Participation In Mammography Screening Research Articles

EPH11 Determinants of Mammography Screening Participation– A Cross-Sectional Analysis of the Hungarian Sample

EPH11 Determinants of Mammography Screening Participation– A Cross-Sectional Analysis of the Hungarian Sample

Incidence-Based Breast Cancer Mortality Trends in Estonia Before and After the Introduction of Organized Mammography Screening: A Register-Based Study.

Despite the relatively low breast cancer incidence in Estonia, mortality remains high, and participation in mammography screening is below the recommended 70%. The objective of this register-based study was to evaluate incidence-based (IB) breast cancer mortality before and after the introduction of organized mammography screening in 2004. Breast cancer deaths individually linked to breast cancer diagnosis were obtained from the Estonian Cancer Registry and used for calculating IB mortality. We compared age-specific IB mortality rates across 5-year birth cohorts and 5-year periods. Poisson regression was used to compare IB mortality for one age group invited to screening (50-63) and three age groups not invited to screening (30-49, 65-69, and 70+) during two periods before and after screening initiation (1993-2003 and 2004-2014). Joinpoint regression was used for age-standardized incidence and IB mortality trends. Age-standardized IB mortality has been decreasing since 1997. Age-specific IB mortality for birth cohorts never exposed to screening showed a continuous increase with age, while in cohorts exposed to organized screening the mortality curve flattened or declined after the age of first invitation. Significant decreases in mortality from 1993-2003 to 2004-2014 were seen in the 30-49 (age-adjusted rate ratio 0.51, 95% CI 90.42-0.63) and 50-63 (0.65, 95% CI 0.56-0.74) age groups, while no decline was seen in the 65-69 and 70+ age groups. The age specific IB mortality curves in birth cohorts exposed to screening and the significant mortality decline in the target age group after the initiation of the organized program suggest a beneficial effect of screening. Improved treatment without screening has not reduced mortality in older age groups. Our results support raising the upper screening age limit to 74 years.

German mammography screening program: adherence, characteristics of (non-)participants and utilization of non-screening mammography—a longitudinal analysis

BackgroundIn Germany, all women aged 50–69 have been invited to biennial mammography screening since 2009. We aimed to assess longitudinal adherence over ten years in women aged 50 in 2009 and characterize the different adherence groups.MethodsUsing the German Pharmacoepidemiological Research Database (GePaRD, ~ 20% of the German population), we included women aged 50 in 2009 (baseline) with continuous health insurance coverage and without breast cancer or in-situ-carcinoma. We followed them until age 59 and categorized them according to mammography screening participation into the following groups: never, 1–2, 3–4, 5–6 times. We characterized these groups, inter alia, regarding the use of other preventive measures, non-screening mammography (i.e., mammography outside the organized screening program) and menopausal hormone therapy.ResultsOverall, 82,666 women were included. Of these, 27.6% never participated in the screening program, 15.1% participated 1–2 times, 31.7% participated 3–4 times and 25.6% participated regularly (5–6 times). Among regular participants, 91% utilized other preventive measures (e.g., cervical cancer screening, general health checkup) before baseline as compared to 66% among non-participants. Menopausal hormone therapy was least common among non-participants (11% vs. 18% among regular participants). Among non-participants, the proportions using ≥ 1, ≥ 2, and ≥ 3 non-screening mammographies between age 50–59 were 25%, 18%, and 15%, respectively.ConclusionsUsing a large cohort based on claims data, this study provides novel insights into longitudinal adherence to the mammography screening program and the use of mammography outside of the program in Germany. Between age 50–59, 57% of eligible women participated at least three times in the German mammography screening program and 28% (~ 3 in 10 women) never participated. Among non-participants, 15% had at least three non-screening mammographies during this period, indicating potential gray screening. Participants more often utilized other preventive measures as compared to non-participants.

