Mammography Guidelines Research Articles

Cancer Screening Experiences of Black Breast and Ovarian Cancer Patients and Family Members.

Black women experience disproportionate rates of advanced breast cancer diagnoses and mortality. Mammography is a proven and effective tool in early breast cancer detection and impacts patient outcomes. We interviewed Black women with a personal or family history of breast and/or ovarian cancer to understand their screening experiences and views. N = 61 individuals completed an interview. Interview transcripts were qualitatively analyzed for themes regarding clinical experiences, guideline adherence, and family sharing specific to Black women and their families. Most participants were college educated with active health insurance. Women in this cohort were knowledgeable about the benefits of mammography and described few barriers to adhering to annual mammogram guidelines. Some with first-degree family history were frustrated at insurance barriers to mammography before the age of 40. Participants were generally comfortable encouraging family and friends to receive mammograms and expressed a desire for a similar screening tool for ovarian cancer. However, they expressed concern that factors such as screening awareness and education, lack of insurance coverage, and other systematic barriers might prevent other Black women from receiving regular screening. Black women in this cohort reported high adherence to mammography guidelines, but expressed concern about cultural and financial barriers that may impact cancer screening access in the population more generally and contribute to disparities. Participants noted the importance of frank and open discussions of breast cancer screening in their families and community as a means of improving awareness.

Surveillance Mammography Behaviors in Black and White Breast Cancer Survivors: Behavioral Risk Factors and Surveillance System, 2016

BackgroundSurveillance mammography is recommended annually for early detection of disease relapse among breast cancer survivors; yet Black women have poorer national rates of surveillance mammography compared to White women. Factors that influence racial disparities in surveillance mammography rates are poorly understood. The purpose of this study is to evaluate the contribution of health care access, socioeconomic status, and perceived health status on adherence to surveillance mammography among breast cancer survivors.MethodsThis is a secondary analysis of a cross-sectional survey among Black and White women ≥ 18 years, who reported a breast cancer diagnosis and completed breast surgery and adjuvant treatment from the 2016 Behavioral Risk Factor Surveillance System National Survey (BRFSS). Bivariate associations (chi-squared, t-test) for independent variables (e.g., health insurance, marital status) were analyzed with adherence to nationally recommended surveillance guidelines defined as two levels: adherent (received a mammogram in the last 12 months), vs. non- adherent (“received a mammogram in the last 2–5 years, 5 or more years or unsure). Multivariable logistic regression models were used to evaluate the relationship between study variables with adherence, while adjusting for potential confounders.ResultsOf 963 breast cancer survivors, 91.7% were White women with an average age of 65. 71.7% reported a surveillance mammogram in the last 12 months, while 28.2% did not. Diagnosed > 5 years (p < 0.001); not having a routine checkup visit within 12 months (p = 0.045); and not seeing a doctor when needed due to cost (p = 0.026), were significantly related to survivor’s non-adherence to surveillance mammography guidelines. A significant interaction was found between race and residential area (p < 0.001). Compared to White women, Black women living in metropolitan/suburban residential areas were more likely to receive surveillance guidelines (OR:3.77;95% CI: 1.32–10.81); however Black women living in non-metropolitan areas were less likely to receive a surveillance mammogram compared to White women living in non-metropolitan areas (OR: 0.04; 95% CI: 0.00–0.50).ConclusionFindings from our study further explain the impact of socioeconomic disparities on racial differences in the use of surveillance mammography among breast cancer survivors. Black women living in non-metropolitan counties are an important subgroup for future research and screening and navigation interventions.

Spillover After Mammography Guideline Change: Evidence From State-Level Trends

Changes to which age groups are recommended for mammography may have affected screening rates for all women. This spillover effect has not previously been shown empirically in a national sample. Using data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System from 2002 to 2018, authors tested whether screening trends at a national level changed after the 2009 U.S. Preventive Services Task Force guideline change. The authors also tested whether state-level screening trends for women aged 40-49 years and 75+ years were associated with screening trends for women aged 50-74 years. Analyses were conducted in March-December 2022. In a model predicting state-level trends in screening for women aged 50-74 years, authors find positive, statistically significant associations with screening trends for women aged 40-49 years (p=0.033) and for women aged 75+ years (p<0.001). Deimplementation is difficult and important for controlling healthcare spending and delivering high value care. However, states most successful at reducing mammography screening rates among those aged 40-49 years and 75+ years also had greater reductions in recommended screening among women aged 50-74 years. More work is needed to understand and mitigate the unintended consequences of deimplementation.

