Mammographic Screening For Breast Cancer Research Articles

Knowledge, Practice, Preferences and Willingness-to-Pay for Mammographic Screening Tests among Iranian Women: A Contingent Valuation Method.

Objective:This study sought to investigate Iranian women’s preferences and willingness-to-pay (WTP) based on the level of breast self-examination and mammography screening practice and knowledge, including risk factors, signs and symptoms, and early detection methods via mammography screening.Methods: This is a descriptive, cross-sectional, population-based study conducted from October to March 2020 on over 35-year-old women living in Mashhad, selected through the convenient sampling method applied in health centers of Mashhad city. To measure the willingness to pay, the study participants were asked for their preferred choices concerning out-of-pocket payment for screening. Results:More than one-half (58.6%) of the study’s sample size had an intermediate level of knowledge regarding breast cancer’s risk factors, and only 12.7% of them had an unsatisfactory level of knowledge. However, most of the participants had a poor level of practice towards breast self-examination and mammography screening. The results of measuring the willingness to pay (WTP) indicated that 11.5% of the participants were not willing to pay at all for mammography breast cancer screening, while 53.3% of the participants were willing to pay 2.27 to 3.41 $U.S, and 35.2% of the participants were willing to pay more than 3.41 $U.S for mammography breast cancer screening. Conclusion:Any attempt to promote breast cancer screening among Iranian women should primarily focus on increasing such indices as awareness, education, health status, and household income. It should be noted that the majority of the participants possessed an average level of knowledge. Moreover, women lack appropriate information about breast cancer and its’ early detection measures. However, it was found that self-employed women were more likely to practice breast self-examination than the women employed in governmental organizations, which could be attributed to the fact that self-employed women could dedicate more time to checking their breasts and practicing breast self-examination.

Cancer Screening Practices Among Healthcare Workers During the COVID-19 Pandemic.

The COVID-19 pandemic has the potential to impact long-standing efforts to increase adherence to cancer screening guidelines. Healthcare workers (HCWs) experienced significant hardship, but generally have greater access to preventive services, making them a particularly relevant population in which to understand cancer screening behaviors during the pandemic. We report data from 794 HCWs enrolled in the NCI-funded Serological Sciences Network for Coronavirus Associations and Longitudinal Evaluation Study from December 2020 to April 2021. Participants reported lifestyle and screening behaviors during relevant look-back periods which included the pandemic timeframe. Among women between the ages of 40 and 74, 25.7% were overdue for mammographic breast cancer screening. Among participants 50–75 years old, 38.9% were overdue for colorectal cancer screening. The proportion over-due varied according to race/ethnicity. Lifetime low-dose computed tomography lung cancer screening among HCWs age 50–80 years who were smokers was 10.9%. Strategies to address screening disruptions are needed to minimize the impact of later stage of diagnosis.

Current status of breast cancer undetected by mammography in population-based breast cancer screening and associated factors

Objective This study aimed to promote the application of mammography (MMG) screening without performing a clinical breast examination (CBE). It examined population-based screening data, including history taking findings, to elucidate the status of breast cancer cases, detected solely by CBE, and to reveal the factors associated with breast cancer. Through this, it explored alternative methods for evaluating breast cancer cases, undetected by MMG, when CBE is omitted.Methods The linked anonymized data from women, who underwent breast cancer screening in 2014, 2016, or 2017, were prepared. The data were obtained from the Nishinomiya City database. Breast cancer, undetected by MMG, were defined as breast cancer cases diagnosed by close examination based on CBE only (MMG findings were category 2 or lower, with no abnormalities). To assess the quality of breast cancer screening, process indices were calculated for the overall population, and for patients indicated for close examination based on CBE but not MMG. The association of breast cancer with each factor was statistically analyzed (χ2 test, etc.).Results In total, 13,504 women underwent breast cancer screening. Close examination was required in 1,247 women (9.2%). Breast cancer was diagnosed in 44 women (3.5%), including four, who had breast cancer undetected by MMG. All of the process indices satisfied the acceptable values. Three of the four women with breast cancer, undetected by MMG, noticed a lump. Breast cancer was significantly associated with "subjective symptoms". The presence of a "lump" and "nipple discharge" were significantly more common in breast cancer patients.Conclusion Three of the four breast cancer cases, undetected by MMG screening, had a subjective symptom (lump). There was a significant association between subjective symptoms (lump and nipple discharge) and breast cancer. To avoid missing breast cancer, undetected by MMG alone, these symptoms should be especially evaluated in women to compensate for the omission of a CBE. This can be achieved by encouraging women experiencing symptoms to seek consult, performing a thorough history-taking and observation, engaging in multidisciplinary collaboration (communication from medical staff to physicians), and promoting breast awareness.

