 streets in six districts of Beijing (Dongcheng, Xicheng, Chaoyang, Haidian, Fengtai and Shijingshan District) using cluster sampling method. General demographic information and potential risk factors, results of clinical examination and follow-up outcomes of the target population (diagnosed breast cancer or not) were collected using epidemiological questionnaire, risk evaluation, clinical examination using ultrasound and (or) joint screening with mammography and follow-up, respectively. Proportion of high-risk cases evaluated by the questionnaire, recall rate, proportion of cases with BI-RADS grade 3 and BI-RADS grade 4/5, proportion of the cases with stage 0 or I, incidence rate and cumulative incidence rate were calculated. Cox proportional hazard regression model was used to estimate the hazard ratio (HR) and 95% confidence interval (95%CI) among females who experienced different screening scenario. Results: A total of 53 916 women with the age of (57.2±7.3) completed high-risk assessment were included into analysis. The proportion of overweigh and obesity were 40.90% (22 053 cases) and 15.34% (8 270 cases), respectively. A total of 17 535 cases (32.52%) were evaluated as positive case detected by the questionnaire. The clinical recall rate was 47.64% (8 353 cases) among the high-risk females. The positive rate detected by ultrasound or mammography alone was 1.84% and 4.00%, while the suspicious positive detection rates were 14.50% and 17.83%, respectively. The positive rate and suspicious positive rate detected by joint screening using ultrasound and mammography were 5.44% and 27.74% respectively. In total, 252 cases were diagnosed with breast cancer after an average of 2.68 years follow-up. The incidence rate and cumulative incidence rate of breast cancer were 174.34/100 000 person years and 470/100 000, respectively. The early detection rate was 68.6% among the residences who received clinical examination. Compared with the negative residence evaluated by the questionnaire, the positive cases has a 55% higher risk of diagnosed with breast cancer (HR=1.55, 95%CI:1.20-2.00); Cases that recognized by baseline ultrasound and mammography joint screening as BI-RADS 4/5 and BI-RADS 3 have higher risk of diagnosed with breast cancer than that of with the results of BI-RADS 1-2, with the HR of 12.60 (95%CI:6.49-24.47) and 1.89 (0.93-3.83), respectively. Conclusion: Females with high risk of breast cancer in Beijing have a better recall rate of receiving the clinical screening examination. Joint using ultrasonography and mammography in breast cancer screening can improve the positive detection rate among high risk females.

Reduced Mammography Screening for Breast Cancer among Women with Visual Impairment

Timely mammography to screen for breast cancer in accordance with the United States Preventive Services Task Force (USPSTF) recommendations can reduce morbidity and mortality substantially. This study assessed whether the odds of undergoing screening mammography are similar for women with and without visual impairment (VI). Retrospective, longitudinal cohort study. Women aged 65 to 72 years enrolled in fee-for-service Medicare from January 1, 2008, through December 31,2015. Patients with no vision loss (NVL), partial vision loss (PVL), and severe vision loss (SVL) were matched 1:1:1 based on age, race, time in Medicare, urbanicity of residence, and overall health. Women with pre-existing breast cancer were excluded. Multivariable conditional logistic regression modeling compared the odds of undergoing screening mammography within a 2-year follow-up period among the 3 groups. Proportion of participants undergoing mammography and adjusted odds ratios (ORs) of undergoing mammography within 2 years of follow-up. A total of 1044 patients were matched (348 in each group). The mean ± standard deviation age at the index date was 69.0 ± 1.5 years for all 3 groups. The proportion of women undergoing 1 mammography screening or more within the 2-year follow-up was 69.0% (n= 240), 56.9% (n= 198), and 56.0% (n= 195) for the NVL, PVL, and SVL groups, respectively (P= 0.0005). The mean ± standard deviation number of mammography screenings undergone per patient during the 5-year period (3-year look-back plus 2-year follow-up) was 3.1±2.0, 2.5 ± 2.0, and 2.3 ± 2.1 for the NVL, PVL, and SVL groups, respectively (P < 0.0001). Women with SVL had 42% decreased odds (OR, 0.58; 95% CI, 0.37-0.90; P= 0.01), and those with PVL had 44% decreased odds(OR, 0.56; CI, 0.36-0.87; P= 0.009) of undergoing mammography during follow-up compared with those with NVL. Women with VI were significantly less likely to undergo mammography screening for breast cancer than women without VI. Clinicians should look for ways to help ensure that patients with VI undergo mammography and other preventive screenings as recommended by the USPSTF.