Behaviour within a Clinical Trial and Implications for Mammography Guidelines.

Mammography guidelines have weakened in response to evidence that mammograms diagnose breast cancers that would never eventually cause symptoms, a phenomenon called "overdiagnosis." Given concerns about overdiagnosis, instead of recommending mammograms, US guidelines encourage women aged 40-49 to get them as they see fit. To assess whether these guidelines target women effectively, I propose an approach that examines mammography behavior within an influential clinical trial that followed participants long enough to find overdiagnosis. I find that women who are more likely to receive mammograms are healthier and have higher socioeconomic status. More importantly, I find that the 20-year level of overdiagnosis is at least 3.5 times higher among women who are most likely to receive mammograms. At least 36% of their cancers are overdiagnosed. These findings imply that US guidelines encourage mammograms among healthier women who are more likely to be overdiagnosed by them. Guidelines in other countries do not.

The effect of emotional disorders on adherence to mammography screening guidelines.

Depression, anxiety, and other emotional disorders are highly prevalent; however, the impact of these on adherence to mammography screening guidelines remains unclear. We sought to determine the effect of feeling limited by emotional disorders on adherence to mammographic screening guidelines. Data from the 2018 National Health Interview Survey were used to evaluate whether women aged 50-74 who felt limited in some way by an emotional issue (EI; defined as depression, anxiety, or another emotional problem) were less likely to report having had a mammogram within the past two years than those who reported no such limitation. Of the 5815 women surveyed, 3.25% stated that they were limited in some way by EI. These women were significantly less likely to report having had a mammogram within the past two years compared to those without EI (68.28% vs. 79.36%, p = 0.002). Controlling for sociodemographic factors, EI no longer predicted worse mammography screening adherence (OR = 0.78; 95% CI: 0.54-1.12, p = 0.182). Rather, family income relative to poverty level, health insurance coverage, and having a usual place of healthcare were independent predictors of adherence to screening mammography guidelines. Women who feel limited by an EI tend to have lower mammography screening rates than those without such limitations; however, this isdriven primarily by socioeconomic factors such as income, insurance status, and access to healthcare.

Emerging From Behind the Workstation.

Emerging From Behind the Workstation.

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

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.

MAMMO_QC: Free software for quality control (QC) analysis in digital mammography and digital breast tomosynthesis compliant with the European guidelines and EUREF/EFOMP protocols

Quality Control (QC) tests in mammography are very important, since mammograms have been used as a population-based screening test for more than 30 years and QCs lead to better image quality and radiation safety for patients. European guidelines, EUREF and EFOMP protocols provide comprehensive QC guidelines for digital mammography (DM) and digital breast tomosynthesis (DBT) units, respectively. We developed a novel, fast, free and platform independent software (named MAMMO_QC) for QC performance tests in DM and tomosynthesis, based on the aforementioned guidelines. MAMMO_QC consists of a series of ImageJ plugins for DM and DBT. It does not require any programming knowledge and can be used to evaluate several performance parameters, such as pre-sampled modulation transfer function (pMTF), normalised noise power spectrum (NNPS), detective quantum efficiency (DQE), contrast-detail analysis based on the CDMAM 3.4 and 4.0 test tools, homogeneity and artefacts, automatic exposure control (AEC) performance. The user can use MAMMO_QC for acceptance, commissioning and routine QC performance analysis based on the European guidelines. We validated our results against well-established software products used in mammography and DBT (i.e., COQ, OBJ_IQ_reduced and Artinis CDMAM Analyzer). All the average relative differences were within 5.5%, and several years of usage and testing allows us to consider MAMMO_QC as an accurate and reliable tool for QC on DM and DBT systems. Our developed software for DM and DBT computes almost all the parameters stated in the European, EUREF and EFOMP guidelines. To the best of our knowledge, no such software has been developed so far.

Identifying Equitable Screening Mammography Strategies for Black Women in the United States Using Simulation Modeling.