County-level correlates of completed HPV vaccination in Indiana

The Healthy People 2030 goal is for 80% of all adolescents to complete their HPV vaccination series. Per the 2021, National Immunization Survey-Teen (NIS-Teen), 61.7% of adolescents have completed the series, and Indiana lags below the national average (55.2%). The present study estimated the 2-dose HPV vaccine series completion rates across Indiana counties among individuals aged 9–14 years who received their first dose of vaccine and determined what factors were associated with series completion at the county level. The association of county-level sociodemographic and health measures with series completion was also examined. Data were extracted from the Indiana Immunization Information System (IIS), administered by the Indiana Department of Health. All vaccine providers are required to report all immunizations to the system for any patient under age 19 years. All Indiana children ages 9–14 years at the time of first dose who had initiated HPV vaccination in 2017 or 2018 were included. Two-dose series completion was evaluated through October of 2020, allowing a minimum gap of 22 months from first dose administration. All statistical analyses were conducted at the county-level. The Indiana HPV vaccination series completion rate among individuals that received the first dose was on average 73% across counties, ranging from 55.7% to 90.4%. Higher series completion was positively associated with primary care providers per capita, participation in mammography screening among Medicare enrollees, median household income, life expectancy, percentage of residents with some college, percentage of adults up-to-date with colonoscopy screening, and percentage of adults with flu vaccine. There was wide variability in series completion across Indiana counties. HPV series completion was associated with county-level sociodemographic and health measures, particularly variables reflecting difficulties with access to care and lack of financial resources.

Impact of Breast Cancer Screening on 10-Year Net Survival in Canadian Women Age 40-49 Years.

In Canada, some provincial/territorial mammography screening programs include women age 40-49 years, whereas others do not. This study examines the impact of this dichotomy on the 10-year breast cancer (BC) net survival (NS) among women age 40-49 years and 50-59 years at diagnosis. Using the Canadian Cancer Registry data record linked to death information, we evaluated the cohort of Canadian women age 40-49 years and 50-59 years diagnosed with BC from 2002 to 2007. We compared 10-year NS estimates in the jurisdictions with organized screening programs that included women age 40-49 years, designated as screeners (Northwest Territories, British Columbia, Alberta, Nova Scotia, and Prince Edward Island), with comparator programs that did not (Yukon, Manitoba, Saskatchewan, Ontario, Quebec, New Brunswick, and Newfoundland and Labrador). BC was the primary cause of 10-year mortality in women age 40-49 years diagnosed with BC (90.7% of deaths). Among these women, the 10-year NS for screeners (84.8%; 95% CI, 83.8 to 85.8) was 1.9 percentage points (pp) higher than that for comparators (82.9%; 95% CI, 82.3 to 83.5; P = .001). The difference in favor of screeners was significant among women age 45-49 years (2.6 pp; P = .001) but not among women age 40-44 years (0.9 pp; P = .328). Similarly, the incidence-based BC mortality rate was significantly lower in screener jurisdictions among women age 40-49 years and 45-49 years, but not for 40-44 years. Provincial/territorial NS increased significantly with higher mammography screening participation (P = .003). The BC incidence rate was virtually identical in screener and comparator jurisdictions among women age 40-49 years (P = .976) but was significantly higher for comparators among women age 50-59 years (P < .001). Screening programs that included women in their 40s were associated with a significantly higher BC 10-year NS in women age 40-49 years, but not an increased rate of BC diagnosis. These results may inform screening guidelines for women age 40-49 years.

Beneficial effect of repeated participation in breast cancer screening upon survival.

The benefit of mammography screening in reducing population mortality from breast cancer is well established. In this paper, we estimate the effect of repeated participation at scheduled screens on case survival. We analysed incidence and survival data on 37,079 women from nine Swedish counties who had at least one to five invitation(s) to screening prior to diagnosis, and were diagnosed with breast cancer between 1992 and 2016. Of these, 4564 subsequently died of breast cancer. We estimated the association of survival with participation in up to the most recent five screens before diagnosis. We used proportional hazards regression to estimate the effect on survival of the number of scheduled screens in which subjects participated prior to the diagnosis of breast cancer. There was successively better survival with an increasing number of screens in which the subject participated. For a woman with five previous screening invitations who participated in all five, the hazard ratio was 0.28 (95% confidence interval (CI) 0.25-0.33, p < 0.0001) compared to a woman attending none (86.9% vs 68.9% 20-year survival). Following a conservative adjustment for potential self-selection factors, the hazard ratio was 0.34 (95% CI 0.26-0.43, p < 0.0001), an approximate three-fold reduction in the hazard of dying from breast cancer. For those women who develop breast cancer, regular prior participation in mammography screening confers significantly better survival.

