Mammography History Research Articles

Abstract PO1-09-08: Mammography adherence modifies the relationship between multilevel social deprivation and tumor characteristics in the Carolina Breast Cancer Study

Abstract Objective: To describe associations of individual and community socioeconomic status (SES) with breast cancer tumor and treatment characteristics, and to assess potential modification by mammography receipt. Methods: The Carolina Breast Cancer Study is a population-based cohort of women diagnosed with breast cancer between 2008 and 2013. We restricted this analysis to participants with stage 1-3 cancer (n=2,841). Socio-demographic information was obtained during in-home study interviews, and tumor characteristics were obtained from medical records and pathology reports. Community characteristics were obtained from American Community Survey census-tract level data. SES subgroups were identified using latent class analysis, a method for identifying group membership based on multiple shared characteristics. This was done separately using individual data (e.g. household income) and census-tract level data (e.g. poverty rate). We reported prevalence differences (PDs) and 95% CIs for each outcome. Finally, analyses were repeated with stratification by race (Black/non-Black) and receipt of at least one mammogram every 2 years (yes/no), based on self-reported mammography history. Results: Based on the latent class models, participants were sorted into 4 groups based on their individual/community SES: “high/high”, “high/low”, “low/high”, and “low/low”. Black women made up 81% of the low/low group compared to 26% of the high/high. All high individual-SES participants were combined as one referent group because they had similar clinical characteristics regardless of community status. We found that participants with low/low SES had more aggressive tumor characteristics at diagnosis compared to the referent group, such as stage 3 cancer (PD = 5.7%, 2.4-9.0), grade 3 tumor (PD = 9.9%, 5.3-14.4), and triple negative breast cancer (PD = 5.8%, 2.4-9.1). Low/low participants were also more likely to have an interval of at least 30 days between diagnosis and treatment (PD = 4.6%, 0.2-9.0). However, none of these associations were significant for low/high women. When reported separately by race, Black women with low/low SES had greater frequency of stage 3 cancer (PD = 6.3, 1.9-10.8) and prolonged treatment length (PD = 7.5%, 1.1-13.8) compared to high-SES Black women. Race-stratified SES differences were non-significant for genomic subtype and other tumor characteristics like grade and tumor size. After stratifying by screening status, we found that associations of SES with stage and tumor size were only present among those with < 1 mammogram every 2 years. The low/low PDs were (7.9%, 1.5-14.3) for stage 3 and (7.8%, 2.2-13.3) for tumor size >5 cm. Low/low women also had greater frequency of lump detected cancer (PD = 12.6%, 4.0-21.2). In contrast, these associations were not present among women with biannual mammography. Finally, screening status did not modify PDs for genomic subtype (ER+/HER2-, ER-/HER2+, TNBC). Conclusions: Lower community-level SES is associated with less favorable tumor characteristics at diagnosis, mainly among those with low individual SES. Access to mammography may explain part of the disparity in stage and tumor size, suggesting public health benefit for targeted screening initiatives in disadvantaged communities. Still, screening and SES are only 2 mechanisms that contribute to racial disparities; our future work will explore additional intervention points. Demographic and clinical characteristics of CBCS participants by individual and community socioeconomic status (n=2,841) SES groups were derived from latent class models. P-values were assessed by chi-square tests. Participants with race classified as “other” includes all those not identifying as Black or White, including American Indian/Alaska Native, Asian, or another race not listed on the questionnaire. Urbanicity is defined at the census tract-level Citation Format: Matthew Dunn, Marc Emerson, Louise Henderson, Katherine Reeder-Hayes, Terry Hyslop, Melissa Troester. Mammography adherence modifies the relationship between multilevel social deprivation and tumor characteristics in the Carolina Breast Cancer Study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-09-08.

Abstract 798: Increasing breast cancer incidence across generation status in Mexican American women: The Multiethnic Cohort