Screening mammography guidelines do not explicitly consider racial differences in breast cancer epidemiology, treatment, and survival. To compare tradeoffs of screening strategies in Black women versus White women under current guidelines. An established model from the Cancer Intervention and Surveillance Modeling Network simulated screening outcomes using race-specific inputs for subtype distribution; breast density; mammography performance; age-, stage-, and subtype-specific treatment effects; and non-breast cancer mortality. United States. A 1980 U.S. birth cohort of Black and White women. Screening strategies until age 74 years with varying initiation ages and intervals. Outcomes included benefits (life-years gained [LYG], breast cancer deaths averted, and mortality reduction), harms (mammographies, false positives, and overdiagnoses), and benefit-harm ratios (tradeoffs) by race. Efficiency (benefits per unit resource), mortality disparity reduction, and equity in tradeoffs were evaluated. Equitable strategies for Black women were defined as those with tradeoffs closest to benchmark values for screening White women biennially from ages 50 to 74 years. Biennial screening from ages 45 to 74 years was most efficient for Black women, whereas biennial screening from ages 40 to 74 years was most equitable. Initiating screening 10 years earlier in Black versus White women reduced Black-White mortality disparities by 57% with similar LYG per mammogram for both populations. Selection of the most equitable strategy was sensitive to assumptions about disparities in real-world treatment effectiveness: The less effective treatment was for Black women, the more intensively Black women could be screened before tradeoffs fell short of those experienced by White women. Single model. Initiating biennial screening in Black women at age 40 years reduces breast cancer mortality disparities and yields benefit-harm ratios that are similar to tradeoffs of White women screened biennially from ages 50 to 74 years. National Cancer Institute at the National Institutes of Health.

Differential effects of the 2015 American Cancer Society guidelines on screening mammography exams based on socioeconomic status.

10539 Background: Guidelines for screening mammography have changed several times since initiation of regular screening mammography in the 1970’s. Most recently, in 2015, the American Cancer Society (ACS) revised their screening guidelines, recommending that a patient discuss screening mammography with her primary care doctor (PCP) between the ages of 40-44 and should begin yearly screening at age 45; after age 54, ACS recommended screening every other year. Prior to this, from 2003-2015, ACS had recommended screening mammography every year beginning at the age of 40. We hypothesized that these guidelines were adopted to varying degrees in different patient populations and may have disproportionately reduced screening mammography utilization in socioeconomically disadvantaged populations. Methods: Here, we analyzed monthly screening mammography rates over time in two large New York City hospitals, one in a socioeconomically advantaged area and the other in a socioeconomically disadvantaged area. Using our radiology records query system, we searched for monthly screening mammography numbers for women by decade from 2012 to 2018. We performed statistical analysis to evaluate changes in number of exams over time. Student’s t-tests were used to evaluate for significant differences. Results: In both groups of 40-49 year old patients, monthly mammograms increased from 2012-2016. In the socioeconomically advantaged group, this increase continued until 2018 resulting in an overall 400% increase in screening mammograms over time. The change in ACS screening guidelines had no effect on the rate of screening mammography in this group. Conversely, after the revision of the ACS guidelines in 2015, there was a marked decline in screening mammography in the 40-49 year old group in the socioeconomically disadvantaged population. By 2018, there was a statistically significant difference in women screened in all age groups (40-49, p&lt;.0001; 50-59, p&lt;.0001; 60-69, p&lt;.01; 70-79, p&lt;.0001; 80+, p&lt;.0001) between these two patient populations. Conclusions: These data suggest that implementation of the 2015 ACS screening guidelines had a disproportionate effect on patients from socioeconomically disadvantaged areas and that these effects have led to significant disparities in screening mammography trends over time. We postulate that lower levels of health literacy may have contributed to misunderstanding of the screening guidelines. More research is needed to elucidate the underlying etiology of these disparities and ensure that women from all socioeconomic backgrounds receive appropriate screening mammography. Over time, this may result in disproportionate breast cancer morbidity and mortality in populations not receiving appropriate screening.

Mammograms and Mortality: How Has the Evidence Evolved?

Decades of evidence reveal a complicated relationship between mammograms and mortality. Mammograms may detect deadly cancers early, but they may also lead to the diagnosis and potentially fatal treatment of cancers that would never progress to cause symptoms. I provide a brief history of the evidence on mammograms and mortality, focusing on evidence from clinical trials, and I discuss how this evidence informs mammography guidelines. I then explore the evolution of all-cause mortality relative to breast cancer mortality within an influential clinical trial. I conclude with some responses to the evolving evidence.