Beneficial effect of repeated participation in breast cancer screening upon survival.

552 Background: The benefit of mammography screening in reducing population mortality from breast cancer is well established. However, the effect of repeated participation at scheduled screens on case survival is less well documented. Methods: In this retrospective analysis of breast cancer survival, we analyzed incidence and survival data on 37,079 women ages 40-69 from nine Swedish counties who had between one and five invitations to mammography screening and were diagnosed with breast cancer between 1992 and 2016. Of these, 4,564 subsequently died of breast cancer. For each breast cancer diagnosed in each county’s period of observation, we obtained data on previous screening history, and subsequent death (or not) from breast cancer. Formal comparisons of survival with respect to numbers of screening exams attended prior to a diagnosis of breast cancer were carried out using Cox proportional hazards regression with time-varying covariates, ie, cumulative numbers of screens, yielding hazard ratios and 95% confidence intervals (CI). We corrected for potential self-selection using the method of Duffy et al, which gives a corrected estimate based on the proportion of participants, the uncorrected estimate, and the relative risk of breast cancer death for non-participants compared to an uninvited population. Results: Depending on number of invitations, 58-73% (average 65%) participated in all scheduled screens, and 73-96% (average 91%) participated in at least one examination. There was successively better survival among women with increasing numbers of screening exams. For a woman with five previous screening invitations who participated in all five screening exams, the hazard ratio was 0.28 (95% CI 0.25-0.33, p&lt;0.0001), a 72% risk of dying from breast cancer, compared to a woman attending none. Following a conservative adjustment for potential self-selection factors, the hazard ratio was 0.34 (95% CI 0.26-0.43, p&lt;0.0001). Conclusions: For those women who develop breast cancer, regular prior participation in mammography screening confers significantly better survival. Most women will not develop breast cancer in their lifetime. These results indicate that for those who do, regular participation in screening considerably improves the probability of surviving it. The distinction between the general, population benefit of mammography screening, and the benefit of regular participation in mammography screening should be clearly articulated in breast cancer screening messaging and decision aids. [Table: see text]

Abstract P6-03-07: Development of an at-home breast health assessment test, to increase compliance with screening mammography using proteins from tears

Abstract Anna E. Daily1,*, Prashanth Ravishankar1, Wanyi Wang3, Ryan Krone3, Steve Harms1,2, and V Suzanne Klimberg1,4,5 1Namida Lab Inc, Fayetteville, Arkansas; 2The Breast Center-Medical Associates of Northwest Arkansas, Fayetteville, Arkansas; 3Elite Research LLC, Irving, Texas; 4Department of Surgery, University of Texas Medical Branch, Galveston, Texas; 5Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas. *anna@namidalab.com Background: There is a growing body of evidence to support tears as a non-traditional biological fluid in clinical laboratory testing. In addition to the simplicity of tear fluid processing, the ability to access key cancer biomarkers in high concentrations quickly and inexpensively make them an attractive biofluid source. Here we report our biomarker discovery study on tears to identify and validate candidate biomarkers for breast cancer and develop a model that is significantly associated with a positive breast cancer diagnosis. Methods: Participants were recruited from individuals having a yearly screening mammogram, biopsy, and/or recently diagnosed with breast cancer. Imaging results were obtained from clinical sites and samples were then classified as: control (normal imaging no biopsy) or diagnosed breast cancer pre-treatment (diagnosed by biopsy). Biomarker discovery was conducted using 102 individual tear samples collected using the Schirmer strip collection method. Liquid chromatography/tandem mass spectrometry (LC-MS/MS) was performed to identify protein biomarker candidates with altered expression levels in breast cancer patients. ELISA assay to confirm LC-MS/MS trends for biomarkers of interest was conducted using 171 tear samples. An additional round of validation utilizing 848 samples was performed which included protein concentrations determined by ELISA and collection of demographic and clinical covariates. The resulting concentration data, combined with the demographic and clinical covariates, was analyzed using logistic regression analysis to build a model for classification of samples as positive or negative. Results: A total of 301 proteins were identified by LC-MS/MS and narrowed to a list of 14 proteins (p-value &amp;lt; 0.05) with potential significance in breast cancer patients. Three biomarkers, S100A8 (p-value = 0.0069), S100A9 (p-value = 0.0048), and Galectin-3 binding protein (p-value = 0.01) with an increased expression in breast cancer patients were selected for validation using ELISA. Logistic regression analysis produced three models, which were then evaluated on breast cancer cases and controls at two diagnostic thresholds and resulted in sensitivity ranging from 52% - 90% and specificity from 31% - 79%. Conclusions: Our results demonstrate clinical feasibility for tear proteins to detect breast cancer and includes the most extensive published data set of individually analyzed tear samples. This analysis suggests that models developed using tear fluid have clinical validity and could be used in further development of a biological assay. We envision positioning this assay as a tool for activation around breast health screening for low to average risk patients who may be screening avoidant or adverse to encourage participation in screening mammography. Citation Format: Anna Daily, Prashanth Ravishankar, Victoria S. Klimberg, Steve Harms. Development of an at-home breast health assessment test, to increase compliance with screening mammography using proteins from tears [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-03-07.