Abstract Background: Breast cancer (BC) is the most commonly diagnosed cancer among Latino women in the US. Compared to foreign-born Latino women, US-born Latino women have a higher incidence of BC. While prior studies have suggested this difference in incidence may be explained by risk factors such as unhealthy lifestyle behaviors, reproductive history, and neighborhood socioeconomic status, it is unclear how the risk of BC has changed over generations among Latinos women. In this study, we investigated the association between generational status and BC incidence among Mexican American women within the Multiethnic Cohort (MEC). Methods: The study population included 15,303 self-reported Mexican Americans from the MEC. Generational status was categorized as: 1st generation (Mexico-born, n = 6,347), 2nd generation (US-born with one or two parents born in Mexico, n = 6,390), or 3rd generation (US-born with both parents born in the US, n = 2,566). Multivariable Cox models were used to calculate the hazard ratios (HR) and 95% confidence intervals (CI) of BC incidence by generational status. All models were adjusted for relevant risk factors including age, physical activity, smoking, alcohol intake, education, body mass index, diet, family history of BC, menopausal status, age at menarche, parity, mammography history, hormone use, neighborhood socioeconomic status, and Hispanic ethnic enclave. Results: During an average 21.5-year follow-up, 815 incident BC cases were identified. The age-adjusted incidence rate (per 100,000) of BC increased by generation (1st: 191.9; 2nd: 265.3; 3rd: 284.0). Third (70.4%) and 2nd (66.5%) generations had a larger proportion of localized disease at diagnosis compared to 1st generation women (59.7%). Compared to 1st generation Mexican Americans, 2nd (HR = 1.24; 95% CI: 1.03-1.49) and 3rd generation (HR = 1.28; 95% CI: 1.02-1.60) had elevated risks of BC (p-trend: 0.02) The positive association with generational status remained significant when restricting to women who reported mammogram use (HR 2nd vs. 1st = 1.27, 95% CI: 1.04-1.55; HR 3rd vs. 1st = 1.34, 95% CI: 1.06-1.70) (p-trend: 0.01). Conclusions: Our findings suggest that generational status among Mexican American women is associated with risk of BC, after adjusting for sociodemographic, lifestyle, neighborhood, and reproductive risk factors. Further studies are warranted to discover the potential factors that contribute to this increased risk and elucidate the underlying etiology. Citation Format: Xinman Zhang, Iona Cheng, Adelynn Paik, Brian Huang, Veronica Wendy Setiawan. Increasing breast cancer incidence across generation status in Mexican American women: The Multiethnic Cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 798.

Breast Cancer Risk Perceptions Among Underserved, Hispanic Women: Implications for Risk-Based Approaches to Screening.

Understanding factors that shape breast cancer risk perceptions is essential for implementing risk-based approaches to breast cancer detection and prevention. This study aimed to assess multilevel factors, including prior screening behavior, shaping underserved, Hispanic women's perceived risk for breast cancer. Secondary analysis of survey data from Hispanic women (N = 1325, 92% Spanish speaking, 64% < 50) enrolled in a large randomized controlled trial. Analyses were performed in two cohorts to account for the role of age on screening guideline recommendations (< 50 and 50 +). For each cohort, we examined differences in three common measures of perceived risk of breast cancer (percent lifetime, ordinal lifetime, comparative) by participant factors with chi-square or Kruskal-Wallis tests, as appropriate. Multivariate analyses examined the association between mammography history with percent perceived lifetime risk (outcome > 10 vs ≤ 10%). Overall, 75% reported a lifetime risk between 0 and 10%, 96% rated their ordinal risk as "not high," and 50% rated their comparative risk as "much lower." Women < 50 with a family history of breast cancer reported significantly higher levels of perceived risk across all three measures. Among women 50 + , those reporting lower levels of perceived risk were significantly more likely to be Spanish speaking. No significant association was observed between mammography history and percent lifetime risk of breast cancer. Factors shaping breast cancer risk perceptions differ by age. Prior screening may play less of role in constructing risk perceptions. Research is needed to develop culturally and linguistically appropriate strategies to improve implementation of risk-based screening.

History of Mammography: Analysis of Breast Imaging Diagnostic Achievements over the Last Century.

Breast cancer is the most common forms of cancer and a leading cause of mortality in women. Early and correct diagnosis is, therefore, essential to save lives. The development of diagnostic imaging applied to the breast has been impressive in recent years and the most used diagnostic test in the world is mammography, a low-dose X-ray technique used for imaging the breast. In the first half of the 20th century, the diagnosis was in practice only clinical, with consequent diagnostic delay and an unfavorable prognosis in the short term. The rise of organized mammography screening has led to a remarkable reduction in mortality through the early detection of breast malignancies. This historical review aims to offer a complete panorama of the development of mammography and breast imaging during the last century. Through this study, we want to understand the foundations of the pillar of radiology applied to the breast through to the most modern applications such as contrast-enhanced mammography (CEM), artificial intelligence, and radiomics. Understanding the history of the development of diagnostic imaging applied to the breast can help us understand how to better direct our efforts toward an increasingly personalized and effective diagnostic approach. The ultimate goal of imaging applied to the detection of breast malignancies should be to reduce mortality from this type of disease as much as possible. With this paper, we want to provide detailed documentation of the main steps in the evolution of breast imaging for the diagnosis of breast neoplasms; we also want to open up new scenarios where the possible current and future applications of imaging are aimed at being more precise and personalized.