Call to action: breast cancer screening recommendations for Black women.

African-American/Black women have more aggressive breast cancer subtypes, are diagnosed at younger ages, and have an increasing incidence rate. These disparities have resulted in Black women continuing to experience the highest mortality rate from breast cancer of any US racial or ethnic group. However, national screening mammography guidelines do not reflect the high-risk status of Black women. Here we review breast cancer screening guidelines and address the lack of inclusion of the specific needs of Black women. In order to equitably care for the health needs of Black women, high-risk designation would improve access to earlier screening and supplemental imaging including breast MRI.

Functional Limitations and Barriers to Care Influence the Likelihood of Adherence to Mammography Guideline.

Objective: In this study, we examined the influence of having a functional limitation (FL) on the likelihood of adherence to mammography guidelines, as well as the potential moderating role of barriers to care on this relationship. Methods: Women aged 50-75 years from the 2017 National Health Interview Survey were assessed for FL and barriers to care as predictors mammography screening prevalence using weighted logistic regression. Results: Of 5627 women, most were without FLs (56%), Caucasian (81%), with at least a high school education (62%), married (63%), had a usual source of care (97%), and reported barriers to care (9%). Compared to women without FLs, those with FLs were less likely to adhere to mammography guidelines in the past year. Endorsement of the items, Could not get through on the phone, Not open when you could go, and No transportation negatively moderated this association (adjusted odds ratio (AOR) = 0.60, 95% Cl [0.59, 0.60], AOR = 0.54, 95% Cl [0.54, 0.55], and AOR = 0.32, 95% [0.31, 0.33], respectively). Conclusions: Improving the ability of women with FLs to schedule appointments that will suit their functional needs within universal design guidelines may improve compliance.

Abstract PO-240: The effect of emotional disorders on adherence to mammography screening guidelines

Abstract INTRODUCTION: Approximately 18 million adults in the US experience a major depressive episode and 48 million report having some anxiety disorder each year. While some studies have found having an emotional disorder to be correlated with lower rates of screening mammography, this is not a consistent finding. We sought to determine whether women who felt limited by such disorders had lower mammography guideline compliance rates compared to women who did not, in a population-based study. METHODS: The National Health Interview Survey is a population-based survey administered annually by the Centers for Disease Control and is designed to be representative of the entire US civilian non-institutionalized population. We defined “emotional disorders” (EMD) as occurring in individuals who felt that they were limited in some way by depression, anxiety or another emotional problem. Women between the ages of 50 and 74, with and without EMD, were compared in terms of their adherence to screening guidelines, defined as having had a mammogram within the past two years, controlling for sociodemographic factors. RESULTS: In 2018, of the 5815 women surveyed who met our inclusion criteria (representing 48,522,391 women in the population), 3.25% stated that they were limited in some way by emotional issues. Of these, 68.28% stated they had a mammogram within the past two years; compared to 79.36% of women without EMD (p=0.002). Compared to those with no EMD, women with EMD tended to have lower education levels (less than grade 12: 19.51% vs 11.22%, p&amp;lt;0.001), lower family income (above four times the poverty threshold: 15.31% vs 44.74%, p&amp;lt;0.001) and less private insurance coverage (16.48% vs 55.93%, p&amp;lt;0.001). However, those with EMD were more likely to report having a usual place to go when sick than those without EMD (90.65% vs. 86.23%, p=0.003). Compliance with mammography screening was similarly influenced by these factors (p&amp;lt;0.001 for all). Controlling for these potential confounders, we found that EMD was no longer a significant predictor of mammography screening adherence (OR=0.77; 95% CI: 0.48-1.22, p=0.131). Rather, having a family income four times the poverty line or greater (OR=1.75; 95% CI: 1.29-2.37, p=0.001), having a usual place of healthcare (OR=2.67; 95% CI: 1.92-3.71, p&amp;lt;0.001), and insurance coverage (OR=1.65; 95% CI: 1.17-2.35, p=0.005 for governmental insurance, and OR=1.74; 95% CI: 1.21-2.51, p=0.003 for private insurance, vs. uninsured) were significant independent predictors of adherence to screening mammography guidelines. CONCLUSION: While EMD is correlated with lower mammography screening rates, adherence to screening mammography guidelines are driven primarily by socioeconomic factors such as income, insurance status, and access to healthcare. There is a need for policy level changes that target these modifiable issues for those who are medically underserved, including those with EMD who are more likely to have a family income that is below the poverty line. Citation Format: Idil Yazgan, Anees Chagpar. The effect of emotional disorders on adherence to mammography screening guidelines [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-240.