Abstract P3-03-02: Can artificial intelligence derived ultrasound breast density provide comparable breast cancer risk estimates to density derived from mammograms

Abstract Can artificial intelligence derived ultrasound breast density provide comparable breast cancer risk estimates to density derived from mammograms Dustin Valdez12, Arianna Bunnell2, Thomas Wolfgruber1, Aleen V. Altamirano3, Brandon Quon1, Gertraud Maskarinec1, Peter Sadowski2, John A. Shepherd1 1 University of Hawaii Cancer Center, Honolulu, HI 2 University of Hawaii at Manoa, Honolulu, HI 3 Instituto Radiodiagnóstico, Managua, Nicaragua Background: Breast cancer is the second leading cause of cancer-related death among women in Hawaii and the Pacific. However, while there are programs like the Breast and Cervical Cancer Early Detection Program (BCCEDP) implemented throughout the Pacific, the lack of access to mammography screening and low screening participation rates contributes to very high advanced breast cancer rates in most cases over 50%. Portable breast ultrasound is a promising screening technology for low resource areas. However, without mammography, mammographic density is not available for risk modeling to determine who should participate in screening programs or at what frequency. In this study, we ask if breast ultrasound (US) images can be used to derive an equivalent mammographic density for risk modeling. We utilized artificial intelligence to derive breast density from diagnostic ultrasound images and compared to BI-RADS mammographic density in an established breast cancer risk model1. Methods: We selected women with negative screening visit who either later developed cancer (positives) or did not (negatives) over a 10-year period. Temporally-matched negative mammographic and ultrasound images, cancer outcome status and cancer risk information were sourced from the Hawaii and Pacific Islands Mammography Registry. US images had to have occurred within a year of the mammogram. BI-RADS mammographic density was derived using an existing deep neural network model2. Mammographic density was estimated from US images by training a deep-learning convolutional neural network model. A hold out set of images (Test set of 20% of the total) was used to compare 10-year breast cancer risk using the Tyrer-Cuzick (TC) risk model1 when calculated using breast density from either mammograms or US. The AUC values, confidence intervals, ROC plots and Pearson correlation were calculated and compared. Results: Over the 10-year study period, 1337 had matched mammograms and US images and 65 went on to develop breast cancer. Using the test set, the Pearson’s correlation between breast density from mammography and US was 0.31 (moderate correlation). There were no covariates found to improve this association. The AUC for TC 10-year personal risk was higher when breast density from mammograms was used 0.71 (95% CI=0.57-0.86) versus US images 0.65 (95% CI=0.53-0.76). Conclusion: Overall breast cancer risk was similar when breast density was derived from either mammograms or US. The performance of our US breast density model is expected to improve further when more US training data becomes available. Breast cancer screening programs exclusively using US imaging may be able to provide equivalent risk modeling to clinics using mammography. 1.Tyrer J, Duffy SW, Cuzick J (2004). A breast cancer prediction model incorporating familial and personal risk factors. Stat Med. 2004 Apr 15;23(7):1111-30. doi: 10.1002/sim.1668. Erratum in: Stat Med. 2005 Jan 15;24(1):156. PMID: 15057881. 2. Wu, N., K. J. Geras, Y. Shen, J. Su, S. G. Kim, E. Kim, S. Wolfson, L. Moy and K. Cho (2018). Breast Density Classification with Deep Convolutional Neural Networks. 2018 IEEE International Conference on Acoustics, Speech and Signal Processing (ICASSP), IEEE. Citation Format: Dustin Valdez, Arianna Bunnell, Thomas Wolfgruber, Aleen Altamirano, Brandon Quon, Gertraud Maskarinec, Peter Sadowski, John Shepherd. Can artificial intelligence derived ultrasound breast density provide comparable breast cancer risk estimates to density derived from mammograms [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-03-02.

