National Breast Cancer Screening Research Articles

Novel deep learning algorithm demonstrates strong performance for detection and quantification of breast arterial calcification and associates with cardiovascular disease

Abstract Background Breast arterial calcification (BAC) on mammography is associated with cardiovascular disease (CVD).1, 2 Given mammography is widely used as part of national breast cancer screening programs, routine reporting of BAC could address current limitations of CVD detection in women. Fully automated artificial intelligence (AI) software can facilitate seamless integration of BAC assessment alongside standard radiological evaluation of mammograms. and advancement in AI imaging software may result in clinically significant, superior BAC detection. Purpose To evaluate the performance of a deep-learning, fully-automated BAC detection algorithm against gold standard human BAC detection, and to evaluate its association with cardiovascular risk and disease. Methods A cohort of 285 women (mean age 61) with 2D digital mammography and CVD assessment with either an anatomic or functional test were evaluated. Cardiovascular risk factors were obtained from medical records. Visual BAC (vBAC) was assessed as present/absent by independent reviewers and BAC was scaled by an algorithm incorporating size, length, density and location (aBAC, 0-100). Diagnostic performance of vBAC and aBAC were compared and expressed as area under the receiver operator characteristic curve (AUC). Cardiovascular risk factor and disease prevalence was compared between vBAC and aBAC with CVD status defined by either abnormal anatomical or functional testing. Results The prevalence of vBAC and aBAC were 30.5% and 59.6%, respectively. The algorithm showed excellent discrimination for BAC detection compared with vBAC (AUC 0.92 [95% CI 0.89-0.98]), with sensitivity 94% and negative predictive value 96%. Interpretation took on average 144 seconds/patient with vBAC and 10 seconds/patient with aBAC (p<0.001). We identified 88 discordant cases (vBAC negative, aBAC positive), which were all represented by ‘faint’ BAC scores (<25). aBAC detected a greater proportion of patients with traditional cardiac risk factors, particularly in women <65 years (Figure 1). CVD was present in 136 (48%), among whom 37.5% were detected by vBAC and 61.7% by aBAC. CVD was present in 42% of the 88 discordant cases. Increasing BAC score was associated with increased relative risk of CVD presence (Figure 2). Conclusion Algorithmic scoring of BAC demonstrates a high performance and is faster to perform when compared to vBAC. Furthermore, it identifies greater proportion of women with higher cardiovascular risk and those with prevalent CVD. Lastly, aBAC detects ‘faint’ (visually missed) lesions that may have significant clinical implications.

Regional variations in breast cancer screening uptake and its associated factors in Ghana

Abstract Introduction Timely identification of breast cancer is critical for successful treatment and prevention, reducing its burden. Despite its significance, breast cancer screening services in Ghana are underutilized, with considerable regional variations in uptake rates. We examined the regional differences in breast cancer screening uptake and its associated factors in Ghana. Methods We analyzed data from 15,014 women of reproductive age from the 2022 Ghana Demographic and Health Survey. Spatial mapping illustrated regional variations in screening uptake. Multilevel logistic regression was employed to examine the factors associated with breast cancer screening uptake. Results National breast cancer screening prevalence was 18.4%, with regional variations observed across the 16 regions. Eastern, Western, Brong Ahafo, and Greater Accra had the highest screening uptake. The likelihood of breast cancer screening was higher among women aged 45-49 (aOR = 3.59; 95% CI = 12.52, 5.12), Married women (aOR = 1.44; 95% CI = 1.17-1.77), Higher education, employment, health insurance, recent health facility visits, media access, and wealth index (middle: aOR = 1.45, 95% CI = 1.08, 1.94; richest: aOR = 1.91, 95% CI = 1.36, 2.70). Islamic and African Traditional affiliations decrease screening likelihood (aOR = 0.77; 95% CI = 0.63, 0.95; aOR = 0.46; 95% CI = 0.22, 0.97). Rural residence and specific regions (Ashanti, Oti, Savannah, Upper West) reduce odds, while living in North East increases odds (aOR: 1.86; 95% CI = 1.14-3.03). Conclusions Cost-effective breast cancer screening services are crucial, particularly in rural areas with geographical disparities. Culturally and religiously sensitive protocols are needed to address regional and religious differences. Expanding Ghana’s national health insurance to cover preventive measures like breast cancer screening is essential. Promoting awareness through conventional and digital platforms is crucial for advocating screening. Key messages • Addressing geographical and cultural differences crucial for equitable breast cancer screening in Ghana. • Expanding health insurance and raising awareness vital to promote screening access and reduce disparities.