Abstract B108: Using patient navigation to inform determinants of breast cancer disparities among under-resourced women in Chicago

Abstract Background: Under-resourced women are subject to many factors that increase their risk of morbidity and mortality from breast cancer, such as being uninsured or underinsured and not having a medical home or primary care provider. They may also lack additional resources to access care such as transportation. Due to variance in mammography recommendations among health organizations, lack of knowledge or confusion about when to receive screening also poses a challenge to both women and providers. Objective: A partnership between University of Illinois (UI) Cancer Center, UI Hospital &amp; Health System, and Chicago Department of Public Health was developed to initiate an implementation science program that aims to mitigate these barriers by providing free breast cancer screening services and patient navigation to under-resourced women at our Mile Square Federally Qualified Health Centers (FQHCs). The program also aims to increase community partnerships to extend community outreach and identify factors that facilitate or challenge women's access to breast care services. Methods: Breast health screening and navigation services are offered at 5 Mile Square FQHC clinics and through “mammography party” events with community partners. Navigators facilitate women's care through screening and any follow-up services, link patients to additional resources, and provide breast health education. Data obtained through electronic medical records and direct correspondence with women and providers are managed securely in REDCap and analyzed with SPSS software. A program evaluation will be implemented in September 2018. Program activities are ongoing. Results: Four hundred ten women completed a screening mammogram from August 1, 2017 to June 30, 2018. Ninety-seven percent of women were racial minorities, most of whom were Latina (60.2%), African American (31.5%) and uninsured (67.8%). Among this cohort of women, the recall rate (24.6%) and cancer detection rate (17 per 1000) exceeded Breast Cancer Surveillance Consortium 2013 recall and cancer detection rate benchmarks (11.5% and 4.8 per 1000, respectively). Ages of women diagnosed (n=7) ranged from 40 to 68 years. The majority of diagnosed women were uninsured (n=6), 4 of whom were not eligible for health insurance. Conclusion: Patient navigation has proven to be effective in increasing breast cancer screening rates, access to care and resources, and disseminating breast health education; however, systematic barriers to care still persist. Although the Affordable Care Act has been instrumental in increasing the number of insured Americans, health care costs still pose a significant challenge for those who are underinsured or not eligible to be insured. Additionally, our data imply that some recommended guidelines for mammography may not address the screening needs for women who are at higher risk for breast cancer, and more personalized screening based on a woman's individual risk factors may be instrumental in ameliorating breast cancer disparities. Citation Format: Vida Henderson, Karriem Watson, Kathy Tossas-Milligan, Erica Martinez, Mariela Rodriguez, Barbara Williams, Paola Torres, Lisa Aponte-Soto, Robert Winn. Using patient navigation to inform determinants of breast cancer disparities among under-resourced women in Chicago [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B108.

Women's views about breast cancer prevention at mammography screening units and well women's clinics.

Women attending mammography screening units (msus) and well women's clinics (wwcs) represent a motivated cohort likely to engage in interventions aimed at primary breast cancer (bca) prevention. We used a feasibility questionnaire distributed to women (40-49 or 50-74 years of age) attending msus and wwcs in Halifax, Nova Scotia, to examine■ women's views about bca primary prevention and sources of health care information,■ prevalence of lifestyle-related bca risk factors, and■ predictors of prior mammography encounters within provincial screening guidelines.Variables examined included personal profiling, comorbidities, prior mammography uptake, lifestyle behaviours, socioeconomic status, health information sources, and willingness to discuss or implement lifestyle modifications, or endocrine therapy, or both. A logistic regression analysis examined associations with prior mammography encounters. Of the 244 responses obtained during 1.5 months from women aged 40-49 years (n = 75) and 50-74 years (n = 169), 56% and 75% respectively sought or would prefer to receive health information from within, as opposed to outside, health care. Lifestyle-related bca risk factors were prevalent, and most women were willing to discuss or implement lifestyle modifications (93%) or endocrine therapy (67%). Of the two age groups, 49% and 93% respectively had previously undergone mammography within guidelines. Increasing age and marital status (single, separated, or divorced vs. married or partnered) were independent predictors of prior mammography encounters within guidelines for women 40-49 years of age; no independent predictors were observed in the older age group. Women attending msus and wwcs seem to largely adhere to mammography guidelines and appear motivated to engage in bca primary prevention strategies, including lifestyle modifications and endocrine therapy. Women's views as observed in this study provide a rationale for the potential incorporation of bca risk assessment within the "mammogram point of care" to engage motivated women in bca primary prevention strategies.

