Mammographic Screening For Breast Cancer Research Articles

Screening Guidelines and Supplemental Screening Tools: Assessment of the Adequacy of Patient-Provider Discussions.

To assess breast imaging radiologists' perceptions of the adequacy of provider-patient discussions regarding the benefits and risks of screening mammography and supplemental screening in women with elevated risk and dense breasts. A 36-item questionnaire developed by the Society of Breast Imaging Patient Care and Delivery Task Force was distributed electronically to Society of Breast Imaging members to evaluate patient communication, education, and screening practices. Data from the 11 items specifically pertaining to screening practices were analyzed. The response rate was 14% (275/1992). Seventy-four percent of survey respondents perceived provider-patient discussions regarding mammography screening guidelines as inadequate, and they agreed that provider-patient discussions regarding screening guidelines (82%) and supplemental screening for increased breast density (74%) should be standardized. Only 38% indicated that mammography screening guidelines are officially endorsed by their institution. Similarly, 37% reported that recommendations were up to the primary provider. Although most respondents include information about breast density in lay letters (73%) and radiology reports (89%), many feel that further patient education regarding breast density, supplemental screening, risk assessment, and screening guidelines should be performed by radiologists, and they are willing to provide additional patient education in these areas in practice. Survey respondents perceived current provider-patient discussions about the risks and benefits of breast cancer mammography screening and supplemental screening as inadequate and felt that standards should be developed. Respondents reported a willingness to take on patient education as part of their daily practice. These findings could inform future initiatives for radiologists to contribute to enhancing provider-patient education.

Genetic mutation analysis of plasma circulating tumor DNA by ultra-deep sequencing in breast benign lesions and cancers.

e14572 Background: Mammography screening for breast cancer results in large number of impalpable lesions without clear determination of the malignancy. Analysis of breast cancer related gene mutations in blood circulating tumor DNA (ctDNA) may provide clarification. This analysis aims to provide insights into the feasibility of the approach. Methods: The clinical trial was conducted at top tier teaching hospitals in China to recruit patients with breast diseases for surgery. Eligible patients were consented and the breast lesions were pathologically diagnosed. Peripheral blood was collected prior to surgical resection. For breast cancer patients, samples of resected tissue were also collected. The samples were analyzed using our proprietary NGS technique called systematic error correction sequencing (Sec-Seq) (detailed in Abstract ##e23057, ASCO 2018). Results: In total, 69 patients with breast lesions (57 malignant and 12 benign) were included in this analysis. Tumor gDNA and plasma ctDNA were analyzed by deep NGS sequencing using a panel of 62 breast cancer-associated genes. The average sequencing depth is 35000. After deduplication, the average number of unique reads is 1500. Detection limit for mutant allele frequency was set at 0.2% for ctDNA and 1% for tumor tissue. For ctDNA mutation detection, 2 out of 12 patients with benign diseases were found with mutations while 10 out of 55 breast cancer patients had no mutations, resulting in an overall sensitivity of 82% and specificity of 83%. By cancer stage, the two Stage 0 (carcinoma in situ) patients had no mutation, and the range of mutations detected is between 53% to 75% from Stage I to III. The tumor tissue samples have higher rate of mutations (only 2 cancer patients, 1 Stage 0 and 1 Stage 2, had no mutations). 15% patients have at least one common mutation detected in both the tumor tissue and ctDNA, and 27% patients have mutations in the same genes in the two matching samples. The concordance increases as the clinical stage advances. The most commonly mutated genes are previously reported breast cancer drivers of PIK3CA (79% of tumor and 18% of ctDNA samples), TP53 (56% and 39%), and BRCA1 (6% and 15%). Conclusions: In this hypothesis generating analysis, we showed the feasibility of plasma ctDNA sequencing for gene mutation detection in early stage breast cancer and differentiation from the benign breast diseases. Although with limited number of samples, the data encourage further improvement of the gene panel and the validation of ctDNA assay as a non-invasive approach to the cancer screening. Clinical trial information: ChiCTR1800017345.