Do women living in northeast Anatolia get mammography screening? A hospital-focused cross-sectional study

Background/Aim: In Turkey, women between 40–69 years of age are routinely subjected to mammography screening for breast cancer. Despite this, the mammography rate is only 28.9% in women aged 15 years and above. This is an indication that women in Turkey are not sufficiently interested in mammography screenings. This study aimed to determine the factors that affect the decision to not have mammography screening for women aged 40 and above. Methods: The study was designed as a hospital-focused cross-sectional study. The population of the study comprised 7,239 women aged 40 years and above. The sample size that would represent the population was calculated as 365 women with 50% prevalence, 95% confidence interval, and 5% deviation in the Epi Info program. A Chi-square test used in the binary analysis (P

A novel sophisticated form of DMAS beamformer: Application to breast cancer detection

Confocal microwave imaging (CMI) has the potential to be an alternative or complementary method for mammography in breast cancer screening. Data acquisition in CMI is very fast, safe, and comfortable for patients, but the reconstructed images are not always of high quality. High level of artifacts and poor resolution cause impaired quality. In this work, a novel, fast and robust beamformer, DMAS-D4 is presented. Delay-multiply-and-sum-degree-4 (DMAS-D4) is a next generation beamformer that expands the two-dimensional summations in delay-multiply-and-sum (DMAS) to four-dimensional summations in which all possible fourth degree terms are summed to increase robustness and resolution. A computationally-efficient implementation is presented which mitigates the additional computation required by DMAS. Furthermore, the proposed method can run iteratively which makes the ability to update the result using new observations. An idealized simulation compares basic performance of the proposed method with two other beamformers: (1) DAS, which is the gold standard, and (2) DMAS, which has been reported as the best beamformer so far. The results demonstrate that the DMAS-D4 achieves higher contrast and finer resolution. The proposed method increased the signal-to-max-ratio (SMXR) from 3.1 dB using DMAS to 5.7 dB in the heterogeneous breast mimicking phantom which illustrates the higher tumor detectability using the proposed method. Similarly, the Signal-to-Clutter Ratio (SCR) is 23.9 dB higher using the proposed method. By exploiting DMAS-D4 these benefits and potentially enhancing clinical decisions are attainable by the same computational load order as DAS. These results may be useful to inform future microwave breast imaging beamformer design.

Digital Breast Tomosynthesis and Digital Mammography Recall and False-Positive Rates by Time of Day and Reader Experience.