Prevalence of Breast Cancer Subtypes Among Different Ethnicities and Bangladeshi Women: Demographic, Clinicopathological, and Integrated Cancer Informatics Analysis.

The molecular subtyping of breast cancer is related to estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). The present study aimed to systematically analyze the expression, function, and prognostic value of ER, PR, HER2, and their prevalence in different ethnic groups and among Bangladeshi breast cancer (BC) patients. This study included 25 BC patients and 25 healthy controls, aged between 25 and 70 years. The study characteristics were compared using the ANOVA and Chi-square tests. Also, the multi-Omics dataset of 775 BC patients from TCGA was analyzed for ER, PR, and HER2 in breast cancer subtypes and compared among different ethnicities. For most BD breast cancer cases, the age at diagnosis was ⩾40 years, had only a histopathological diagnosis (P-value .004), and no history of mammography or other pathological tests. For treatment, had only chemotherapy (P-value .004) and no hormone therapy (P-value <.001). The majority of patients (>60%) were of stage-II cancer and TNBC (40%) subtype. The BC ethnicity-stratified data of ER, PR, and HER2 indicated a strong correlation across all ethnicities (P-value 4.99e-35; P-value 3.79e-18). The subtypes stratified data indicated a higher percentage of Luminal A (58.3%) in Caucasians whereas Luminal B (24.3%) and HER2 (25.2%) subtypes were found higher in Asians and TNBC (36.0%) were found in Africans. However, a significantly higher frequency of TNBC (52.2%) compared to Asians (14.8%) was found in BD patients (P-value <.001). The overall survival analysis of BC subtypes demonstrated that Luminal B (P-value .005) and HER2 enriched (P-value .015) were significantly more aggressive and were dominant in the Asian population. A significant association was found between BC subtypes with different ethnicities and Bangladeshi women and these findings might aid in the prevention, management, and raising of awareness against risk factors in the near future.

An Integrated Machine Learning Scheme for Predicting Mammographic Anomalies in High-Risk Individuals Using Questionnaire-Based Predictors.

This study aimed to investigate the important predictors related to predicting positive mammographic findings based on questionnaire-based demographic and obstetric/gynecological parameters using the proposed integrated machine learning (ML) scheme. The scheme combines the benefits of two well-known ML algorithms, namely, least absolute shrinkage and selection operator (Lasso) logistic regression and extreme gradient boosting (XGB), to provide adequate prediction for mammographic anomalies in high-risk individuals and the identification of significant risk factors. We collected questionnaire data on 18 breast-cancer-related risk factors from women who participated in a national mammographic screening program between January 2017 and December 2020 at a single tertiary referral hospital to correlate with their mammographic findings. The acquired data were retrospectively analyzed using the proposed integrated ML scheme. Based on the data from 21,107 valid questionnaires, the results showed that the Lasso logistic regression models with variable combinations generated by XGB could provide more effective prediction results. The top five significant predictors for positive mammography results were younger age, breast self-examination, older age at first childbirth, nulliparity, and history of mammography within 2 years, suggesting a need for timely mammographic screening for women with these risk factors.

Mobile Mammography Services and Underserved Women.

Breast cancer, the second most common cause of cancer in women, affects people across different ages, ethnicities, and incomes. However, while all women have some risk of breast cancer, studies have found that some populations are more vulnerable to poor breast cancer outcomes. Specifically, women with lower socioeconomic status and of Black and Hispanic ethnicity have been found to have more advanced stages of cancer upon diagnosis. These findings correlate with studies that have found decreased use of screening mammography services in these underserved populations. To alleviate these healthcare disparities, mobile mammography units are well positioned to provide convenient screening services to enable earlier detection of breast cancer. Mobile mammography services have been operating since the 1970s, and, in the current pandemic, they may be extremely helpful. The COVID-19 pandemic has significantly disrupted necessary screening services, and reinstatement and implementation of accessible mobile screenings may help to alleviate the impact of missed screenings. This review discusses the history and benefits of mobile mammography, especially for underserved women.