Comparison between opportunistic and organised breast cancer mammography screening in the Swiss canton of Fribourg

BackgroundBreast cancer screening mammography is widespread in industrialised countries within the framework of public health program or opportunist form. Only few data exist on the comparison of effectiveness between organised and opportunistic screening. The aim of this study is to compare organised and opportunistic screening using population-based data from the Fribourg cancer registry, Switzerland.MethodsWe included all first primary breast adenocarcinoma diagnosed between 2006 and 2014 in women aged 50–69 years resident in the canton of Fribourg. We considered only breast cancer discovered by mammography screening. We compared patients, tumour characteristics and treatment modalities between breast cancer detected by the organised screening program versus opportunistic screening using logistic regression.ResultsOut of 989 patients diagnosed with breast cancer, 402 (40.6%) were diagnosed by organised and 205 (20.7%) by opportunistic screening. Women with breast cancer detected within the screening program were more likely to be from rural areas (P = 0.035) and lived less frequently in high favoured regions (P = 0.020). They presented more frequently in situ than invasive cancer (P = 0.022). For patients with invasive breast cancer, those detected by the program were less likely to undergo mastectomy (P = 0.06) and consequently, they were more likely to undergo radiation therapy (P = 0.003). Adjustment for area of residence and financial context of the region did not modify the results presented.ConclusionsThe present study reports an increased rate of detection of carcinoma in situ in organised screening program as compared to opportunistic screening mammographies, an indirect evidence of a higher radiologic sensitivity. Furthermore, the results show a trend towards more mastectomies among patients with breast cancer discovered after opportunistic than after organized mammography screening, reflecting lower treatment burden. Those results were independent of socio-economic factors which differed across screening groups.

Comparison of Contrast-Enhanced Mammography With Conventional Digital Mammography in Breast Cancer Screening: A Pilot Study

PurposeTo perform a pilot evaluation of contrast-enhanced mammography (CEM) for screening to determine whether it can improve accuracy and reader confidence in diagnosis. Methods and MaterialsThis institutional review board–approved reader study was comprised of 64 de-identified CEM cases acquired from December 1, 2014, to June 7, 2016, including 48 negative, 5 biopsy-proven benign, and 11 biopsy-proven malignancies. Negative cases were followed for at least 2 years without evidence of cancer. Ten breast imagers of varying experience first rated the low-energy (LE) mammogram and then the CEM examination using BI-RADS categories and a 5-point Likert scale for confidence in diagnosis. ResultsThere were 635 out a total possible 640 complete reader interpretations included in this analysis. The remaining five incomplete interpretations were excluded. Median sensitivity and specificity improved with the addition of CEM (sensitivity: 0.86 [95% confidence interval {CI}: 0.74-0.95] versus 1 [95% CI: 0.83-1.00], specificity: 0.85 [95% CI: 0.64-0.94] versus 0.88 [95% CI: 0.80-0.92]). Individual receiver operating characteristic curves showed significant improvement with CEM (mean area under the curve increase = 0.056 [95% CI: 0.015-0.097], P = .002). The addition of CEM significantly improved average confidence in 5 of 10 readers when compared with LE (P < .0001) and improved pooled confidence across all tissue density categories, except the almost entirely fatty category. There was a trend toward improved confidence with increasing tissue density with CEM. Degree of background parenchymal enhancement did not affect readers’ level of improvement in confidence when interpreting CEM. SummaryCEM improved reader performance and confidence compared with viewing only LE, suggesting a role for CEM in breast cancer screening for which larger trials are warranted.

Implementing Abbreviated MRI Screening Into a Breast Imaging Practice.

OBJECTIVE. The purpose of this article is to describe steps for implementing abbreviated breast MRI into a breast imaging practice. CONCLUSION. Mammographic screening for breast cancer has been the standard of care. However, breast cancer remains a leading cause of death of women. Studies have shown that MRI performed with an abbreviated protocol for women at average and slightly increased risk depicts mammographically occult biologically significant cancers at early stages.