Socioeconomic inequalities in uptake of outreach mammography before and after accessibility improvement of Taiwan’s national universal breast cancer screening policy

BackgroundTaiwan implemented the Cancer Screening Quality Improvement Program (CAQIP) in 2010. The program sought to enhance mass breast cancer screening accessibility. This study aimed to examine socioeconomic disparities in outreach screening utilization pre-CAQIP (2005–2009) and post-CAQIP (2010–2014).MethodWe conducted a nationwide population-based observational study in Taiwan, analyzing four population databases to evaluate socioeconomic disparities among women aged 50 to 69 years undergoing their first mammography screening pre-CAQIP. Multivariate logistic regression was used to examine changes in utilization of outreach screening pre- and post-CAQIP implementation, and to estimate the Slope Index of Inequity (SII) and Relative Index of Inequity (RII) values.ResultsUtilization of outreach screening through mobile mammography units (MMUs) increased from 6.12 to 32.87% between the two periods. Following CAQIP, a higher proportion of screened women were older, less educated, and from suburban or rural areas. The SII and RII for age, income, and urbanization levels decreased post-CAQIP. However, regarding education level, SII was − 0.592 and RII was 0.392 in the pre-CAQIP period, increasing to -0.173 and 0.804 post-CAQIP, respectively.ConclusionsOur study observed that utilization of outreach screening through MMUs increased after CAQIP. The MMUs made outreach screening services more accessible in Taiwan. Expanding outreach screening services and educational programs to promote mammography uptake in local communities could help reduce the potential effect of socioeconomic disparities, and thus may enhance early detection of breast cancer. Further study could focus on the accessibility of outreach screening and breast cancer outcomes.

Effect of Smoking on the Development of Migraine in Women: Nationwide Cohort Study in South Korea.

Smoking is known to be a significant risk factor for various diseases. Migraine, a condition requiring careful lifestyle management, currently lacks specific guidelines advocating for smoking cessation as a preventive measure. Although cross-sectional studies have suggested a potential link between smoking and an increased risk of migraine, the findings have been inconsistent and conflicting. To date, there has been no longitudinal study which investigated the effect of smoking on the risk of migraine in a prospective setting. This longitudinal study aimed to investigate the impact of smoking on the incidence of migraine in women and examine the modifying effect of menopausal status. Using nationally representative National Health Insurance Service (NHIS) data, women aged ≥40 years who participated in national breast cancer screening in 2009 were followed-up until the end of 2019. Baseline data on smoking status (non-, ex-, and current smoker) as well as the duration and amount of cigarette smoking were collected. A Cox proportional hazards regression model was used to examine the independent effect of smoking on the risk of incident migraine after adjusting for demographics, comorbidities, and female reproductive factors. The results were stratified by menopausal status, and an interaction analysis (smoking × menopause) was performed. In total, 1,827,129 women were included in the analysis. Women with a history of smoking exhibited a higher risk of developing migraine, compared with nonsmokers. Specifically, a higher risk of migraine was observed in women with past (adjusted hazard ratio [HR] 1.044, 95% CI 1.000-1.089) and current cigarette use (adjusted HR 1.050, 95% CI, 1.023-1.079) than in nonsmokers. The effect was greater in premenopausal women (adjusted HR 1.140, 95% CI, 1.108-1.172) than in postmenopausal women (adjusted HR 1.045, 95% CI 1.018-1.073; P<.001). The risk increased with an increased amount of smoking, with a greater association in premenopausal women (P<.001). Smoking increases the risk of migraine in women, with a dose-dependent relationship. Menopause modifies this effect. Our findings suggest that smoking is an important modifiable risk factor of migraine, with a higher impact in premenopausal women. The interaction between smoking and estrogen may increase the vulnerability of the migraine brain.

A structured process for the validation of a decision-analytic model: application to a cost-effectiveness model for risk-stratified national breast screening.