Background Digital breast tomosynthesis (DBT) image interpretation might be more cognitively demanding than interpretation of digital mammography (DM) images. The time of day of interpretation might affect recall and false-positive (FP) rates, especially for DBT. Purpose To determine whether recall and FP rates vary by time of day of interpretation for screening mammography for breast cancer performed with DM and DBT. Materials and Methods This is a retrospective study examining 97 671 screening mammograms interpreted by 18 radiologists between January 2018 and December 2019 at one of 12 community radiology sites. The association between the time of day of interpretation, the type of image interpreted (DM vs DBT), and radiologist experience (≤5 posttraining years vs >5 posttraining years) and the likelihood of a patient being recalled from screening mammography and the likelihood of whether the interpretation was FP or true positive were analyzed. Analyses were conducted using generalized linear mixed modeling with a binary distribution and sandwich estimation where observations were nested by radiologist. Results Screening mammograms interpreted by 18 radiologists were reviewed (40 220 DBTs, 57 451 DMs). Nine radiologists had 5 or fewer posttraining years of experience, and nine had more than 5 posttraining years of experience. The overall recall rates for DM (10.2%) and DBT (9.0%) were different (P = .006); FP rate also differed (9.8% DM, 8.6% DBT; P = .004). For radiologists with 5 or fewer posttraining years of experience, odds of recall increased 11.5% (odds ratio [OR] = 1.12, P = .01) with every hour when using DBT, but this was not found for DM (OR = 1.09, P = .06); DBT and DM were different (OR = 1.12 vs 1.09, P = .02). For radiologists with more than 5 posttraining years of experience, no evidence of increase in recall was observed for DBT (OR = 1.02, P = .27) or DM (OR = 1.0, P = .80), and there was no evidence that these were different (OR = 1.02 vs 1.0, P = .13). Conclusion Patients were more likely to be recalled when their screening digital breast tomosynthesis images were interpreted later in the day by less-experienced radiologists. © RSNA, 2022 Online supplemental material is available for this article.

Trends in incidence, molecular diagnostics, and treatment of patients with breast cancer in Kazakhstan, 2014-2019

Relevance: Globocan reported 4,390 new breast cancer cases and 1,654 deaths from breast cancer in the Republic of Kazakhstan (RK) in 2020. Molecular diagnostics of breast cancer includes the determination of Hormone Receptor (HR), HER2, and Ki-67 status to detect patients
 with HR-positive tumors and administer effective treatment.
 Methods: This observational study included a retrospective analysis of incidence, molecular diagnostics, and treatment regimens in women with a confirmed breast cancer diagnosis aged 18 years old and older, registered in the RK Electronic Registry of Cancer Patients (ERCP) from 1 January 2014 till 31 December 2019.
 Results: In the study period (2014 to 2019), the number of breast cancer cases registered annually has doubled. The incidence increased by 46.9%. The share of locally advanced and advanced forms of breast cancer has decreased. The proportion of Luminal type A (HR+/HER2-)
 among newly diagnosed patients ranged from 17.9% to 30%. Chemotherapy and endocrine therapy with goserelin, buserelin, leuprorelin, and fulvestrant are standard first- and second-line treatments for HR+ breast cancer. Since fulvestrant indications have been expanded, more
 than 50% of patients with HR-positive advanced breast cancer receive fulvestrant as the first-line therapy.
 Conclusion: Breast cancer incidence growth and a decrease in the share of locally advanced and advanced breast cancer cases in the RK could be attributed to increased coverage of eligible women aged 40 to 70 with breast cancer mammographic screening. Although international guidelines support the administration of hormone therapy with or without targeted therapy in women with HR-positive, HER2-metastatic breast cancer, upfront use of chemotherapy remains common in the RK even in the absence of visceral crisis. The use of CDK4/6 inhibitor palbociclib in combination with hormone therapy has become routinely available since 2019

Trends in incidence, molecular diagnostics, and treatment of patients with breast cancer in Kazakhstan, 2014-2019

Relevance: Globocan reported 4,390 new breast cancer cases and 1,654 deaths from breast cancer in the Republic of Kazakhstan (RK) in
 2020. Molecular diagnostics of breast cancer includes the determination of Hormone Receptor (HR), HER2, and Ki-67 status to detect patients
 with HR-positive tumors and administer effective treatment.
 Methods: This observational study included a retrospective analysis of incidence, molecular diagnostics, and treatment regimens in
 women with a confirmed breast cancer diagnosis aged 18 years old and older, registered in the RK Electronic Registry of Cancer Patients
 (ERCP) from 1 January 2014 till 31 December 2019.
 Results: In the study period (2014 to 2019), the number of breast cancer cases registered annually has doubled. The incidence increased
 by 46.9%. The share of locally advanced and advanced forms of breast cancer has decreased. The proportion of Luminal type A (HR+/HER2-)
 among newly diagnosed patients ranged from 17.9% to 30%. Chemotherapy and endocrine therapy with goserelin, buserelin, leuprorelin,
 and fulvestrant are standard first- and second-line treatments for HR+ breast cancer. Since fulvestrant indications have been expanded, more
 than 50% of patients with HR-positive advanced breast cancer receive fulvestrant as the first-line therapy.
 Conclusion: Breast cancer incidence growth and a decrease in the share of locally advanced and advanced breast cancer cases in the RK
 could be attributed to increased coverage of eligible women aged 40 to 70 with breast cancer mammographic screening. Although international guidelines support the administration of hormone therapy with or without targeted therapy in women with HR-positive, HER2-metastatic breast cancer, upfront use of chemotherapy remains common in the RK even in the absence of visceral crisis. The use of CDK4/6 inhibitor
 palbociclib in combination with hormone therapy has become routinely available since 2019.