BPI19-012: Differences in Stakeholder Perspectives Regarding Key Components of Shared Decision-Making for Mammography in Breast Cancer Screening for Women Ages 40–50

Background: National health organizations offer contrasting guidelines for women aged 40–49 regarding when to begin and how often to use mammography screening for breast cancer. The ACS recommends average risk women aged 40–44 receive annual screening “if they wish to do so” and annual screening for women aged 45–54. The United States Preventive Services Task Force recommends individualized screening for average-risk women before age 50 advised by risk assessment and shared decision-making (SDM). Clinicians lack guidance on how to conduct and what elements to include in mammography SDM. Our prior work identified core elements via scoping review applied to a modified Delphi consensus process involving patients, primary care physicians (PCP), and healthcare decision scientists (HDS). This study examines stakeholder group differences in endorsing core SDM elements. Methods: The Delphi consensus included 10 patients, 10 PCP, and 10 HDS and fielded 48 items to codify core elements of mammography SDM. A threshold of 80% agreement across all participants was set to establish consensus for retaining or dropping an item. In this study, separate stakeholder groups’ endorsement rates for each item were calculated. Items were deemed to have stakeholder discrepancy if one group differed from the 2 others in either meeting or not meeting the 80% threshold criteria. Results: 16 items (13 retained, 3 dropped in Delphi) had a discrepant group. For all retained items, the discrepant group fell below 80% criteria for retaining. For 2 of the dropped items, discrepant groups achieved threshold for retaining the item. One item was dropped despite most participants voting to retain it (&gt;80%) due to the discrepant group’s rating &lt;80%. Patients rated less importance to educating women about risks and recommendations. PCPs rated lower importance to training PCPs and women for discussions about mammograms and having discussions on a regular basis. HDSs rated greater importance to considering mammogram procedures and costs in SDM. Discussion: Leading healthcare organizations are increasingly recommending SDM in breast cancer screening, among other decisions. Guidelines enumerating core elements of SDM are needed to effectively direct clinicians. This study, by illuminating differences between stakeholder group perspectives, highlights the importance of eliciting varied perspectives in identifying core elements of SDM when informing healthcare practices and policy.

Trends in Breast MRI Use Among Women with BRCA Mutations: A National Claims Analysis 2006–2016

Abstract Women with BRCA mutations are recommended to receive breast MRI as an adjunct to annual mammography for breast cancer screening however adoption of these guidelines is unclear. We estimated breast MRI use from 2006–2016 among insured US women to understand use over time. Methods: Using medical care claims, we conducted a cohort study of breast MRI use in commercially-insured women aged 20–64 years continuously enrolled for ≥1 year in a large national insurer between 2006–2016. Women were identified as BCRA mutation carriers without a personal history of breast cancer using ICD9/10 diagnosis codes. We used CPT codes to identify breast MRIs and developed claims-based algorithms to categorized MRI indication as: screening, diagnostic or other. We calculated annual age-specific and age-adjusted rates of use overall and by indication among BCRA mutation carrier women. We used autoregressive time series models to estimate the yearly trend. Results: We identified 12,457 women with BRCA mutations during the study period. Breast MRI use overall among BRCA+ women aged 20–64 was 47/1000 women in 2006 and increased on average by 11 MRIs per year to a rate of 174/1000 in 2016 (P &amp;lt; 0.001). Across this time period, use for screening accounted for over 80% of breast MRIs and rates mirrored the overall trend with a 4.8-fold increase from 31/1000 in 2006 to 146/1000 women by 2016. Over the same time period, use of breast MRI for diagnostic workup or other indications remained stable. Use of screening breast MRI was highest among older women aged 50–64 compared with women &amp;lt;40 and 40–49 years (in 2016, 189, 95, and 177/1000, respectively) Discussion: Breast MRI screening increased dramatically over the past decade in women with BRCA mutations concordant with clinical guidelines. Additional research is needed to understand use of breast imaging relative to health outcomes for this high-risk population.