Poor health literacy associated with stronger perceived barriers to breast cancer screening and overestimated breast cancer risk.

Low health literacy (HL) is negatively associated with mammography screening uptake. However, evidence of the links between poor HL and low mammography screening participation is scarce. We conducted a cross-sectional questionnaire survey among participants of a cancer screening program. We measured HL using a validated Chinese instrument. We assessed breast cancer screening-related beliefs using the Health Belief Model and the accuracy of risk perception. We used multivariable regression models to estimate the relationship between HL and the outcomes. A total of 821 females were included. 264 (32.2%) had excellent or sufficient, 353 (43.0%) had problematic, and 204 (24.8%) had inadequate health literacy (IHL). Women with IHL were more likely to agree that high price (β = -0.211, 95% CI -0.354 to -0.069), lack of time (β = -0.219, 95% CI -0.351 to -0.088), inconvenient service time (β = -0.291, 95% CI -0.421 to -0.160), long waiting time (β = -0.305, 95% CI -0.447 to -0.164), fear of positive results (β = -0.200, 95% CI -0.342 to -0.058), embarrassment (β = -0.225, 95% CI -0.364 to -0.086), fear of pain (β = -0.154, 95% CI -0.298 to -0.010), fear of radiation (β = -0.177, 95% CI -0.298 to -0.056), lack of knowledge on service location (β = -0.475, 95% CI -0.615 to -0.335), and lack of knowledge on mammography (β = -0.360, 95% CI -0.492 to -0.228) were barriers. They were also less likely to have an accurate breast cancer risk perception (aOR 0.572, 95% CI 0.341 to 0.956). Women with lower HL could have stronger perceived barriers to BC screening and an over-estimation of their breast cancer risk. Tackling emotional and knowledge barriers, financial and logistical assistance, and guidance on risk perception are needed to increase their breast cancer screening uptake.

Role of mammography accessibility, deprivation and spatial effect in breast cancer screening participation in France: an observational ecological study

BackgroundThe detection of cancer in its early latent stages can improve patients’ chances of recovery and thereby reduce the overall burden of the disease. Our objectives were to investigate factors (geographic accessibility and deprivation level) affecting mammography screening participation variation and to determine how much geographic variation in participation rates can be explained by spillover effects between adjacent areas, while controlling for covariates.MethodsMammography screening participation rates between 2015 and 2016 were calculated by census blocks (CB), for women aged 50–74 years, residing in Lyon metropolitan area. Global spatial autocorrelation tests were applied to identify the geographic variation of participation. Spatial regression models were used to incorporate spatial structure to estimate associations between mammography participation rate and the combined effect (geographic accessibility and deprivation level) adjusting for modes of travel and social cohesion.ResultsThe mammography participation rate was found to have a statistically significant and positive spatial correlation. The participation rate of one CB was significantly and positively associated with the participation rates of neighbouring CB. The participation was 53.2% in residential and rural areas and 46.6% in urban areas, p < 0.001. Using Spatial Lag models, whereas the population living in most deprived CBs have statistically significantly lower mammography participation rates than lower deprived ones, significant interaction demonstrates that the relation differs according to the degree of urbanization.ConclusionsThis study makes an important methodological contribution in measuring geographical access and understanding better the combined effect of deprivation and the degree of urbanization on mammography participation and other contextual factors that affect the decision of using mammography screening services -which is a critical component of healthcare planning and equity.