Evaluation of the Knowledge Level of Family Medicine Residents about Mammography and Breast Cancer Screening Programs

Aim: It was aimed to evaluate the level of knowledge of family medicine residents about breast cancer screening program national standards and mammography. Methods: In this cross-sectional study, an online questionnaire was used to measure the knowledge level of family medicine resident doctors about breast cancer and mammography. In addition to demographic information, the questionnaire included questions about the diagnostic advantages of radiological breast imaging methods, the age of onset of breast cancer screening in different risk groups, and the national breast cancer screening program. The questionnaire, prepared through Google forms, was announced on social media channels used by family physicians and kept open for three months. Results: The mean age of 151 physicians was 30.4±4.3. 61.6% of the physicians were female and 38.4% were male. Only 11.9% (n=18) of the participants had previously attended a training/course on mammography. The mean correct answer score was 4.58±1.50 for 9 questions. The test scores of the residents who received specialized training in the education and research hospital were statistically significantly higher than those who received training in the university hospital (4.77±1.86 and 3.64±1.63). The mean score of residents who received previous mammography education was significantly higher than others. Conclusion: Awareness and knowledge levels of family medicine residents about breast cancer screening methods and programs should be increased with multidisciplinary training programs. Keywords: mammography, breast cancer, screening, family practice

Investigating attitudinal barriers to breast cancer mammography screening among women in Zabol city

Investigating attitudinal barriers to breast cancer mammography screening among women in Zabol city

Benefits and harms of annual, biennial, or triennial breast cancer mammography screening for women at average risk of breast cancer: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC)

BackgroundAlthough mammography screening is recommended in most European countries, the balance between the benefits and harms of different screening intervals is still a matter of debate. This review informed the European Commission Initiative on Breast Cancer (BC) recommendations.MethodsWe searched PubMed, EMBASE, and the Cochrane Library to identify RCTs, observational or modelling studies, comparing desirable (BC deaths averted, QALYs, BC stage, interval cancer) and undesirable (overdiagnosis, false positive related, radiation related) effects from annual, biennial, or triennial mammography screening in women of average risk for BC. We assessed the certainty of the evidence using the GRADE approach.ResultsWe included one RCT, 13 observational, and 11 modelling studies. In women 50–69, annual compared to biennial screening may have small additional benefits but an important increase in false positive results; triennial compared to biennial screening may have smaller benefits while avoiding some harms. In younger women (aged 45–49), annual compared to biennial screening had a smaller gain in benefits and larger harms, showing a less favourable balance in this age group than in women 50–69. In women 70–74, there were fewer additional harms and similar benefits with shorter screening intervals. The overall certainty of the evidence for each of these comparisons was very low.ConclusionsIn women of average BC risk, screening intervals have different trade-offs for each age group. The balance probably favours biennial screening in women 50–69. In younger women, annual screening may have a less favourable balance, while in women aged 70–74 years longer screening intervals may be more favourable.

ASO Visual Abstract: A Single Center Study of Adherence to Breast Cancer Screening Mammography Guidelines by Transgender and Non-Binary Patients

ASO Visual Abstract: A Single Center Study of Adherence to Breast Cancer Screening Mammography Guidelines by Transgender and Non-Binary Patients

Evaluation of Different Breast Cancer Screening Strategies for High-Risk Women in Beijing, China: A Real-World Population-Based Study.