Twenty-Five Year Trends in the Incidence of Ductal Carcinoma in Situ in US Women

The rising incidence of ductal carcinoma in situ (DCIS) since the widespread enactment of mammography screening has been well documented. Patterns in DCIS incidence among women of various ages and across different racial and ethnic groups have not been well described. The Surveillance, Epidemiology, and End Results public-use data set was queried for all women aged 40 years and older diagnosed with DCIS between 1990 and 2014. Annual age-adjusted incidence rates were compared among white, black, Hispanic, and Asian-Pacific Islander women. Additionally, using mammography screening data obtained from the CDC, patterns in mammography screening over time and as they relate to DCIS incidence rates by race and ethnicity were evaluated. We identified 200,400 women aged 40 years or older with DCIS. Between 1998 and 2014, a period that saw flux in national breast screening guidelines, DCIS incidence rates increased in blacks, Hispanics, and Asian-Pacific Islanders, but remained relatively unchanged in whites (increase in number of DCIS diagnoses per 100,000 individuals in the population per year among blacks+0.66/p < 0.01, Hispanics+3.0/p < 0.01, Asian-Pacific Islanders+0.53/p < 0.01, and whites+0.07/p= 0.21). After accounting for age, year of diagnosis, and mammography screening rates, DCIS incidence was found to be similar between white and black women (0.8 fewer diagnoses per 100,000 individuals compared with whites; p= 0.36) but lower for Hispanic women (9.7 fewer diagnoses per 100,000 individuals compared with whites; p < 0.01). The DCIS incidence rates are influenced substantially by breast cancer mammography screening patterns. However, differences exist by race and ethnicity and are not fully explained by screening mammography trends alone. Consideration should be given to including race and ethnicity in determining optimal breast screening guidelines.

Double reading of automated breast ultrasound with digital mammography or digital breast tomosynthesis for breast cancer screening

PurposeTo evaluate the impact of double reading automated breast ultrasound (ABUS) when added to full field digital mammography (FFDM) or digital breast tomosynthesis (DBT) for breast cancer screening. MethodsFrom April 2014 to June 2015, 124 women with dense breasts and intermediate to high breast cancer risk were recruited for screening with FFDM, DBT, and ABUS. Readers used FFDM and DBT in clinical practice and received ABUS training prior to study initiation. FFDM or DBT were first interpreted alone by two independent readers and then with ABUS. All recalled women underwent diagnostic workup with at least one year of follow-up. Recall rates were compared using the sign test; differences in outcomes were evaluated using Fisher's exact test. ResultsOf 121 women with complete follow-up, all had family (35.5%) or personal (20.7%) history of breast cancer, or both (43.8%). Twenty-four women (19.8%) were recalled by at least one modality. Recalls increased from 5.0% to 13.2% (p = 0.002) when ABUS was added to FFDM and from 3.3% to 10.7% (p = 0.004) when ABUS was added to DBT. Findings recalled by both readers were more likely to result in a recommendation for short term follow-up imaging or tissue biopsy compared to findings recalled by only one reader (100% vs. 42.1%, p = 0.041). The cancer detection rate was 8.3 per 1000 screens (1/121); mode of detection: FFDM and DBT. ConclusionsAdding ABUS significantly increased the recall rate of both FFDM and DBT screening. Double reading of ABUS during early phase adoption may reduce false positive recalls.

Changes in Final BI-RADS Assessment Categories and Clinical Outcome Metrics When Digital Breast Tomosynthesis Is Included in Diagnostic Mammography

The benefits of digital breast tomosynthesis (DBT) in breast cancer screening have been analyzed [ 1 Yun S.J. Ryu C.W. Rhee S.J. Ryu J.K. Oh J.Y. Benefit of adding digital breast tomosynthesis to digital mammography for breast cancer screening focused on cancer characteristics: a meta-analysis. Breast Cancer Res Treat. 2017; 164: 557-569 Crossref PubMed Scopus (47) Google Scholar ], but only a few studies have investigated the impact of DBT in the diagnostic setting [ 2 Raghu M. Durand M.A. Andrejeva L. et al. Tomosynthesis in the diagnostic setting: changing rates of BI-RADS final assessment over time. Radiology. 2016; 281: 54-61 Crossref PubMed Scopus (48) Google Scholar ]. Diagnostic mammography is performed to further evaluate findings seen on screening mammography in women recently treated for breast cancer and in patients with clinical concerns, such as a palpable breast lump or suspicious nipple discharge.

A survey of attitudes toward breast cancer screening mammography in the Philippines

A survey of attitudes toward breast cancer screening mammography in the Philippines

Cost-effectiveness of breast cancer screening programme for women in rural China.