Decision-makers require knowledge of the strengths and weaknesses of decision-analytic models used to evaluate healthcare interventions to be able to confidently use the results of such models to inform policy. A number of aspects of model validity have previously been described, but no systematic approach to assessing the validity of a model has been proposed. This study aimed to consolidate the different aspects of model validity into a step-by-step approach to assessing the strengths and weaknesses of a decision-analytic model. A pre-defined set of steps were used to conduct the validation process of an exemplar early decision-analytic-model-based cost-effectiveness analysis of a risk-stratified national breast cancer screening programme [UK healthcare perspective; lifetime horizon; costs (£; 2021)]. Internal validation was assessed in terms of descriptive validity, technical validity and face validity. External validation was assessed in terms of operational validation, convergent validity (or corroboration) and predictive validity. The results outline the findings of each step of internal and external validation of the early decision-analytic-model and present the validated model (called 'MANC-RISK-SCREEN'). The positive aspects in terms of meeting internal validation requirements are shown together with the remaining limitations of MANC-RISK-SCREEN. Following a transparent and structured validation process, MANC-RISK-SCREEN has been shown to have satisfactory internal and external validity for use in informing resource allocation decision-making. We suggest that MANC-RISK-SCREEN can be used to assess the cost-effectiveness of exemplars of risk-stratified national breast cancer screening programmes (NBSP) from the UK perspective. A step-by-step process for conducting the validation of a decision-analytic model was developed for future use by health economists. Using this approach may help researchers to fully demonstrate the strengths and limitations of their model to decision-makers.

Risk Factors and Mortality Among Women With Interval Breast Cancer vs Screen-Detected Breast Cancer

The risk factors for interval breast cancer (IBC) compared with those for screen-detected breast cancer (SBC) and their association with mortality outcomes have not yet been evaluated among Korean women. To evaluate risk factors associated with IBC and survival among Korean women with IBC compared with those with SBC. This retrospective cohort study used data from the Korean National Health Insurance Service Database. Women who participated in a national mammographic breast cancer screening program between January 1, 2009, and December 31, 2012, were included. Mortality outcomes were calculated from the date of breast cancer diagnosis to the date of death or December 31, 2020. Data were analyzed from March 1 to June 30, 2023. Breast cancer diagnosed within 6 to 24 months after a negative screening result (ie, IBC) or within 6 months after a positive screening result (ie, SBC). Risk factors and survival rates for IBC and SBC. This study included 8702 women with IBC (mean [SD] age, 53.3 [8.6] years) and 9492 women with SBC (mean [SD] age, 54.1 [9.0] years). Compared with SBC, the probability of IBC decreased as mammographic density increased. Lower body mass index, menopausal status, hormone replacement therapy (HRT) use, and lack of family history of breast cancer were associated with a higher likelihood of IBC. When stratified by detection time, younger age at breast cancer diagnosis and family history of breast cancer were associated with an increased likelihood of IBC diagnosed at 6 to 12 months but a decreased likelihood of IBC diagnosed at 12 to 24 months. Overall mortality of IBC was comparable with SBC, but total mortality and cancer-related mortality of IBC diagnosed between 6 and 12 months was higher than that of SBC. The findings of this cohort study suggest that breast density, obesity, and HRT use were associated with IBC compared with SBC. These findings also suggest that higher supplemental breast ultrasound use among Korean women, especially those with dense breasts, could be attributed to a lower incidence of IBC among women with dense breasts compared with women with SBC, due to greater detection. Finally, overall mortality of IBC was comparable with that of SBC.

Screening for hepatitis C virus at the time of mammography using rapid diagnostic tests in women aged between 50 and 74 years (Mamm'OC NCT05067374).

Chronic hepatitis C Virus (HCV) infection presents a global health challenge, with significant morbidity and mortality worldwide. Despite remarkable progress in treatment options, achieving elimination targets by 2030, as set by the World Health Organization, remains elusive. Our study aimed to address this gap by integrating HCV screening into a national breast cancer screening program. Between March 2022 and March 2023, a prospective cross-sectional multicenter study was conducted in four radiology centers in Montpellier, France. We proposed HCV screening to consecutive women undergoing mammography, targeting 1,500 participants aged 50-74 years. A rapid diagnostic test (RDT) for HCV antibodies (HCV Ab) was performed on capillary whole blood, with positive cases undergoing serological and RNA confirmation. Participants also completed a questionnaire on demographic data and risk factors. Acceptance rates, HCV prevalence, and linkage to care were assessed. The acceptance rate for this integrated screening approach was 82.4%. Notably, the seroprevalence of HCV was found to be 0.65%. Linkage to care was prompt, and the cascade of care demonstrated successful treatment outcomes. Importantly, the majority of detected infections were successfully resolved. These findings underscore the feasibility and acceptability of integrating HCV screening with breast cancer screening programs providing updated prevalence data and valuable insights for refining future screening strategies.