BackgroundMammography-based breast cancer screening has been widely implemented in many developed countries. Evidence was needed on participation and diagnostic performance of population-based breast cancer screening using ultrasound in China.MethodsWe used data from the Cancer Screening Program in Urban China in Beijing from 2014 to 2019 and was followed up until July 2020 by matching with the Beijing Cancer Registry database. Eligible women between the ages of 45 and 69 years were recruited from six districts and assessed their risk of breast cancer through an established risk scoring system. Women evaluated to be at high risk of breast cancer were invited to undergo both ultrasound and mammography. Participation rates were calculated, and their associated factors were explored. In addition, the performance of five different breast cancer screening modalities was evaluated in this study.ResultsA total of 49,161 eligible women were recruited in this study. Among them, 15,550 women were assessed as high risk for breast cancer, and 7,500 women underwent ultrasound and/or mammography as recommended, with a participation rate of 48.2%. The sensitivity of mammography alone, ultrasound alone, combined of ultrasound and mammography, ultrasound for primary screening followed by mammography for triage, and mammography for preliminary screening followed by ultrasound for triage were19.2%, 38.5%, 50.0%, 46.2%, and 19.2%, and the specificity were 96.1%, 98.6%, 94.7%, 97.6%, 95.7%, respectively. The sensitivity of combined ultrasound and mammography, ultrasound for primary screening followed by mammography for triage, was significantly higher than mammography alone (p=0.008 and p=0.039). Additionally, ultrasound alone (48,323 RMB ($7,550)) and ultrasound for primary screening followed by mammography for triage (55,927 RMB ($8,739)) were the most cost-effective methods for breast cancer screening than other modalities.ConclusionsUltrasound alone and ultrasound for primary screening and mammography are superior to mammography for breast cancer screening in high-risk Chinese women.

A Single-Center Study of Adherence to Breast Cancer Screening Mammography Guidelines by Transgender and Non-Binary Patients.

Adherence to screening guidelines among transgender and non-binary (TGNB) populations is not well studied. This study examines breast cancer screening patterns among TGNB patients at an urban academic medical center. Demographic information, risk factors, and screening mammography were collected. Mammography rates were calculated in populations of interest according to national guidelines, and mammogram person-years were also calculated. Univariate and multivariate logistic regression was performed. Overall, 253 patients were analyzed: 193 transgender women and non-binary people designated male at birth (TGNB DMAB) and 60 transgender men and non-binary people designated female at birth (TGNB DFAB). The median (interquartile range) age was 53.2years (42.3-62.6). Most patients had no family history of breast cancer (n=163, 64.4%) and were on hormone therapy (n=191, 75.5%). Most patients where White (n=164, 64.8%), employed (n=113, 44.7%), and had public insurance (n=128, 50.6%). TGNB DFAB breast screening rates were low, ranging from 2.0 to 50.0%, as were TGNB DMAB screening rates, ranging from 7.1 to 47.6%. The screening rates among the TGNB DFAB and TGNB DMAB groups did not significantly differ from one another. Among TGNB DFAB patients, univariate analyses showed no significant predictors for mammography. Among TGNB DMAB patients, not being on hormone therapy resulted in fewer odds of undergoing mammography. There were no significant findings on multivariate analyses. Mammography rates in the TGNB population are lower than institutional and national rates for cisgender patients, which are 77.3% and 66.7-78.4%, respectively. Stage of transition, organs present, hormone therapy, and risk factors should be considered to guide screening.