A Procedure for Eliciting Women's Preferences for Breast Cancer Screening Frequency.

BackgroundWe evaluate the construct validity of a proposed procedure for eliciting lay preferences among health care policy options, suited for structured surveys. It is illustrated with breast cancer screening, a domain in which people may have heterogeneous preferences.MethodsOur procedure applies behavioral decision research principles to eliciting preferences among policy options expressed in quantitative terms. Three-hundred women older than 18 y without a history of breast cancer were recruited through Amazon MTurk. Participants evaluated 4 screening options for each of 4 groups of women, with varying risk of breast cancer. Each option was characterized by estimates of 3 primary outcomes: breast cancer deaths, false alarms, and overdiagnosis resulting in unnecessary treatment of cancers that would not progress. These estimates were based on those currently being developed by the Breast Cancer Surveillance Consortium. For each risk group, participants stated how frequently they would wish to receive screening, if the predicted outcomes applied to them.ResultsA preregistered test found that preferences were robust enough to be unaffected by the order of introducing and displaying the outcomes. Other tests of construct validity also suggested that respondents generally understood the task and expressed consistent preferences. Those preferences were related to participants’ age and mammography history but not to measures of their numeracy, subjective numeracy, or demographics. There was considerable heterogeneity in their preferences.ConclusionsMembers of the public can be engaged more fully in informing future screening guidelines if they evaluate the screening options characterized by the expected health outcomes expressed in quantitative terms. We offer and evaluate such a procedure, in terms of its construct validity with a diverse sample of women.HighlightsA novel survey method for eliciting lay preferences for breast cancer screening is proposed and evaluated in terms of its construct validity.Participants were generally insensitive to irrelevant task features (e.g., order of presentation) and sensitive to relevant ones (e.g., quantitative estimates of breast cancer risk, harms from screening).The proposed method elicits lay preferences in terms that can inform future screening guidelines, potentially improving communication between the public and policy makers.

Influencia de la incorporación de la tomosíntesis en un centro de diagnóstico mamario.

Introduction: significant technological progress has been made in the history of mammography. Recently, direct digital mammography plus tomosynthesis arrived and improved breast cancer screening.Objective: to evaluate the effects of new technology in the performance of mammography, at the Breast Diagnostic Service of the British Hospital.Method: mammography performance during 2019- 2020 was compared to that between 2010 and 2018.In 2019 the previous tehcnology was substituted by a direct digital mammogram with tomosynthesis, Hologic, Selenia Dimensions model.Results: 10.725 mammographies were done in 2019-2020. Cancer was detected in 84 cases and the cancer detection rate was 8 per 1000 persons. PPV was 35%. 45.438 mammographies were done in 2010-2018. Cancer was detected in 229 cases and the cancer detection rate was 5 per 1.000 persons. PPV was 40%. As to images, it is worth pointing out an increase in microcalcifications between 2019 and 2020, when they grew from 7% of cases to 19% of cases and distortions increased from 11% to 13%.DCIS was 4 times greater in 2019-2020 when compare to the previous period of time (17% of all detected cases).Conclusions: the integration of tomosynthesis increased 60% the cancer detection rate and the DCIS was 4 times greater.

Mammographic Breast Densities among 200 Nigerian Females in Sokoto, North Western Nigeria

Background: Breast density has been reported to be an independent predictor of breast cancer risk. Women with highest mammographic breast density may have four to six fold increased risk of developing cancer. Aim and Objective: This study is aimed at evaluating the various forms of breast densities following screening and diagnostic mammographic examination. Materials and Methods: From December 2010 and November 2012, 200 females had mammographic breast examination. Seventy-seven (77) females had routine screening mammography while 123 had diagnostic mammographic examination in the department with the General Electric (GE) Alpha-RT machine with model number MGF-101(manufactured 2010). All the subjects had to fill a mammographic form consisting of variables like age, sex, occupation, family history of breast cancer, tribe, contraception, parity, and caffeine consumption, history of surgical intervention (lumpectomy, biopsy and/or mastectomy), previous mammography and last child birth. MLO and CC views were done for the breast examination though additional views were occasionally employed. Results: Breast density decreases with increase in age of the female subjects and breast lesions are better detected following mammography on fatty or less dense breast.