The correlation of deep learning-based CAD-RADS evaluated by coronary computed tomography angiography with breast arterial calcification on mammography

This study sought to evaluate the association of breast arterial calcification (BAC) on breast screening mammography with the Coronary Artery Disease-Reporting and Data System (CAD-RADS) based on Deep Learning-coronary computed tomography angiography (CCTA). This prospective single institution study included asymptomatic women over 40 who underwent CCTA and breast cancer screening mammography between July 2018 and April 2019. CAD-RADS was scored based on Deep Learning (DL). Mammograms were assessed visually for the presence of BAC. A total of 213 patients were included in the analysis. In comparison to the low CAD-RADS (CAD-RADS < 3) group, the high CAD-RADS (CAD-RADS ≥ 3) group, more often had a history of hypertension (P = 0.036), diabetes (P = 0.017), and chronic kidney disease (P = 0.006). They also had a significantly higher level of LDL-C (P = 0.024), while HDL-C was lower than in the low CAD-RADS group (P = 0.003). BAC was also significantly higher in the high CAD-RADS group (P = 0.002). In multivariate analysis, the presence of BAC [odd ratio (OR) 10.22, 95% CI 2.86–36.49, P < 0.001] maintained a significant associations with CAD-RADS after adjustment by meaningful variable. The same tendency was also found after adjustment by all covariates. There was a significant correlation between the severities of CAD detected by DL based CCTA and BAC in women undergoing breast screening mammography. BAC may be used as an additional diagnostic tool to predict the severity of CAD in this population.

Abstract C100: Perceptions of breast cancer screening guidelines and intentions for screening: Qualitative commonalities of and differences between Black and White women age 50-75

Abstract The purpose of this investigation was to explore perceptions of Black and White women 50-75 years of age about current breast cancer screening guidelines from three national organizations (National Comprehensive Cancer Network, American Cancer Society, and the U.S. Preventive Services Task Force) and in how these guidelines impact their screening intentions. Non-Hispanic Black (n = 29) and White (n = 28) average risk women were recruited from Houston community sites serving those with low-SES to participate in focus groups. Using questionnaires, women reported on: sociodemographic information, knowledge of screening guidelines, personal history of mammograms, and screening intentions. During the focus groups, participants were presented with the three organizations’ screening guidelines and engaged in discussion on the benefits and harms of breast cancer screening mammography. We used a qualitative descriptive approach with inductive and deductive coding to analyze transcripts of video-recorded focus groups. Descriptive statistics were used to summarize questionnaire data. Participant average age was 65.93 years (SD=7.10). Among Black women, 12 had more than a high school degree and $30k was the median annual household income. Among White women, 25 held higher than high school degree and $60k-$70k was the median income. All women reported receiving a mammogram. Most women also reported they “definitely will be tested” in the next year (Black N=22, White N=21). Qualitative analysis revealed both groups of women expressed they enjoyed learning about the three guidelines but questioned the rationale for guideline development; Black women appeared to do so more strongly, whereas some White women expressed satisfaction with multiple guidelines. Although Black and White women expressed concern for younger generations’ access to screening information, White women expressed additional concern for low resource groups. Both groups expressed mistrust with the healthcare system, yet Black women expressed a desire to receive screening information from providers with whom they have deep and lasting relationships with, whereas White women expressed an interest in seeking information from multiple doctors in a less personal manner. Differences also emerged regarding screening intentions; while Black women expressed renewed motivation to continue screening, White women expressed greater openness to screen with less frequency and with discontinuation. These findings help to inform the ways healthcare providers might effectively customize and communicate screening information to racially/ethnically diverse groups of women. Although both groups of women expressed concerns regarding the guidelines, differences emerged in preferences for communicating and receiving screening information, as well as in the impact on their screening intentions. Citation Format: Maggie Britton, Ashley J. Housten, Diana S. Hoover, Lorna H. McNeill, Robert J. Volk. Perceptions of breast cancer screening guidelines and intentions for screening: Qualitative commonalities of and differences between Black and White women age 50-75 [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C100.

Radiation protection in mammography for breast cancer screening: not covered by the French press

BackgroundIn the context of major exposure to medical-based ionizing radiation (IR), French health institutions agree that adopting a precautionary approach is essential. A number of scientific studies have highlighted the risk of developing breast cancer after exposure to IR, even from low doses. However, the information circulating on the subject is varied. ObjectivesA study of the mainstream press was performed to better understand the elements constituting women's representations of IR in mammography for breast cancer screening. Study designThe data used came from a corpus created with the mainstream press database ‘Europresse.’ The keyword ‘mammography’ was chosen. The software package Iramuteq was used to perform a statistical analysis of textual data using the Reinert method. ResultsThis study highlights a paradox between the social principle of prevention and the discourse elements on mammography screening present in the mainstream press. ConclusionThe general French press does not take into account radiation protection in cancer screening discourses. A greater effort to provide information on this subject is needed.