Abstract PO1-10-09: The Performance Of Mobile Units Versus Hospital Units In National Breast Cancer Screening Program In Taiwan, 2010-2020

Abstract Purpose After the implementation of mobile units, the screened population increased from 3.9% to 40% of all women from 2004 to 2019 in Taiwan’s Breast Cancer Screening Program. There are limited studies comparing mobile units to hospital units. This study evaluated and compared the performance of the biennial mammography breast cancer screening in mobile units to hospital units in Taiwan over the past decade. Methods A cohort of 3 062 190 women aged 40 to 69 years who underwent biennial breast cancer mammography screenings from 2010 to 2020 was conducted, and data were obtained from the Health Promotion Administration, Ministry of Health and Welfare of Taiwan. Comparing participation of screened women mobile units and hospital units across national screening. Performance measures were determined as percentages and 95% confidence intervals (CIs) using the Wald asymptotic method. Results Among 3 062 190 women who underwent 7 444 450 examinations in the study population, the screened population by mobile units accounted for approximately 45.45 % of total examinations. The volume of screening mammograms performed in the mobile unit increased the number of people reached by this program. Since 2015, screenings performed in the mobile units have outnumbered those performed at brick-and-mortar hospitals: they comprised 480 456 of the 859 221 examinations (55.9%) performed in 2019. During the 10-year periods, the screen-detected cancers were 12 000 and 18 370 for mobile units and hospital units, respectively. Young women preferred screening in hospitals, resulting in a greater proportion of screen-detected cancers among those attending hospitals (49.4%) compared to the mobile unit (34.3%). The mean recall rate was higher in the hospitals at 8.95% (95% CI, 8.93%-8.99%) than in the mobile units at 7.27% (95% CI, 7.25%-7.32%). Conclusion Implementing mobile units increased the coverage of the screening program across the population. Hospital units had a younger patient population and higher recall rate than those mobile units. We can enhance mammography screening rates and follow-up among these groups by identifying these features, which can use to develop programs and materials fitting populations' specific requirements. Summary statement In Taiwan, the development of breast cancer screening has shown beneficial outcomes, especially with the deployment of mobile unit services to increase screened women. Our results could serve as an informative reference for other nations. Keywords: Breast cancer; screening; mobile units; hospital units. Table 1. Clinical Demographics for Mammographic Screening Examinations Table 2. Performance Measures of Digital Mammographic Screenings for Breast Cancer Citation Format: Vy Vu, Amy Ming-Fang Yen, Melissa Min-Szu Yao, Wing P. Chan. The Performance Of Mobile Units Versus Hospital Units In National Breast Cancer Screening Program In Taiwan, 2010-2020 [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 PO1-10-09.

National Breast, Cervical, and Colorectal Cancer Screening Use in Federally Qualified Health Centers

Federally qualified health centers (FQHCs) deliver health care to nearly 30 million underserved persons across the US, yet nationwide and state-level breast, cervical, and colorectal cancer screening use in FQHCs is not described. Furthermore, it is unknown how the underscreened FQHC population contributes to the total underscreened population at national and state levels. To describe national- and state-level breast, cervical, and colorectal cancer screening use among individuals served by FQHCs in the US and to estimate the percentage of underscreened individuals in the general population served by FQHCs. This cross-sectional analysis of cancer screening used data from January 1 through December 31, 2020, from the FQHC Uniform Data System, reported by 1364 FQHCs across the US, and self-reported estimates from the Behavioral Risk Factor Surveillance System. Participants were 16 696 692 US adults served by FQHCs who were eligible for breast (age, 50-74 years), cervical (age, 21-64 years), and colorectal (age, 50-75 years) cancer screening. Analyses were conducted between January 1 and June 30, 2023. Breast, cervical, and colorectal cancer screening. Percentages of breast, cervical, and colorectal cancer screening-eligible individuals up to date on screening. A total of 3 162 882 breast, 7 444 465 cervical, and 6 089 345 colorectal screening-eligible individuals were served by FQHCs in 2020. Nationally, screening use in FQHCs was 45.4% (95% CI, 45.4%-45.5%) for breast cancer, 51.0% (95% CI, 51.0%-51.1%) for cervical cancer, and 40.2% (95% CI, 40.1%-40.2%) for colorectal cancer. Screening use among the US general population was 78.2% (95% CI, 77.6%-78.9%) for breast cancer, 82.9% (95% CI, 82.3%-83.4%) for cervical cancer, and 72.3% (95% CI, 71.7%-72.8%) for colorectal cancer. The contribution of the underscreened population served by FQHCs to the national underscreened general population was 16.9% (95% uncertainty interval [UI], 16.4%-17.4%) for breast cancer, 29.7% (95% UI, 28.8%-30.7%) for cervical cancer, and 14.7% (95% UI, 14.4%-15.0%) for colorectal cancer. Findings from this national cross-sectional study indicated major gaps in cancer screening use in FQHCs in the US. Improved prevention is urgently needed to address screening disparities.