Digital breast tomosynthesis (DBT) plus synthesised two-dimensional mammography (s2D) in breast cancer screening is associated with higher cancer detection and lower recalls compared to digital mammography (DM) alone: results of a systematic review and meta-analysis

ObjectivesDigital breast tomosynthesis (DBT) plus digital mammography (DM) in screening is problematic due to increased radiation by the double exposure. Synthesised two-dimensional mammography (s2D) calculated from DBT datasets at no additional dose appears a sensible alternative compared to adding DM. This systematic review and meta-analysis focuses on screening performance outcomes in women screened with DBT plus s2D compared to DM alone.MethodsPubMed was searched from January 1, 2010, to September 2, 2020. Studies comparing DBT plus s2D to DM alone in breast cancer screening were included. Pooled risk ratios (RR) were estimated for cancer detection rates (CDR), recall rates, interval cancer rates (ICR), biopsy rates, and positive predictive values for recalls (PPV-1), for biopsies recommended (PPV-2), and for biopsies performed (PPV-3). Sensitivity analyses were performed using the leave-one-out approach. Risk of bias (RoB) was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool.ResultsTwelve papers covering 414,281 women were included from 766 records identified. CDR is increased ([RR, 95% CI] 1.35, 1.20–1.52), recall rates are decreased (0.79, 0.64–0.98), and PPV-1 is increased (1.69, 1.45–1.96) when using DBT plus s2D compared to DM alone. ICR and biopsy rates did not differ, but PPV-2 respectively PPV-3 increased with DBT plus s2D (1.57, 1.08–2.28 respectively 1.36, 1.17–1.58). Overall RoB of studies was assessed to be low.ConclusionResults show improved diagnostic outcomes with DBT plus s2D compared to DM alone and underline the value of DBT in combination with s2D in breast cancer screening.Key Points• DBT plus s2D is associated with higher CDR, lower recall rates, and a higher PPV-1 compared to DM alone in breast cancer screening.• No differences in biopsy rates were found between screening modalities, but PPV-2 and PPV-3 were higher in women screened with DBT plus s2D compared to DM alone.• We identified inconsistent results of ICR in two studies comparing DBT plus s2D to DM alone—resulting in no differences when pooling ICR in meta-analysis.

Fully Automated Volumetric Breast Density Estimation from Digital Breast Tomosynthesis.

Background While digital breast tomosynthesis (DBT) is rapidly replacing digital mammography (DM) in breast cancer screening, the potential of DBT density measures for breast cancer risk assessment remains largely unexplored. Purpose To compare associations of breast density estimates from DBT and DM with breast cancer. Materials and Methods This retrospective case-control study used contralateral DM/DBT studies from women with unilateral breast cancer and age- and ethnicity-matched controls (September 19, 2011-January 6, 2015). Volumetric percent density (VPD%) was estimated from DBT using previously validated software. For comparison, the publicly available Laboratory for Individualized Breast Radiodensity Assessment software package, or LIBRA, was used to estimate area-based percent density (APD%) from raw and processed DM images. The commercial Quantra and Volpara software packages were applied to raw DM images to estimate VPD% with use of physics-based models. Density measures were compared by using Spearman correlation coefficients (r), and conditional logistic regression was performed to examine density associations (odds ratios [OR]) with breast cancer, adjusting for age and body mass index. Results A total of 132 women diagnosed with breast cancer (mean age ± standard deviation [SD], 60 years ± 11) and 528 controls (mean age, 60 years ± 11) were included. Moderate correlations between DBT and DM density measures (r = 0.32-0.75; all P < .001) were observed. Volumetric density estimates calculated from DBT (OR, 2.3 [95% CI: 1.6, 3.4] per SD for VPD%DBT) were more strongly associated with breast cancer than DM-derived density for both APD% (OR, 1.3 [95% CI: 0.9, 1.9] [P < .001] and 1.7 [95% CI: 1.2, 2.3] [P = .004] per SD for LIBRA raw and processed data, respectively) and VPD% (OR, 1.6 [95% CI: 1.1, 2.4] [P = .01] and 1.7 [95% CI: 1.2, 2.6] [P = .04] per SD for Volpara and Quantra, respectively). Conclusion The associations between quantitative breast density estimates and breast cancer risk are stronger for digital breast tomosynthesis compared with digital mammography. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Yaffe in this issue.

Assessing the Stress Echocardiography in Women With Breast Arterial Calcification.