CO146 Potential Predictors Affecting Access to Breast Cancer Screening Among Women in the United States Using the Health Behavioral Model: A MEPS Panel Analysis

Despite the national campaign and multiple efforts to reduce the mortality associated with Breast Cancer (BC), mammography screening participation rates remain below the goal set by American Cancer Society (ACS) for the early detection of cancer. The access of mammography screening (MS) and clinical breast examination (CBE) could be improved if potential factors that impact nonattendance were better understood. Therefore, the objective of this study is to evaluate the predictors of breast cancer screening (BCS) behaviors within the frame work of Health belief model.

Factors associated with breast cancer mammography screening and breast self-examination in Irish women: results from the Irish Longitudinal Study on Ageing (TILDA)

Background BreastCheck is Ireland’s breast screening service which offers biennial mammograms to women aged 50–69. Practicing regular breast self-examination (BSE) enhances women’s awareness and increases their perception of their susceptibility to the risk of breast cancer, possibly increasing their likelihood of attending a screening programme which reduces breast cancer mortality. Research is needed to identify the promotors and barriers to both attending breast cancer screening and practicing BSE. Purpose The aim of this study was to determine the promotors and barriers associated with attending breast cancer screening and practicing BSE in Irish women. Materials and Methods Data from the participants of TILDA wave 3 (2014–2015) was used, the participant population included females only (≥50 years old), a total of 3575 women. Bivariate analysis was used to identify variables that were significantly associated with having had a mammogram since the last interview (wave 2) or regularly checking their breasts for lumps (BSE). Regression analysis was then used to determine the effect the significant variables had on predicting the likelihood of participants attending breast screening or practicing BSE. Results Over half (55%) of all women over the age of 50 had a mammogram since wave 2 was completed (2012) and two thirds reported practicing regular BSE. The factors associated with having attended for breast cancer screening were: having private health insurance (OR = 1.86, 95%CI = 1.45–2.380), and practicing BSE (OR = 1.683, 95%CI = 1.344–2.107). The factors found to be associated with practicing regular BSE were: higher quality of life (OR = 1.035, 95%CI = 1.015–1.057), higher BMI (OR = 1.118, 95%CI = 1.020–1.226), being married (OR = 1.436, 95%CI = 1.190–1.732) and attending mammogram screening (OR = 1.691, 95%CI = 1.353–2.114). Conclusion Regular participation in mammography screening reduces breast cancer mortality. Women eligible for BreastCheck were significantly more likely to attend screening. BSE is associated with increased attendance at screening. Health-care professionals should encourage BSE in order to increase screening uptake.

Health Care Accessibility and Breast Cancer Mortality in Europe.

Background: Breast cancer is the most common cause of death, due to malignant neoplasms in women worldwide. The nature of the symptoms associated with breast cancer depends on the stage of the disease. In this case, any cancerous changes in the initial phase of the disease can only be detected during imaging tests. Participation in mammography screening can reduce breast cancer mortality by up to 40%, if only 70% of the eligible population participates in preventive programs. The purpose of the study was to assess the impact of accessibility to health care resources on breast cancer mortality. Methods: Eurostat aggregated health care data was extracted. Hierarchical cluster analysis of average breast cancer mortality identified four groups of countries with similar mortality rates and trends. The data was then analyzed, in terms of access to health care. Results: It was observed that the higher the financial expenditure on health care and the better the health care accessibility, the lower the mortality rates of breast cancer. Conclusions: There are examples indicating that the studied elements are not the only factors affecting the improvement of population health. The authors would like to emphasize the need to influence lifestyle factors, direct cancer risk, and introduce a multidisciplinary approach to breast cancer prevention.

Evaluation of knowledge and practice regarding mammography among a group of Turkish women attending a tertiary hospital.