The Prognostic Quality of Risk Prediction Models to Assess the Individual Breast Cancer Risk in Women: An Overview of Reviews

Purpose. Breast cancer is the most common cancer among women globally, with an incidence of approximately two million cases in 2018. Organised age-based breast cancer screening programs were established worldwide to detect breast cancer earlier and to reduce mortality. Currently, there is substantial anticipation regarding risk-adjusted screening programs, considering various risk factors in addition to age. The present study investigated the discriminatory accuracy of breast cancer risk prediction models and whether they suit risk-based screening programs. Methods. Following the PICO scheme, we conducted an overview of reviews and systematically searched four databases. All methodological steps, including the literature selection, data extraction and synthesis, and the quality appraisal were conducted following the 4-eyes principle. For the quality assessment, the AMSTAR 2 tool was used. Results. We included eight systematic reviews out of 833 hits based on the prespecified inclusion criteria. The eight systematic reviews comprised ninety-nine primary studies that were also considered for the data analysis. Three systematic reviews were assessed as having a high risk of bias, while the others were rated with a moderate or low risk of bias. Most identified breast cancer risk prediction models showed a low prognostic quality. Adding breast density and genetic information as risk factors only moderately improved the models’ discriminatory accuracy. Conclusion. All breast cancer risk prediction models published to date show a limited ability to predict the individual breast cancer risk in women. Hence, it is too early to implement them in national breast cancer screening programs. Relevant randomised controlled trials about the benefit-harm ratio of risk-adjusted breast cancer screening programs compared to conventional age-based programs need to be awaited.

Inequality by Skin Color in Breast Cancer Screening in Brazil: a Differences-in-Differences Analysis of the COVID-19 Pandemic.

Breast cancer is the second most common cancer type and the first in mortality among Brazilian women. Mammograms are one of the main early diagnosis strategies. National breast cancer screening coverage is still low. Brazil's low screening coverage is due to high mammography access inequality. Skin color defines healthcare access differences. Our article explores the natural event of the COVID-19 pandemic to analyze differences in screening rates between two racial groups of women through the application of the differences in differences (DiD) estimator. The results indicate that BBI women (Black, Brown, and Indigenous Brazilian) have lower screening rates than WY women (White and Yellow) and that the pandemic reduced the difference between these two groups due to the lower number of mammograms performed by WY women. It is believed that the information channel can explain much of this result. The BA population, wealthier and more educated, may have had additional information about COVID-19 and its consequences, as well as an increased likelihood of working remotely and practicing social distance. Structural racism causes many social indicators to be correlated with inequality of access to mammography and negatively impacts health conditions for BBI women. Public policies are necessary for equal access to breast cancer screening for the most vulnerable women.

Performance measures of 8,169,869 examinations in the National Breast Cancer Screening Program in Taiwan, 2004–2020

BackgroundThe benefits of mammographic screening have been shown to include a decrease in mortality due to breast cancer. Taiwan’s Breast Cancer Screening Program is a national screening program that has offered biennial mammographic breast cancer screening for women aged 50–69 years since 2004 and for those aged 45–69 years since 2009, with the implementation of mobile units in 2010. The purpose of this study was to compare the performance results of the program with changes in the previous (2004–2009) and latter (2010–2020) periods.MethodsA cohort of 3,665,078 women who underwent biennial breast cancer mammography screenings from 2004 to 2020 was conducted, and data were obtained from the Health Promotion Administration, Ministry of Health and Welfare of Taiwan. We compared the participation of screened women and survival rates from breast cancer in the earlier and latter periods across national breast cancer screening programs.ResultsAmong 3,665,078 women who underwent 8,169,869 examinations in the study population, the screened population increased from 3.9% in 2004 to 40% in 2019. The mean cancer detection rate was 4.76 and 4.08 cancers per 1000 screening mammograms in the earlier (2004–2009) and latter (2010–2020) periods, respectively. The 10-year survival rate increased from 89.68% in the early period to 97.33% in the latter period. The mean recall rate was 9.90% (95% CI: 9.83–9.97%) in the early period and decreased to 8.15% (95%CI, 8.13–8.17%) in the latter period.ConclusionsThe evolution of breast cancer screening in Taiwan has yielded favorable outcomes by increasing the screening population, increasing the 10-year survival rate, and reducing the recall rate through the participation of young women, the implementation of a mobile unit service and quality assurance program, thereby providing historical evidence to policy makers to plan future needs.