Out-of-pocket cost of screening with breast MRI for women at high risk for breast cancer.

2017 Background: The prevention provision of Affordable Care Act (ACA) mandates private insurance to waive cost sharing for preventive services with grade A or B recommendations from the US Preventive Services Task Force. Although several professional societies have recommended augmenting screening mammography with MRI for women at high risk for breast cancer, the ACA prevention provision does not apply to screening MRI. This study examined the proportion of high-risk women having zero cost sharing associated with breast MRI for screening purposes and estimated out of pocket (OOP) costs as well as sources of variations. Methods: We identified women who underwent MRI and mammography for breast cancer screening from Marketscan database, 2009-2017. We quantified OOP costs as the sum of copayment, coinsurance, and deductible and defined zero cost sharing as having no OOP cost. We calculated the proportion of zero cost sharing for mammography and that for MRI and compared the time trend of each before and after ACA (enacted in 2010). We used multivariable logistic regression to examine factors associated with zero cost sharing for MRI use. We estimated OOP costs of MRI and examined cost variations by geographic regions or whether a woman had high deductible plans. Results: 25,232 women were included in the analysis. For screening mammography, the rate of zero cost sharing increased from 81% in 2009 to 91% in 2011 (post ACA) then 97% in 2017. For MRI, the rate was 41%, 37%, and 25%, respectively. The odds ratio (OR) of zero cost sharing for MRI screening was significantly lower for women with high deductible plans (OR = 0.65, 95% CI: 0.59-0.72) and for those resided in South (vs. Northeast) region (OR = 0.50, 95% CI: 0.46-0.53), after controlling for age, MSA, family breast cancer history, and year. OOP costs of MRI varied by region and insurance plan (Table); the mean OOP cost for women with high deductible plan were more than twice the mean cost for those in other plan types. Conclusions: With the financial protection under the ACA prevention provision applying to only screening mammography, many women at high risk for breast cancer are subject to high OOP costs for MRI screening. Those enrolled in high deductible plans and resided in the South are especially vulnerable financially. [Table: see text]

Accuracy and Effectiveness of Mammography versus Mammography and Tomosynthesis for Population-Based Breast Cancer Screening: A Systematic Review and Meta-Analysis

We proposed to compare the accuracy and effectiveness of digital breast tomosynthesis (DBT), plus digital or synthetic mammography, with digital mammography alone in women attending population-based breast cancer screenings. We performed a systematic review and included controlled studies comparing DBT with digital mammography for breast cancer screening. Search strategies were applied to the MEDLINE, Embase, LILACS, and CENTRAL databases. With moderate quality of evidence, in 1,000 screens, DBT plus digital mammography increased the overall and invasive breast cancer rates by 3 and 2 (RR 1.36, 95% CI 1.18 to 1.58 and RR 1.51, 95% CI 1.27 to 1.79, respectively). DBT plus synthetic mammography increased both overall and invasive breast cancer rates by 2 (RR 1.38, 95% CI 1.24 to 1.54 and RR 1.37, 95% CI 1.22 to 1.55, respectively). DBT did not improve recall, false positive and false negative rates. However due to heterogeneity the quality of evidence was low. For women attending population-based breast cancer screenings, DBT increases rates of overall and invasive breast cancer. There is no evidence with high or moderate quality showing that DBT compared with digital mammography decreases recall rates, as well as false positive and false negative rates.

Wire Guided Wide Local Excision of Clinically Undetectable Breast Cancer - Initial Experience in Bangladesh

Background: With the rise of awareness of breast cancer and better screening mammography, there are increasing number of breast cancers detected before becoming clinically evident. These cancers are mostly treated by wide local excision under guidance of a wire which is put with mammogram and/or USG. In Bangladesh this procedure has never been done. We started it in Surgical Oncology Division in BSMMU with the collaboration of Department of Radiology.&#x0D; Methods: We have performed the procedure on 7 patients within 19 months. All of them had USG and mammography detected small lesions. The average size being 7.24mm. From needle biopsy 3 cases showed suspicious cytology, 4 had IDCC, and 1 had DCIS. Wire was put in all cases under USG guidance. Wire Guided Wide Local Excision was performed in all cases. $ patients underwent SLNB.&#x0D; Results: The age range was between 26 to 55 years with the average age of 43.86 years. 4 of them being post-menopausal. One case came benign. Other were malignant with clear margins. One case had close margin, which was later re-excised. All cases were sent for adjuvant therapy. Histopathology showed 4 patients of invasive ductal carcinoma, 1 patient each of invasive lobular carcinoma, DCIS and 1 being benign.&#x0D; Conclusion: This well-established procedure can be performed in Bangladesh to meet the goal of ensuring adequate treatment and cosmesis of the patients with impalpable cancer, amidst constrained facilities.&#x0D; Journal of Surgical Sciences (2019) Vol. 23(2): 81-86

Computational reader design and statistical performance evaluation of an in-silico imaging clinical trial comparing digital breast tomosynthesis with full-field digital mammography.