In low and middle-income countries mammographic breast cancer screening is prohibitively expensive and a cheaper alternative option is to use ultrasound as the primary screening test. In 2009, China launched a breast cancer screening programme for rural women aged 35-64 years with clinical breast examination coupled with ultrasound as the primary tool. Our study aimed to analyse the cost-effectiveness of breast screening compared to no screening among Chinese rural women. We developed a Markov model to estimate the lifetime costs and effects for rural women aged 35 years from a societal perspective. Asymptomatic women in the intervention arm were screened every 3 years before age 64 years. Breast cancer in the non-screening arm can only be diagnosed on presentation of symptoms. Parameter uncertainty was explored using one-way and probabilistic sensitivity analyses. Compared to no screening, breast cancer screening cost $186.7 more and led to a loss of 0.20 quality-adjusted life years (QALYs). Breast screening was more expensive and did harm to health among rural women with an incremental cost-effectiveness ratio (ICER) of $-916/QALY. The sensitivity analysis identified utility loss from false positives as the factor that most influenced the results, but this did not affect the conclusions. In a rural setting with such low breast cancer incidence, screening for asymptomatic disease is not cost-effective with current screening tools. Priority should be given to ensure that symptomatic women have proper access to diagnosis and treatment at an early stage as this will lead to mortality reductions without the usual screening harms.

Breast dose in conventional and digital mamography

Introduction: The amount of doses received in mammography is one of the biggest concerns in the world. According to some statistics, every 12 minutes a woman dies due to breast cancer. Mammography concerned to detect breast cancer at an early stage of the disease as well as for screening, however due to the risk of exposure, the increasingly and widespread use of mammography for breast cancer screening is a controversial subject. This research was done to compare the breast dose in the conventional and digital mammography devices that used in mammography centers in Tabriz city on 1395. Materials and Methods: This research is a descriptive study. In the first three mammograms, according to the instructions of the Atomic Energy Organization of Iran (AEOI) for quality control were tested. Information about 322 patients who for mammography went to four centers over four months were collected, then the values of average dose of mammary glands in the mammogram images as milli-Gray (mGy) were calculated and analyzed. Results: In the 4 clinics, the mean values of compressed tissue thickness in the conventional mammography device for CC and MLO were 4.01 ± 0.92 cm and 4.49 ± 1.63 cm and the dose values were 1.53 ± 0.58 mGy and 1.58 ± 0.59 mGy respectivel, P-value that received is 1. Also the mean values of compressed tissue thickness in digital mammography device for CC and MLO were 5.8 ± 1.00 cm and 6.30 ± 1.01 cm and the dose values 2.07 ± 0.71 mGy and 2.15 ± 0.69 mGy were obtained respectively and also p-value is received 0.925. Conclusion: According to this study, it seems that despite the benefits of digital mammography on the conventional mammography, digital mammography device has more average absorbed dose rather than conventional mammography device. Due to the higher absorbed dose, doing of regular quality control and dose reduction techniques are recommended in digital mammography.

The Effect of Psychoeducation on Anxiety in Women Undergoing Their Initial Breast Cancer Screening Mammography.

We conducted a prospective, randomized, single-blinded study to determine whether a psychoeducational intervention for patients undergoing screening mammography could influence the level of anxiety related to the procedure. Fifty women undergoing mammography for the first time were included in the study and randomized to two groups. In the study group, patients received a psychoeducational session before mammography. In the control group, psychoeducation was not applied. To evaluate the level of anxiety, we used the State-Trait Anxiety Inventory. State Anxiety Scale (S-Anxiety) score and Trait Anxiety Scale (T-Anxiety) scores were assessed before and after mammography in both groups. After evaluating the S-Anxiety score in the study group before mammography and after the procedure, a statistically significant difference (p = 0.043) was observed. In contrast, no statistically significant changes were noticed in the control group (p = 0.886). Our study showed that psychoeducation reduced state anxiety among the participants of a breast cancer screening.