Prolonged screening interval due to the COVID-19 pandemic and its association with tumor characteristics and treatment; a register-based study from BreastScreen Norway

ObjectiveDuring the COVID-19 pandemic Norway had to suspend its national breast cancer screening program. We aimed to investigate the effect of the pandemic-induced suspension on the screening interval, and its subsequent association with the tumor characteristics and treatment of screen-detected (SDC) and interval breast cancer (IC). MethodsInformation about women aged 50–69, participating in BreastScreen Norway, and diagnosed with a SDC (N = 3799) or IC (N = 1806) between 2018 and 2021 was extracted from the Cancer Registry of Norway. Logistic regression was used to investigate the association between COVID-19 induced prolonged screening intervals and tumor characteristics and treatment. ResultsWomen with a SDC and their last screening exam before the pandemic had a median screening interval of 24.0 months (interquartile range: 23.8–24.5), compared to 27.0 months (interquartile range: 25.8–28.5) for those with their last screening during the pandemic. The tumor characteristics and treatment of women with a SDC, last screening during the pandemic, and a screening interval of 29–31 months, did not differ from those of women with a SDC, last screening before the pandemic, and a screening interval of 23–25 months. ICs detected 24–31 months after screening, were more likely to be histological grade 3 compared to ICs detected 0–23 months after screening (odds ratio: 1.40, 95% confidence interval: 1.06–1.84). ConclusionsPandemic-induced prolonged screening intervals were not associated with the tumor characteristics and treatment of SDCs, but did increase the risk of a histopathological grade 3 IC. This study provides insights into the possible effects of extending the screening interval.

Impact of health disparities on national breast cancer screening participation rates in South Korea

Socioeconomic barriers to cancer screening exist at a regional level. The deprivation index is used to estimate socioeconomic gradients and health disparities across different geographical regions. We aimed to examine the impact of deprivation on breast cancer screening participation rates among South Korean women. Municipal breast cancer screening participation rates in women were extracted from the National Cancer Screening Information System and linked to the Korean version of the deprivation index constructed by the Korea Institute for Health and Social Affairs. A generalised linear mixed model was employed to investigate the association between the deprivation index and age-standardised breast cancer screening participation rates in 2005, 2012, and 2018. Participation rates increased gradually across all age groups from 2005 to 2018. Participants in their 60 s consistently had one of the highest participation rates (2005: 30.37%, 2012: 61.57%, 2018: 65.88%). In 2005, the most deprived quintile had a higher estimate of breast cancer screening participation than the least deprived quintile (2nd quintile; estimate: 1.044, p = 0.242, 3rd quintile; estimate: 1.153, p = 0.192, 4th quintile; estimate: 3.517, p = 0.001, 5th quintile; estimate: 6.913, p = < 0.0001). In 2012, the participation rate also increased as the level of deprivation increased. There were no statistically meaningful results in 2018. Regions with high deprivation have a higher participation rate in breast cancer screening. The role of health disparities in determining cancer outcomes among women in Korea requires further examination.

Engaging Black sexual minority women in breast cancer research: Lessons in community partnerships.

Black sexual minority women (BSMW) face significant breast cancer health inequities and are underrepresented in health research because of historical and present-day exclusion. However, there exists no peer-reviewed literature on best practices for the inclusion of BSMW in cancer research. "Our Breast Health: The Access Project" was a national primary data collection study in June 2018 through October 2019 that aimed to identify facilitators and barriers to breast cancer care among BSMW, and that successfully recruited the highest number of BSMW for any national breast cancer screening study at the time of its publication. The present analysis highlights best practices for reaching BSMW by examining by how effective various recruitment sources were at recruiting BSMW. Recruitment partners were grouped into several categories: (1) cancer focused, (2) Black women or sexual minority women focused, (3) BSMW focused, (4) social media, and (5) other. Then logistic regression was used to estimate the odds that a particular recruitment source category could recruit BSMW compared with other categories. Partnerships with community-based organizations led by and intended for BSMW were the most successful at recruiting BSMW, demonstrating the importance of an intersectional approach to recruitment. Community-based organizations focused on BSMW specifically were 26 times more successful in recruiting BSMW to the study compared with recruiting Black women who were not sexual minorities (odds ratio,26.43 [95% CI, 7.50-93.10]). Successful recruitment enables breast cancer research grounded in the perspectives of BSMW, which can generate key findings that have the potential to remedy longstanding health inequities for this population.