A recent study reported on an in-silico imaging trial that evaluated the performance of digital breast tomosynthesis (DBT) as a replacement for full-field digital mammography (FFDM) for breast cancer screening. In this in-silico trial, the whole imaging chain was simulated, including the breast phantom generation, the x-ray transport process, and computational readers for image interpretation. We focus on the design and performance characteristics of the computational reader in the above-mentioned trial. Location-known lesion (spiculated mass and clustered microcalcifications) detection tasks were used to evaluate the imaging system performance. The computational readers were designed based on the mechanism of a channelized Hotelling observer (CHO), and the reader models were selected to trend human performance. Parameters were tuned to ensure stable lesion detectability. A convolutional CHO that can adapt a round channel function to irregular lesion shapes was compared with the original CHO and was found to be suitable for detecting clustered microcalcifications but was less optimal in detecting spiculated masses. A three-dimensional CHO that operated on the multiple slices was compared with a two-dimensional (2-D) CHO that operated on three versions of 2-D slabs converted from the multiple slices and was found to be optimal in detecting lesions in DBT. Multireader multicase reader output analysis was used to analyze the performance difference between FFDM and DBT for various breast and lesion types. The results showed that DBT was more beneficial in detecting masses than detecting clustered microcalcifications compared with FFDM, consistent with the finding in a clinical imaging trial. Statistical uncertainty smaller than 0.01 standard error for the estimated performance differences was achieved with a dataset containing approximately 3000 breast phantoms. The computational reader design methodology presented provides evidence that model observers can be useful in-silico tools for supporting the performance comparison of breast imaging systems.

Abstract P4-01-05: Circulating ensembles of tumor associated cells for detection of breast cancer

Abstract Background: Mammographic screening for breast cancer offers the possibility of reducing morbidity and mortality from the disease but has economic and safety implications. Thromboembolism is a well-recognized, potentially life-threatening complication of cancer. Detection and characterization of tumour emboli comprising Circulating Ensembles of Tumor Associated Cells (C-ETACs) has however remained largely unstudied, essentially due to the difficulties in their isolation. Here we present for the first time an observational study describing the prevalence of C-ETACs in breast cancer patients and in asymptomatic individuals using a novel, label and hypothesis free process. Methods:15 ml of peripheral blood was collected from 7075 female volunteers including 1582 previously diagnosed cases of breast cancer with definite radiological and histopathological evidence of disease of which 361 were non-metastatic, 792 were metastatic, 425 cases were recently diagnosed and treatment naïve and 1006 patients had received prior treatments. The control population comprised 5493 asymptomatic individuals with age-related increased risk of breast cancer. The control patients underwent mammography and had a BI-RADS category score of 1, consistent with absence of malignancy in the breast. Peripheral blood mononuclear cells from the study population were grown in an epigenetically active cell culture medium with paradoxical cytotoxicity that selectively kills normal cells and confers survival and growth advantage on apoptosis-resistant cells of tumorigenic origin and their emboli, viz., C-ETACs. C-ETACs are defined as clusters comprising Epcam+ and CK+ cells irrespective of CD45 expression. In a subset of 100 samples from breast cancer patients we confirmed that the isolated C-ETACs contained cells that were positive for GCDFP. Results: C-ETACs were detected in 1413 / 1582 cases of breast cancer giving a sensitivity of 89.3%. There were no statistically significant differences between metastatic vs non-metastatic status of the disease or prior treatment. Among the 5493 individuals with unremarkable mammography, C-ETACs were detected in 104 (1.89 %) individuals. These individuals are being followed up prospectively for manifestation of clinical or radiological signs of malignancy of the breast as well as in other organs. Conclusions: Our study shows that heterotypic C-ETACs are a common feature of breast cancer irrespective of type, stage and grade and are almost entirely absent in asymptomatic, mammographically normal individuals. Our results therefore identify a potential biomarker for breast cancer which is specific and sensitive and which satisfies the requirements for the non-invasive, radiation-free detection of breast cancer. As such, it is a candidate for development as a modality for population screening. Citation Format: Timothy Crook, Dadasaheb Akolkar, Pradip Fulmali, Revati Patil, Cynthe Sims, Pooja Fulmali, Vineet Datta, Sachin Apurwa, Ajay Srinivasan, Rajan Datar. Circulating ensembles of tumor associated cells for detection of breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-01-05.