Organizational challenges to equity in the delivery of services within a new personalized risk-based approach to breast cancer screening

Emerging evidence opens new possibilities to improve current breast cancer mammography screening programs. One promising avenue is to tailor mammography screening according to individual risk. However, some factors could challenge the implementation of such approach, specifically its potential impact on the equitable delivery of services. This study aims to identify the barriers and facilitators to the equitable delivery of services within a future integration of a personalized approach in the Québec screening program. We then propose different means to address them. We conducted 16 semi-structured interviews with stakeholders with a role in the management, implementation or assessment of the Québec screening program. The barriers and facilitators identified by respondents were regrouped in two themes: 1) Reproduction of social inequities, and 2) Amplification of regional disparities in access to services. We consider that fostering inclusion through communication strategies and relying on electronic communication technologies could help in addressing these issues.

Automatic Labeling of Special Diagnostic Mammography Views from Images and DICOM Headers

Applying state-of-the-art machine learning techniques to medical images requires a thorough selection and normalization of input data. One of such steps in digital mammography screening for breast cancer is the labeling and removal of special diagnostic views, in which diagnostic tools or magnification are applied to assist in assessment of suspicious initial findings. As a common task in medical informatics is prediction of disease and its stage, these special diagnostic views, which are only enriched among the cohort of diseased cases, will bias machine learning disease predictions. In order to automate this process, here, we develop a machine learning pipeline that utilizes both DICOM headers and images to predict such views in an automatic manner, allowing for their removal and the generation of unbiased datasets. We achieve AUC of 99.72% in predicting special mammogram views when combining both types of models. Finally, we apply these models to clean up a dataset of about 772,000 images with expected sensitivity of 99.0%. The pipeline presented in this paper can be applied to other datasets to obtain high-quality image sets suitable to train algorithms for disease detection.

The health economics of cancer screening in Germany: Which population-based interventions are cost-effective?

Only asmall proportion of German health expenditure is spent on prevention and early detection (screening). The rationale for screening is to identify persons with disease precursors or at the early stage of diseases when they are still asymptomatic, in order to decrease disease-specific morbidity and mortality. In Germany, the economic evidence is one of the evaluation criteria for screening measures, which, among other things, takes into account the additional cost per additional case detected or per case-related event avoided, as well as acost-benefit balance.For this purpose, cost-effectiveness analyses, which report marginal or incremental cost effectiveness ratios, comparing ameasure with its appropriate alternatives, may be auseful tool. Their application requires adefensible benchmark (threshold) for cost effectiveness and asupplementary analysis of the necessary infrastructure and the budgetary impact associated with program implementation. Also (albeit not only) because of the usually long time required to observe the clinical outcomes of ascreening measure, the economic evaluation of such programs regularly involves the application of decision analytic simulation models. With regard to cancer screening programs, the available models indicate an excellent cost-benefit ratio for the fecal occult blood test and colonoscopy for colorectal cancer screening and, similarly, for the use of mammography for breast cancer screening. On the other hand, the economic evidence in favor of low-dose computed tomography for lung cancer screening does not yet appear sufficiently strong, and the currently available health economic evidence does not support the use of PSA testing for prostate screening.

An automated method for the evaluation of breast cancer using infrared thermography.

Breast cancer is one of the major causes of death for women. Temperature measurement is advantageous because it is non-invasive, non-destructive, and cost-effective. Temperature measurement through infrared thermography is useful to detect changes in blood perfusion that can occur due to inflammation, angiogenesis, or other pathological causes. In this work, we analyzed 206 thermograms of patients with suspected breast cancer, using a classification method, in which thermal asymmetries were computed, the most vascularized areas of each breast were extracted and compared; then these two metrics were added to yield a thermal score, indicative of thermal anomalies. The classification method based on this thermal score allowed us to obtain the test sensitivity of 100 %, specificity of 68.68 %; a positive predictive value of 11.42 % and negative predictive value of 100 %. These results highlight the potential of thermography imaging as adjunctive tool to mammography in breast cancer screening.