Beyond a decade: a comparative study of 15-year survival rates in screen-detected vs. symptomatic breast cancer patients in Hungary

BackgroundBreast cancer is the leading cancer in women globally. Despite decreasing mortality rates, largely due to early detection and modern treatment, the effectiveness of screening on long-term survival outcomes remains unclear.AimsThis study evaluates the 15-year survival outcomes of a national breast cancer screening program initiated in Hungary in 2002.MethodsUsing a prospectively maintained patient database, the study included individuals from the first 6 years of the program who underwent surgery for histologically confirmed breast cancer and had available follow-up information. Patients were categorized based on the method of breast cancer detection into two groups: those diagnosed during or 2 years after the population-based screening exam (Group A), and those who self-detected or sought medical attention for symptoms (Group B).ResultsOf the 309 patients who underwent breast cancer surgery, 208 were screen-detected (Group A) and 101 were symptomatic (Group B). The 15-year overall survival was 75.0% for Group A and 76.2% for Group B (p = 0.927). The 15-year disease-specific survival was 85.6% and 81.2% (p = 0.249), respectively. A statistically not significant positive trend in disease-free survival was observed in Group A (81.7% vs. 75.2%; p = 0.144).ConclusionsThe study underscores the importance of extended follow-up periods in evaluating the outcomes of breast cancer screening programs. While the screening program may not significantly enhance overall survival rates, it has demonstrated a reduction in the mastectomy rate and could potentially extend periods of disease-free survival. These findings contribute to the ongoing discourse about the long-term benefits of breast cancer screening programs.

Evaluating a Comprehensive and Cost-Effective Accelerated Breast Health Curriculum in Guyana for Healthcare Providers

The incidence and mortality rate of breast cancer continues to rise in Guyana. One key factor contributing to this issue is that Guyana does not have a national breast cancer screening program nor the resources or infrastructure to support one. As a result, it is important to consider cost-effective solutions that can promote the early detection of breast cancer. The literature suggests a promising intervention could address gaps in frontline healthcare providers' knowledge and understanding of breast health. Providers who receive dedicated curricular training in breast health in conjunction with learning the clinical breast exam (CBE) and ultrasound tend to show an increase in their early detection rates. With this in mind, we sought to evaluate an existing breast health curriculum in Georgetown, Guyana, by measuring provider fund of knowledge before and after the intervention. Over 1 week, sixty-two participants, mostly nursing students, were divided into two groups. Each group participated in the two-and-a-half-day course. Participants were given a pretest assessment and then went through an intensive 8-module course complete with CBE training and ultrasound demonstration before taking a posttest. We found that while only one of the sixty-two participants passed the initial pretest assessment, forty of the sixty-two participants passed the posttest. Statistical analysis showed that the difference in test scores between the pretest and the posttest was statistically significant. While more studies are needed, these findings suggest that focusing on the breast health knowledge of providers in Guyana and other similar countries may be a highly effective yet cost-friendly intervention that could significantly improve early detection rates and ease the breast cancer disease burden.

A brief intervention for improving alcohol literacy and reducing harmful alcohol use by women attending a breast screening service: a randomised controlled trial.

To assess the effectiveness of a brief alcohol intervention for improving awareness of alcohol as a breast cancer risk factor, improving alcohol literacy, and reducing alcohol consumption by women attending routine breast screening. Single-site, double-blinded randomised controlled trial. Maroondah BreastScreen (Eastern Health, Melbourne), part of the national breast cancer screening program. Women aged 40 years or more, with or without a history of breast cancer and reporting any alcohol consumption, who attended the clinic for routine mammography during 5February - 27 August 2021. Active arm: animation including brief alcohol intervention (four minutes) and lifestyle health promotion (three minutes). lifestyle health promotion only. Change in proportion of women who identified alcohol use as a clear risk factor for breast cancer (scaled response measure). The mean age of the 557 participants was 60.3 years (standard deviation, 7.7 years; range, 40-87 years); 455 had recently consumed alcohol (82%). The proportions of participants aware that alcohol use increased the risk of breast cancer were larger at four weeks than at baseline for both the active intervention (65% v 20%; odds ratio [OR], 41; 95% confidence interval [CI], 18-97) and control arms of the study (38% v 20%; OR, 4.9; 95% CI, 2.8-8.8), but the change over time was greater for the active intervention arm (arm × time: P < 0.001). Alcohol literacy also increased to a greater extent in the active than the control arm, but alcohol consumption did not significantly change in either arm. A tailored brief alcohol intervention for women attending breast screening was effective for improving awareness of the increased breast cancer risk associated with alcohol use and alcohol literacy more broadly. Such interventions are particularly important given the rising prevalence of risky drinking among middle-aged and older women and evidence that even very light alcohol consumption increases breast cancer risk. ClinicalTrials.gov, NCT04715516 (prospective; 20January 2021).