Objective: breast arterial calcification (BAC) is one of the most prevalent mammographic findings and has been debated as a marker of cardiovascular disease (CVDs). The present study aimed to assess the findings of stress echo in women with BAC. Materials and methods: This cross-sectional study was conducted on women who undergo mammography for routine breast cancer screening at Imam Reza hospital, western Iran from March 2018 to July 2018. The patients underwent stress echocardiography to evaluate the probability of myocardial ischemia (MI). Chi-square and independent t-tests were used to assess the differences between subgroups. Results: BAC was present in 61 (15.2%) women. The mean age of the patients with BAC was significantly higher than the patients without BAC (58.59± 7.82 vs. 55.32±6.57, p =0.003). Prevalence rates of the menopause (88.5% vs. 71.1%, p=0.009), hypertension (29.5% vs. 17.7%, p=0.032), and hypercholesterolemia (24.6% vs. 13.0, p=0.018) were significantly higher in the patients with BAC compared to the patients without BAC. The prevalence rate of MI symptoms in the patients with BAC was equal to 24.6%. Significantly, more women with BAC were positive for myocardial ischemia compared to the women without BAC (24.6% vs. 8.5%, p<0.001). The prevalence rates of the diabetes mellitus, hypertension, hypercholesterolemia, and history of CVDs were significantly higher in the patients who were positive for MI. Conclusion: It was found that BACs are correlated with an increased occurrence rate of CVDs. Our results illustrated that the patients who were positive for MI were more plausible to be diabetic, hyperlipidemic, hypertensive, and having a history of CVDs.

Evaluation of Adjunctive Ultrasonography for Breast Cancer Detection Among Women Aged 40-49 Years With Varying Breast Density Undergoing Screening Mammography

Mammography has limited accuracy in breast cancer screening. Ultrasonography, when used in conjunction with mammography screening, is helpful to detect early-stage and invasive cancers for asymptomatic women with dense and nondense breasts. To evaluate the performance of adjunctive ultrasonography with mammography for breast cancer screening, according to differences in breast density. This study is a secondary analysis of the Japan Strategic Anti-cancer Randomized Trial. Between July 2007 and March 2011, asymptomatic women aged 40 to 49 years were enrolled in Japan. The present study used data from cases enrolled from the screening center in Miyagi prefecture during 2007 to 2020. Participants were randomly assigned in a 1:1 ratio to undergo either mammography with ultrasonography (intervention group) or mammography alone (control group). Data analysis was performed from February to March 2020. Ultrasonography adjunctive to mammography for breast cancer screening regardless of breast density. Sensitivity, specificity, recall rates, biopsy rates, and characteristics of screen-detected cancers and interval breast cancers were evaluated between study groups and for each modality according to breast density. A total of 76 119 women were enrolled, and data for 19 213 women (mean [SD] age, 44.5 [2.8] years) from the Miyagi prefecture were analyzed; 9705 were randomized to the intervention group and 9508 were randomized to the control group. A total of 11 390 women (59.3%) had heterogeneously or extremely dense breasts. Among the overall group, 130 cancers were found. Sensitivity was significantly higher in the intervention group than the control group (93.2% [95% CI, 87.4%-99.0%] vs 66.7% [95% CI, 54.4%-78.9%]; P < .001). Similar trends were observed in women with dense breasts (sensitivity in intervention vs control groups, 93.2% [95% CI, 85.7%-100.0%] vs 70.6% [95% CI, 55.3%-85.9%]; P < .001) and nondense breasts (sensitivity in intervention vs control groups, 93.1% [95% CI, 83.9%-102.3%] vs 60.9% [95% CI, 40.9%-80.8%]; P < .001). The rate of interval cancers per 1000 screenings was lower in the intervention group compared with the control group (0.5 cancers [95% CI, 0.1-1.0 cancers] vs 2.0 cancers [95% CI, 1.1-2.9 cancers]; P = .004). Within the intervention group, the rate of invasive cancers detected by ultrasonography alone was significantly higher than that for mammography alone in both dense (82.4% [95% CI, 56.6%-96.2%] vs 41.7% [95% CI, 15.2%-72.3%]; P = .02) and nondense (85.7% [95% CI, 42.1%-99.6%] vs 25.0% [95% CI, 5.5%-57.2%]; P = .02) breasts. However, sensitivity of mammography or ultrasonography alone did not exceed 80% across all breast densities in the 2 groups. Compared with the control group, specificity was significantly lower in the intervention group (91.8% [95% CI, 91.2%-92.3%] vs 86.8% [95% CI, 86.2%-87.5%]; P < .001). Recall rates (13.8% [95% CI, 13.1%-14.5%] vs 8.6% [95% CI, 8.0%-9.1%]; P < .001) and biopsy rates (5.5% [95% CI, 5.1%-6.0%] vs 2.1% [95% CI, 1.8%-2.4%]; P < .001) were significantly higher in the intervention group than the control group. In this secondary analysis of a randomized clinical trial, screening mammography alone demonstrated low sensitivity, whereas adjunctive ultrasonography was associated with increased sensitivity. These findings suggest that adjunctive ultrasonography has the potential to improve detection of early-stage and invasive cancers across both dense and nondense breasts. Supplemental ultrasonography should be considered as an appropriate imaging modality for breast cancer screening in asymptomatic women aged 40 to 49 years regardless of breast density. NIPH Clinical Trial Identifier: UMIN000000757.