Early detection is the most important cornerstone of breast cancer in determining treatment outcome and survival. In this study, it was aimed to investigate the level of knowledge, attitude, and practice of mammography in the early diagnosis of breast cancer in a group of women. Data of this descriptive study were collected under observation with the help of a questionnaire. Female patients over 40 years of age or over 30 years of age with a family history of breast cancer admitted to our general surgery outpatient clinic for a health problem other than breast were included. A total of 300 female patients with a mean age of 48.7 ± 10.9 years (min-max, 33-83 years) were included. Median frequency of correct answers among the women participating in the study was 83.7% (76.0-92.0). Mean score obtained by the participants from the questionnaire was 75.7 ± 15.8 (the median score 80; 25th-75th centiles, 73.3-86.7). Slightly more than half of the patients (159 patients, 53%) had at least one mammography scan before. The level of mammography knowledge was negatively correlated with age and the number of previous mammographies, and positively correlated with education level (r= -0.700, p <0.001; r= -0.419, p <0.001 and r= 0.643, p <0.001, respectively). Although the level of knowledge about breast cancer and early diagnosis methods in women was at a satisfactory level, it is obvious that mammography screening practice of women without any breast symptoms is very low. Therefore, it should be aimed to increase women's awareness of cancer prevention and compliance with early diagnosis methods and to promote participation in mammography screening.

Factors affecting intention to screen after being informed of benefits and harms of breast cancer screening: a study in 5 European countries in 2021

BackgroundParticipation in mammography screening comes with harms alongside benefits. Information about screening provided to women should convey this information yet concerns persist about its effect on participation. This study addressed factors that may influence the intention to screen once a woman has been informed about benefits and harms of participation.MethodsA cross-sectional survey of women from five countries (Belgium, France, Italy, Spain, and the United Kingdom) was performed in January 2021. The survey contained a statement regarding the benefits and harms of mammography screening along with items to measure cognitive variables from the theory of planned behaviour and health belief model and the 6-item version of the European Health Literacy Survey Questionnaire (HLS-EU-Q6). Logistic regression and mediation analysis were performed to investigate the effect of cognitive and sociodemographic variables.ResultsA total of 1180 participants responded to the survey. 19.5% of participants (n = 230) were able to correctly identify that mammography screening carries both benefits and harms. 56.9% of participants (n = 672) responded that they would be more likely to participate in screening in the future after being informed about the benefits and harms of mammography screening. Perceived behavioural control and social norms demonstrated were significant in predicting intention, whereas, the effect of health literacy was limited.ConclusionsInforming women about the presence of benefits and harms of in mammography screening participation did not negatively impact upon intention to be screened. Information should also address perception on implementation factors alongside messages on benefits and harms. Overall, screening programme managers should not be discouraged by the assumption of decreased participation through increasing efforts to address the lack of knowledge on benefits and harms.

Breast cancers originating from the terminal ductal lobular units: In situ and invasive acinar adenocarcinoma of the breast, AAB

PurposeTo use mammographic tumour features (imaging biomarkers) to identify and investigate breast cancers originating from the terminal ductal lobular units (TDLUs) of the breast in order to overcome the confusion arising from the current histopathology terminology, which calls cancers arising from the TDLUs either “ductal” or “lobular”. MethodProspectively collected data from a randomized controlled mammography screening trial with more than four decades of follow up, and data from the subsequent population-based service screening program in Dalarna County, Sweden, provided the database necessary for studying nonpalpable, primarily screen-detected breast cancer cases in their earliest detectable phases. Large format thick (subgross) and thin section histopathologic images of breast cancers originating from the TDLUs were correlated with their mammographic tumour features (imaging biomarkers) and long-term patient outcome. ResultsThis systematic correlation indicates that imaging biomarkers can reliably determine the site of origin of breast cancers arising from the terminal ductal lobular units (TDLUs). This breast cancer subgroup has four specific mammographic tumour features: the in situ carcinomas developing from the TDLUs appear as powdery or crushed stone-like calcifications, while the invasive carcinomas appear as stellate/spiculated or circular/oval shaped tumour masses. These features are easily identified with breast imaging, either alone or in combination, unifocal or multifocal. We propose calling breast cancers of TDLU origin acinar adenocarcinoma of the breast (AAB). ConclusionsThe era of early detection necessitates rectifying the current, confusing histopathological nomenclature to one that is based on the anatomical site of origin of breast cancers. Invasive cancers originating from the TDLUs are either stellate/spiculated or circular, irrespective of the complex WHO histopathologic terminology. The mortality reduction accomplished by participation in mammography screening is mostly accomplished by identifying and treating the AABs in their non-palpable, early phase. AABs detected when < 15 mm diameter with no associated carcinoma originating from the major lactiferous ducts (ductal adenocarcinoma of the breast, DAB) have a good to excellent long-term outcome, irrespective of the current terminology, which tends to lead to overtreatment of these early invasive tumours. The conventionally used prognostic factors, including immunohistochemical biomarkers, fail to identify those 1–14 mm invasive AABs tumours that are eventually fatal. This identification can be made preoperatively by including the characteristic mammographic tumour features, imaging biomarkers, in primary diagnosis, treatment planning, and predicting long-term patient outcome. Forthcoming articles will address breast malignancies originating from structures of the breast other than the TDLUs.