Women's health literacy and attendance in breast cancer screening: A Danish population-based study combining survey and register data.

To investigate the association between women's health literacy and attendance in the Danish national breast cancer screening programme. In a population-based cross-sectional study, information on two health literacy subscales, measured using the Health Literacy Questionnaire (HLQ), and sociodemographic factors was obtained from the 'How are you? 2017' survey in the Central Denmark Region. Information on screening attendance was obtained from register data from 2016-2017. Data were linked based on individual civil registration numbers. To account for missing data, multiple imputation by chained equations was implemented to fill in missing values on all variables. Unadjusted and adjusted logistic regression analyses were performed separately for two HLQ subscales to estimate odds ratio (OR) of screening attendance. Both multiple imputation analyses and complete case analyses were performed. A total of 6012 women were included in multiple imputed statistical analyses. Generally, women had high health literacy levels. In multiple imputed analyses, the unadjusted OR of the primary HLQ subscale, understanding, was 1.32 (95% confidence interval (CI): 1.10-1.59), indicating higher odds for screening attendance with higher health literacy level. However, after adjustment no significant association between the HLQ subscale of understanding and screening attendance was found (OR 1.09 (95% CI: 0.90-1.33)). Similar results were found for the secondary HLQ subscale of engaging (insignificant association in adjusted analysis). No effect modification from sociodemographic characteristics was found. Similar results were found in complete case analyses. No significant association was found between health literacy and attendance in the Danish breast cancer screening programme.

One-year results of the national breast and cervical cancer screening program: Giresun province in the black sea region

Background/Aim: Increasing the survival rate of patients with breast and cervical cancers is possible by early diagnosis through screening individuals for cancer in the asymptomatic period. Especially during the COVID-19 pandemic period, the possibility of early diagnosis in breast and cervical cancers has decreased due to the decrease in cancer screening applications. The aim of cancer screening is to increase the survival of patients by detecting precancerous lesions early. The purpose of our study is to evaluate the application and results of breast and cervical cancer screening in the Black Sea region’s Giresun province. Methods: This is a cross-sectional and descriptive study. The results of patients who were admitted to the Giresun Early Diagnosis Cancer Screening and Education Center between July 1, 2021, and June 28, 2022, were examined. The mammography report results of women aged 40–69 years who applied to the cancer screening center for breast cancer screening, and the HPV and Pap smear results of the patients aged 30–65 years who applied for cervical cancer screening, were evaluated retrospectively through the public health management system. Mammography results were evaluated with BIRADS (Breast Imaging Reporting and Dated System) scoring. The type of HPV and the cytology results from cervical swab samples were analyzed for cervical cancer screening. Results: A total of 3567 people underwent mammography. Per the mammography results, the percentage of those with BIRADS 0 was 7.7% (n=278), the percentage of those with BIRADS 1–2 was 91% (n=3256), the percentage of those with BIRADS 4 was 0.7% (n=25), and the percentage of those with BIRADS 5 was 0.14% (n=5). HPV-DNA and cervical cytology examinations were performed for cervical cancer screening in 2326 patients. As a result of cervical cancer screening, HPV positivity was found in 6.44% (n=150) patients, and 14 different HPV types were found in the positive samples. When HPV types were examined, the two most common types were HPV type 16 (13.6%) and type 56 (11.9%). When the HPV types were examined in the positive samples, the two most common types were HPV type 16 (13.6%) and type 56 (11.9%). HPV type 18 was the least detected HPV type in patients (3.7%). When the Pap smear screening results of the 150 cases with positive screening results were examined, 3.33% were ASC-US (atypical squamous cells of undetermined significance), 22% were reported as infection, and 62.6% were normal. Conclusion: The role of primary care physicians directing patients registered in their coverage area to cancer screening programs is especially effective in raising society’s awareness and education on the issue. As a result, it is important that primary care physicians and related specialist physicians, together with cancer early detection and screening centers, adopt a supportive stance towards these programs in order for them to be implemented effectively.