Using Facebook Live to Advocate Breast Cancer Screening.

With current conflicting and confusing screening mammography guidelines between major medical organizations, radiologists have an opportunity to educate and advocate for patients using the power of social media. The authors provide a brief overview on the impact of social media in radiology, in particular Facebook, as well as challenges encountered by radiologists as they establish an online presence, and how to effectively use Facebook Live to advocate for screening mammography.

Radiographic Surveillance of Patients with Non-BRCA1/2 Pathogenic Variants.

The National Comprehensive Cancer Network (NCCN) developed clinical practice guidelines for germline pathogenic variants in highly penetrant genes, such asTP53andPTEN, and in moderately penetrant genes, such asCHEK2, ATM andPALB2. Whether the practice of radiographic surveillance of patients with pathogenic variants in genes other than BRCA1/2 complies with current NCCN guidelines remains unclear. Retrospective review of patients identified with pathogenic variants in genes other than BRCA1/2 from 2007 through 2017 to determine if radiographic surveillance was in accordance with NCCN guidelines for mammography and consideration of magnetic resonance imaging (MRI). Exclusions included variants of unknown significance, pathogenic variants not associated with an increased risk of breast cancer, and previous breast cancer diagnosis. After exclusions, 35 patients with pathogenic variants in ATM, CDH1, CHEK2, NBN, PALB2, PTEN, and STK11 genes were reviewed to assess whether radiographic surveillance was in accordance with NCCN guidelines. Guidelines for those with variants in ATM, CHEK2 and NBN includes annual mammography with tomosynthesis and consideration of breast MRI at age 40, variants in CDH1 and PALB2 at age 30, variants in PTEN at age 30-35 or 5-10 years before the earliest family breast cancer, and variants in STK11 at age 25. Of these 35 patients, 11 (31%) received mammography only; 11 (31%) received mammography and MRI, and 13 (37%) received no radiographic surveillance. Two of the 35 (6%) patients who received radiographic surveillance were diagnosed with ductal carcinoma in situ or invasive breast cancer. Thirty-one percent of patients with pathogenic variants in genes other than BRCA1/2 received both mammography and MRI. Thirty-seven percent of patients with these highly penetrant and moderately penetrant genes received no radiographic follow-up, clearly demonstrating an opportunity for improvement.

Examining Breast Cancer Screening Behavior Among Southern Black Women After the 2009 US Preventive Services Task Force Mammography Guideline Revisions.

Updated United States Preventive Services Task Force (USPSTF) and American Cancer Society mammography screening recommendations push for increased age of initiation and lengthened breast cancer screening intervals. These changes have implications for the reduction of breast cancer mortality in Black women. The purpose of this study was to examine breast cancer screening behavior in a cohort of Southern Black women after the release of the 2009 USPSTF recommendations. Surveys assessing cancer screening information were collected from members of Black churches between 2006 and 2013. The sample was restricted to women aged 40 to 74years, who did not report a breast cancer diagnosis, or a recent diagnostic mammogram (n = 789). Percentages of women ever completing a mammogram (age 40-49) and annual mammography (age 50-74) in 2006-2009 and 2010-2013 were compared using chi-square statistics. Logistic regression models were fit to determine the predictors of adherence to pre-2010 screening guidelines. No significant changes in mammography rates were found for women in the 40-49 age group (X2 = 0.42, p = 0.52) nor for those in the 50-74 age group (X2 = 0.67, p = 0.41). Completing an annual clinical breast exam was a significant predictor of adherence to pre-2010 screening guidelines for both age groups (OR 19.86 and OR 33.27 respectively) and participation in education sessions (OR 4.26). Stability in mammography behavior may be a result of PCP's advice, or community activities grounded pre-2010 screening recommendations. More research is needed to understand how clinical interactions and community-based efforts shape Black women's screening knowledge and practices.