History of Mammography in Iran

History of Mammography in Iran

Women's Views on Multifactorial Breast Cancer Risk Assessment and Risk-Stratified Screening: A Population-Based Survey from Four Provinces in Canada.

Risk-stratified screening for breast cancer (BC) is increasingly considered as a promising approach. However, its implementation is challenging and needs to be acceptable to women. We examined Canadian women’s attitudes towards, comfort level about, and willingness to take part in BC risk-stratified screening. We conducted an online survey in women aged 30 to 69 years in four Canadian provinces. In total, 4293 women completed the questionnaire (response rate of 63%). The majority of women (63.5% to 72.8%) expressed favorable attitudes towards BC risk-stratified screening. Most women reported that they would be comfortable providing personal and genetic information for BC risk assessment (61.5% to 67.4%) and showed a willingness to have their BC risk assessed if offered (74.8%). Most women (85.9%) would also accept an increase in screening frequency if they were at higher risk, but fewer (49.3%) would accept a reduction in screening frequency if they were at lower risk. There were few differences by province; however, outcomes varied by age, education level, marital status, income, perceived risk, history of BC, prior mammography, and history of genetic test for BC (all p ≤ 0.01). Risk-based BC screening using multifactorial risk assessment appears to be acceptable to most women. This suggests that the implementation of this approach is likely to be well-supported by Canadian women.

8. Contrast-enhanced Mammography-History, Current Status in the World and Future Directions in Japan

8. Contrast-enhanced Mammography-History, Current Status in the World and Future Directions in Japan

Abstract PO-238: Breast density knowledge and awareness among Latinas in a low-resource setting: A comparison nationally-representative sample of Latinas

Abstract Objective: Breast density notification laws aim to increase women’s awareness and knowledge about breast density (BD). This study’s aim was to compare BD knowledge and awareness in two Hispanic populations: a safety-net clinic serving Latina population in Maricopa County, Arizona (AZ) and a national sample of Hispanic women participating in an online research panel. Materials/Methods: Women ages 40-74 were recruited at the AZ clinic from 2016-2019 at a screening mammography appointment as part of a larger clinical trial (AZ cohort). Surveys were completed in person (English or Spanish) at enrollment to assess awareness of BD, understanding of BD risk, and mammography history. The same questions were asked in a nationally representative online panel survey conducted in 2017. All data from the national survey were weighted to adjust for probability of selection into the panel and post-stratified to match known U.S. Hispanic population distributions (NS cohort). Univariate comparisons between the clinic and the national panel were performed using Rao-Scott chi-square tests. Associations with awareness and correct knowledge were examined with multivariable logistic regression. All summaries and analyses are weighted, and were performed with SAS version 9.4 SURVEY procedures (SAS Institute Inc., Cary, NC). Results: The analysis included 1332 Hispanic women from the AZ clinic and 152 Hispanic women who completed the national survey. The AZ cohort was younger (mean age: 48.5 vs 52.8), had less education (less than high school: 68.7% vs 34.8% less than high school), more likely to prefer Spanish (92.3% vs 53.1%) and less likely to have had a prior mammogram as compared NS cohort (82.8% vs 90.4%) (all p≤ 0.03). NS cohort was more likely to have awareness of BD (32.6% vs 20.7%); correct understanding of the masking effect of BD, (67.8% vs 37.0%,) and breast cancer risk (72.2% vs 32.6%,), compared to the AZ cohort (all p &amp;lt; 0.004). When adjusted for differences in education, age, language, and screening mammography history, BD awareness was similar between the two cohorts (adjusted odds ratio [ORadj] 0.95, p=0.83). Awareness was positively associated with more education, previous mammogram history, and English language. However, differences in BD knowledge remained (ORadj=2.8 [p=0.03] and 7.2 [P&amp;lt;0.001] for knowledge of masking and risk, respectively). Conclusions: There were significant differences in BD awareness and knowledge between a nationally-representative sample of Latinas and Latinas in a low-resource setting. The differences in BD awareness, but not knowledge, could be explained by education, screening history and preferred language. These findings suggest that a one-size-fits-all approach to raising BD awareness and knowledge will not work. To ensure equitable dissemination of health care to Latina women undergoing screening mammography, future work should be aimed at developing effective tools and resources for educating Spanish-speaking women about BD and risk-based screening. Citation Format: Jillian Leaver, Bhavika K. Patel, Jennifer L. Ridgeway, Sarah Jenkins, Vera Suman, Deborah J. Rhodes, Aaron Norman, Karthik Ghosh, Bijan Borah, Carrie Hruska, Edna Ramos, Davinder Singh, Matt Jewett, Carmen Radecki-Breitkof, Celine Vachon. Breast density knowledge and awareness among Latinas in a low-resource setting: A comparison nationally-representative sample of Latinas [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-238.