Makna Mobile Mammography Screening Unit

Amount allocated in 2017 for this initiative RM 754,892.00 (US$ 195,353 or CHF 187,509.16) Background and context: Urbanization and its discontent have seen more urban poor in need of immediate medical intervention. Only a small percentage of women ever performed mammogram due to medical screening cost and poor knowledge pertaining to mammography screening for breast cancer. A massive health education campaign through multiple methods and agencies is necessary to upend this deep-seated perception. Aim: MAKNA's mobile mammography screening unit aims to improve lifesaving chances of people afflicted by cancer through early detection of presymptomatic cancer, using approved and fully equipped vehicle with the latest technology available. Focusing in early detection Garnering resources inter alia to help the financially-challenged cancer patients Many cases that come to MAKNA come in the late stages where help of a cure is usually less than 30% Enhancing knowledge and awareness among general public Economic-wise: cheaper to screen for diseases compared with treating patient Reducing death rate from breast cancer by conduct and deliver nationwide campaign all over Malaysia from districts to cities, rural to urban dwellings Strategy: Equipment overall specs Breast screenings with mammography using full fledge digital unit (GE SENOGRAPHE 2000D) Primary objectives: To conduct mammograms and clinical breast examinations (CBE) to public. To conduct general screening to public. Secondary objectives: To conduct cancer awareness and screening program to public. To educate staffs on early detection of cancer. To raise fund for financially challenged cancer patients via MAKNA various fundraising projects Key messages: Early detection saves lives - know the early warning signs and get screened. Care for yourself and others -help us to help the financially challenged cancer patient. (Cancer treatment is very expensive.) Get involved! -Participate in our activities Further targeted communities: Rural interior villages across Malaysia Costs and returns: A. Total 2007-2017: Total costs: RM 5,787,634 (US$ 1,497,398 or CHF 1,437,713) (RM 2,499,500 for fixed assets + RM 3,288,134 for services) Total ROI: Total screenings: 204 locations Results (by case): Normal: 20,027 Benign: 2434 Abnormal/referred: 383 Cancer diagnoses: 23 B. Year of 2017´s impacts: Costs: RM 753,109 (US$ 194,878 or CHF 187,083) ROI: 6378 screenings: 47 locations Result (by case) Normal: 5329 Benign: 956 Abnormal/referred: 93 Cancer diagnoses: 7 What was learned: Majority of cancers are the result of unhealthy lifestyle rather than inherited genetic faults. Breast cancer rate by ethnic: highest in Chinese &gt; Malay &gt; Indian &gt; others. Early stage of breast cancer most detected. Patient navigation program to improve follow-up with positive cases. Overall, this is a scalable solution. Specifically in good prospect to operate in Borneo, East Malaysia with 2 more units.

A partially observable Markov chain framework to estimate overdiagnosis risk in breast cancer screening: Incorporating uncertainty in patients adherence behaviors

Overdiagnosis is the diagnosis of a medical condition that would never have caused any symptoms or problems in a patient’s lifetime if left undetected. Although overdiagnosis is known to be the major risk inherent in mammography screening; currently there is no way to distinguish between overdiagnosed cancers and the ones that would cause problems over a patient’s lifetime. Therefore, the extent of overdiagnosis risk must be estimated indirectly. This and the limitations in previous studies on quantification of overdiagnosis cause a wide variation in the estimation of this risk. In this study, we develop a stochastic framework, which eliminates some of the limitations of the previous studies, to estimate various measures of overdiagnosis. We introduce different measures of overdiagnosis risk including age and stage-specific overdiagnosis risks, as well as the lifetime overdiagnosis risk. Moreover, overdiagnosis risk significantly depends on a patient’s compliance with screening recommendations. Specifically, we develop two partially observable Markov chains to quantify the risks associated with various screening policies while considering the uncertainty in a patient’s adherence behavior. Our results show that overdiagnosis risk is a function of a patient’s age at diagnosis, as well as the number, frequency, and distribution of screening tests over a patient’s lifetime. Further, the results suggest that detecting breast cancer in early stages poses a higher risk of overdiagnosis than detection in advanced stages. A harm-benefit analysis is also performed to compare the overdiagnosis risk with the benefits that breast cancer screening provides. Our results show that, although overdiagnosis rate is relatively high in breast cancer screening, the benefits of breast cancer mammography screening outweigh the overdiagnosis risk.