A Mobile Health Breast Cancer Educational and Screening Intervention Tailored for Low-Income, Uninsured Latina Immigrants.

Objective: To investigate the efficacy of mobile health (mHealth) intervention strategies that delivered either personalized, culturally, and linguistically tailored cell phone voice messages or text messages related to breast cancer and prevention, compared to the control group, to determine which strategy is more likely to increase breast cancer knowledge and screening mammography among low-income Latina immigrants.Methods: This randomized controlled trial assigned 256 Latina immigrants 40 years of age or older to one of three groups: an automated cell phone voice message group, an automated text message group, or the control group (mail). The mHealth intervention employed a comprehensive approach that included breast cancer and prevention education and free mammography screening. Outcome measures included knowledge of breast cancer and breast cancer prevention, and adherence to screening mammography.Results: There was a general increase in breast cancer knowledge after the educational intervention for all the groups [p = 0.01, t(199) = 3.996]. Knowledge increase and mammography adherence did not differ based on group.Conclusion: More important than the actual method of communication is how breast cancer and prevention messages are constructed, who the messenger is, and the enabling factors that facilitate screening adherence. A breast cancer preventive intervention program that is personalized, culturally and linguistically tailored, and offers a free or low-cost mammogram holds promise to be an effective method in reaching an underserved Latina population with a high breast cancer burden.

Cost-Sharing and Out-of-Pocket Cost for Women Who Received MRI for Breast Cancer Screening.

The financial protection of the prevention provision of the Affordable Care Act (ACA) doesn't apply to breast MRI but only to mammography for breast cancer screening. The purpose of the study is to examine the financial burden among women who received breast magnetic resonance imaging (MRI) for screening. This observational study used the Marketscan database. Women who underwent breast MRI between 2009 and 2017 and had screening mammography within 6 months of the MRI were included. We compared the time trend of the proportion of zero cost-share for women undergoing screening mammography and that for MRI. We quantified out-of-pocket (OOP) costs as the sum of copayment, coinsurance, and deductible and defined zero cost-share as having no OOP cost. We conducted multivariable logistic regression and 2-part model to examine factors associated with zero cost-share and OOP costs of MRI, respectively. During the study period, 16 341 women had a screening breast MRI. The proportion of screening MRI claims with zero cost-share decreased from 43.1% (2009) to 26.2% (2017). The adjusted mean OOP cost for women in high-deductible plans was more than twice the cost for their counterparts ($549 vs $251; 2-sided P < .001). Women who resided in the South in the post-Affordable Care Act era were less likely to have zero cost-share and paid higher OOP costs for screening MRI. Many women are subject to high financial burden when receiving MRI for breast cancer screening. Those enrolled in high-deductible plans and who reside in the South are especially vulnerable financially.