Abstract A030: Empowering Latinas to obtain breast cancer screenings: Comparing intervention effects and cost effectiveness

Abstract Purpose: Latinas suffer disproportionately from breast cancer relative to non-Latina Whites, partially due to lower guideline-concordant screening. Multiple approaches are used to address this disparity including educational interventions and empowerment-related interventions, wherein a subset of the population is trained to share information with other members of the priority population. However, little is known about the relative effects of these different approaches. Objective: To analyze preliminary data regarding the effectiveness and cost-effectiveness of education and empowerment approaches. Methods: This ongoing, quasiexperimental trial is situated in two lower-income Latino communities in Chicago. Eligibility criteria include: 1) age of 52-74; 2) no mammography use within past 2 years; 3) no previous breast cancer diagnosis; and 4) no prior health volunteerism experience. Women are assigned to a cohort and participate in a three-week intervention (education: breast cancer, diet, physical activity; empowerment: breast cancer, sharing information with networks, health volunteerism). For women who wish to obtain mammography (from either arm), the study team provides navigation to free/low-cost services. Data collected at baseline, post-intervention, and six-month follow-up include standard demographics and self-reported mammography use, which are verified by study navigation records. The perspective for cost-effectiveness analyses was the community-based organization implementing the program. Cost data include overhead, non-personnel, and personnel costs (per task, per person encounter). Cost data were standardized to US dollars in 2018 and extrapolated to the duration of study implementation. Results: Our current sample is 97 women (51 education; 46 empowerment). Most women were 52-64 years old (70%), had insurance (58%), had less than a 9th grade education (60%), had an annual household income of &amp;lt;$15,000 (67%), and were born in Mexico (86%). More empowerment participants obtained a mammogram than education participants, after adjusting for age, education, income, insurance, mammography history, and mammography plans (47% vs. 74%; OR = 3.2, 95%CI [1.1, 9.00], p=.001). The empowerment intervention was also less expensive. The costs for education and empowerment interventions were $32,919 and $24,983 ($645 and $490 per person), respectively. Hence, empowerment appears to be a dominant strategy. Discussion: Empowerment approaches may be more effective and more cost effective in promoting mammography than education approaches among non-adherent Latinas. Limitations concern generalizability due a non-probability based sample, and limited ability for causal inferences due to a lack of randomization. Next steps include incorporating participants' costs and including unintended effects (e.g., number of non-participant women obtaining mammography). Citation Format: Yamile Molina, Liliana G. San Miguel, Catherine Pichardo, Genesis Rios, Leslie Diaz, Stephanie Cardenas, Esmeralda Cardoso-Mendoza, Juanita Arroyo, Maria Medina, Nora Coronado, Araceli Lucio, Olivia Hernandez, Surrey Walton. Empowering Latinas to obtain breast cancer screenings: Comparing intervention effects and cost effectiveness [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 A030.

The impact of ductal carcinoma in situ on health services utilization.

To determine the intermediate-term impact of diagnosis and treatment of ductal carcinoma in situ of the breast (DCIS) on health services utilization, we compared utilization by cases of DCIS to unaffected controls. We identified a population-based cohort of Ontario females diagnosed with DCIS between 2010 and 2015. We matched 5 controls without any history of cancer to each case, on the date of diagnosis of the case (the index date), by age, annual mammography history, socioeconomic status, and comorbidity. We identified billing claims and hospital records, during the interval 13 to 60months prior to, and subsequent to the index date, and computed rates per 100 person-years during both intervals, to conduct a difference-in-differences analysis. We used negative binomial regression to test if the change in rates in health services differed between cases and controls. Visits with a breast diagnosis code, and claims for breast surgery and imaging, were significantly increased among cases compared to controls (all p values < 0.0001) after DCIS;however, there was no increase in visits for anxiety or depression (RR 1.13 (95% CI 0.97, 1.32, p = 0.11), visits to psychiatrists (RR 1.07 (95% CI 0.82, 1.40) p = 0.6), or hospital procedures other than breast surgery (RR 1.10 (95% CI 0.88, 1.37) p = 0.4). DCIS is associated with more visits and procedures related to the breast compared to controls following diagnosis and treatment, but other health services utilization and visits related to anxiety and depression were not increased.