Factors associated with mammography screening among Reunionese women : a cross-sectional study

ObjectiveTo explore the factors associated with the uptake of mammography screening in Reunionese women aged 50-65 years. MethodsThis study included all women aged 50 to 65 years participating in a population-based cross-sectional study "FOSFORE". Participants were recruited between March and June 2017 using two sampling frames. The first frame consisted of households with a landline telephone, with or without a mobile line, by first randomly generating a telephone number and then randomly selecting an individual from among all eligible women in the household. The second sampling frame was constituted of women with an exclusive mobile line, who were selected directly if they met the eligibility criteria. Data were weighted for age and socio-professional status to ensure representativeness at the Reunion Island level. Weighted logistic regression was used to calculate odds ratios while adjusting for confounders. Results417 women were included in the study; 63.8% were up to date with guidelines on mammography screening and 36.2% were not up to date. Four factors were significantly associated with mammography screening, with an adjusted odds ratio of 2.92 (95% CI 1.51–5.61) for not having an Active Solidarity Income, 1.98 (95% CI 1.22–3.23) for having a regular gynecological follow-up by a physician, 6.53 (95% CI 3.23–13.21) for performing a Pap smear test in the past two years, and 2.07 (95% CI 1.21–3.52) for having an adequate literacy level (HLQ3). ConclusionThe findings of this study suggest that higher socio-economic status is an indicator of participation in mammography screening in La Réunion, and future educational and intervention programs should target women in deprived areas.

Demographic variables affecting participation in mammography screening: a cross-sectional study

Breast cancer is one of the most common cancers among women. There are three commonly used diagnostic methods in this cancer type, in which the survival rate can be quite high with early diagnosis. Compared to breast self-examination and clinical examination, mammography stands out as a more accurate diagnostic method. Although there are health policies regarding mammography screening in many countries, mammography screening behavior has not reached the desired level worldwide. In this study, we tried to reveal the demographic factors affecting the frequency of women getting mammograms in Turkey. The frequency of mammography screening was estimated with a generalized logit model using the microdata of TURKSTAT Turkey Health Survey. As a result of the model, it was observed that mammography screening differentiated in different age and income groups. It was determined that the disease status increased the frequency of mammography screening, however, marital status and employment status did not have a significant effect.

Breast cancer in Colombia: a growing challenge for the healthcare system.

To provide a comprehensive overview of breast cancer in Colombia. Data on breast cancer in Colombia are scarce. We present incidence data from population-based cancer registries that represent 4 distinct regions of the country. Other data originate from non-governmental institutions and healthcare providers within Colombia, official sources, expert opinion, Colombian legislation, and the Cancer Mortality Atlas publishes by Colombian National Cancer Institute. In Colombia, the age-standardized incidence rate remained relatively stable between 2012 and 2020 (43.1 to 47.8 cases per 100,000 women-years); Additionally, survival since 1995 has presented a substantial improvement from 65.7 to 72.1. In 33% of cases, the diagnosis of breast cancer was made in advanced stages, stage III or higher. The health demography survey conducted in 2015 showed that the participation in mammography screening in women aged 40 to 69 remains low 48.1%. Some limitations regarding access to early detection and diagnosis include economic strata, health insurance coverage, origin, and accessibility. On average, a 90-day period was reported from onset of symptoms to diagnosis of breast cancer. The first action towards improving outcomes in breast cancer should be to improve stage at diagnosis and timely access to care.