Histomorphological study of invasive breast carcinoma and its prognostic scoring using Nottingham prognostic index

Introduction: Breast carcinoma is the common malignant tumor in women accounting for 15% of cancer related deaths. Clinical history, examination and use of mammography has improved the diagnostic approach to breast cancer. Nottingham prognostication index is considered to be a useful marker that takes into consideration some of the important factors like tumor size, histologic grade and lymphnode stage. Aims and Objectives: 1. To study histomorphological distribution pattern of various invasive breast carcinoma. 2. To estimate prognosis by using Nottingham prognostic index score. Materials and Methods: One year six months descriptive study was performed which included all the invasive breast carcinoma cases comprising of mastectomy specimen with lymphnode sampling. Based on tumor size, histologic grade and lymphnode stage; Nottingham prognostic index score was calculated and cases were categorised into different prognostic group. Results: 68 cases were included in the study with 67 female patients and one male patient. Histopathologically, 80.88% were Infiltrating ductal carcinoma – not otherwise specified. Tumor size belonging to T2 in 66.17%. 45.58% showed no lymphnode involvement and 33.82% belonged to lymphnode stage N1. Majority (50%) belonged to histologic grade II. Nottingham Prognostic Index (NPI) score in 42.64% showed moderate prognosis. Conclusion: Histomorphological study showed commonest lesion to be Infiltrating Ductal carcinomanot otherwise specified and majority belonged to moderate prognosis category according to Nottingham Prognostic Index score. Keywords: Histomorphology, Infiltrating ductal carcinoma, Tumor size, Nottingham Prognostic index.

Abstract 2424: Smoking and mammography screening: An analysis of knowledge, barriers, self-efficacy, benefits, and perceived risk

Abstract Introduction: Breast cancer is the second leading cause of cancer death among women in the United States. Although mammography screening is supported by the U.S. Preventive Services Task Force and has been found to effectively reduce mortality, only about 65% of women over 40 years of age are adherent to mammography screening guidelines, a rate far below the 81.1% goal proposed for Healthy People 2020. Screening rates are even lower among smokers compared to non-smokers; however, the reasons for this disparity remain unclear. Overall, knowledge, barriers, benefits, self-efficacy, and perceived risk play a role in decision making and may influence cancer screening behavior. Therefore, the purpose of this study was to examine the association between smoking status and mammography adherence, and to determine whether differences in knowledge, barriers, benefits, self-efficacy, and perceived risk could account for screening disparities between smokers and non-smokers. Methods: A prospective, randomized screening intervention of women aged 50-75 (n=1,196) was conducted in Indiana from 2013-2015. A total of 846 women had complete smoking and mammography data for use in this analysis. Women were surveyed at baseline to ascertain current smoking status and mammography history, as well as knowledge, barriers, self-efficacy, benefits, and perceived risks for mammography. Binary logistic regression was used to estimate multivariate-adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between smoking and mammography adherence. T-tests were used to evaluate differences between current smokers and non-smokers with regard to knowledge, barriers, benefits, self-efficacy, and perceived risk. Regression analyses were adjusted for age, education, income, insurance coverage, ever receiving a physician recommendation for mammography, and family history of breast cancer. Results: Smokers were significantly younger, less educated, and had lower income relative to non-smokers. Smokers were less likely to be adherent to mammography screening relative to non-smokers [OR = 0.54 (0.32 - 0.90), p=0.020)]. Smokers also demonstrated significantly less knowledge of breast cancer and mammography (p=0.0016), reported more barriers to screening (p=0.020), had less self-efficacy (p=0.0018), and had a lower perceived risk of breast cancer (p=&amp;lt0.0001) compared with non-smokers. No differences were observed for benefits to screening (p=0.81). Conclusions: Women who smoke are less likely to adhere to mammography screening guidelines than non-smokers, possibly due to less knowledge about breast cancer and mammography, more barriers to screening, less self-efficacy, and less perceived risk. Future interventions to increase mammography should consider smoking status disparities and tailor intervention content accordingly. Citation Format: Andrew R. Marley, Lisa Carter-Harris, Wambui Gathirua-Mwangi, Victoria L. Champion. Smoking and mammography screening: An analysis of knowledge, barriers, self-efficacy, benefits, and perceived risk [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2424.

Analyzing Factors of Breast Cancer Screening Adherence among Korean American Women Using Andersen's Behavioral Model of Healthcare Services Utilization.

Regular uptake of mammography screening reduces the risk of advanced stage diagnosis of breast cancer (BC). However, BC screening rates remain suboptimal among Korean American (KA) women. Using the Andersen's Behavioral Model of Healthcare Services Utilization, this study examined factors associated with mammography screening among KA women aged 50 to 80 years in the state of Georgia, USA. We used purposive sampling to recruit study participants in the Atlanta metropolitan area from May 2015 to February 2016. A total of 303 KA women completed a cross-sectional, self-report survey about their sociodemographics, health care access information, knowledge, self-efficacy, decisional balance, and mammography history. Descriptive analyses confirmed low rates of mammography screening in the participants. Multiple logistic regression analyses showed that having a mammogram within the past year was associated with greater BC knowledge, higher scores of decisional balance and fewer annual health check-ups among KA women without any cancer history. The findings offer implications for health policy aimed at increasing BC screening by leveraging enabling factors among medically underserved KA women at both structural and cultural levels.

Abstract P6-16-03: The impact of ductal carcinoma in situ of the breast on health services utilization and general health and well-being of women

Abstract Background: The impact of DCIS diagnosis on the development of significant anxiety and depression and on the utilization of breast imaging and breast biopsy procedures, which may reflect fears of breast cancer recurrence, is unknown. We established a population cohort of women with DCIS and examined the impact of the DCIS diagnosis on health services utilization (physician, emergency room visits) before and after DCIS, including those related to anxiety or depression, and all breast-related interventions, compared to similar women without DCIS. Methods: From hospital claims we identified a population-based cohort of women with a first diagnosis of DCIS between 2010-2015. Cases with prior history of cancer were excluded. We identified treatment (mastectomy, breast-conserving surgery (BCS) +/- radiation therapy (RT) by linkage of administrative databases. Using DCIS diagnosis date for each case, we matched 5 unaffected controls (with no history of DCIS) by age, mammography history, socioeconomic status, and comorbidity at same date. For all cases and controls we extracted the following from physician billing claims: breast imaging (mammography, ultrasound, MRI), breast biopsies, breast surgery, all physician visits, and all hospital claims (including those with a diagnosis of anxiety or depression), for five years prior to and following the index date. We excluded claims from the year prior to and subsequent to the index date to remove the effect of services utilization surrounding the diagnosis and management of the index DCIS lesion. We then computed the rate of each service per 100 person-years for 5 years before and after the index date. Cases who developed local recurrence (LR) (and their matched controls) were censored 3 months prior to LR date. We used negative binomial regression to test differences in rates of service utilization before and after DCIS diagnosis and between cases and unaffected controls. Results: The cohort includes 4,977 women treated for DCIS were identified, each matched to 5 controls. 911/4,977 (18.3%) of cases were &amp;lt; 50 years old at diagnosis; 1,006/4,977 (20.2%) were treated by BCS alone, 2,995/4,977 (60.2%) by BCS+RT, and 976 (19.6%) by mastectomy. For cases diagnosed with visits with a breast diagnosis code, utilization of breast imaging procedures and the use of breast surgery was significantly greater relative to unaffected controls irrespective of age at diagnosis and treatment (all p values &amp;lt;0.0001). Primary care visits were higher among cases (RR=1.10 (95% CI 1.06, 1.14), p&amp;lt;0.0001), including those with a breast diagnosis code (RR=3.69 (95%CI 3.29, 4.14)). However, there was no increase in relative rates of physician or hospital visits for anxiety or depression (RR 1.13 (95% CI 0.97, 1.32 p=0.11), psychiatry visits (RR 1.07 (95% CI 0.82, 1.40) p=0.6), non-breast surgical procedures (RR 1.10 (95% CI 0.88, 1.37) p=0.4), or emergency department visits (unrelated to breast) in cases with DCIS compared to unaffected controls. Conclusion: DCIS is associated with more visits and procedures related to the breast compared to women without a diagnosis of DCIS but overall health services utilization and visits related to anxiety and depression were not increased. Citation Format: Rakovitch E, Sutradhar R, Zhou L, Nofech-Mozes S, Hanna W, Paszat L. The impact of ductal carcinoma in situ of the breast on health services utilization and general health and well-being of women [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-16-03.