Breast Cancer Screening Outcomes Research Articles

Transforming Breast Cancer Care and Clinical Outcomes: Local Experience in Yanbu Industrial City, Saudi Arabia

ObjectiveThis study aimed to enhance outcomes for women undergoing breast cancer screening in a low utilization setting by implementing structured improvement cycles. MethodsImprovement cycles were conducted using the Plan-Do-Study-Act (PDSA) methodology. Three cycles were implemented: (1) dedicating a specific day for breast screening and increasing appointment slots; (2) establishing a breast screening clinic with same-day registration; and (3) introducing a breast surgery clinic to expedite biopsy procedures for BI-RADS-4 category cases. ResultsFollowing each improvement cycle, dramatic increases in patient attendance were observed. In 2021, there was a 67.5% rise compared to the previous year, and a 72% increase in 2022 compared to 2021 figures. Patient characteristics revealed that 60% of attendees were new patients, with 53% of cancer and precancerous cases observed in women below 50 years old. Before the third cycle, the estimated diagnosis turnaround time (TAT) showed that only 23% of patients had their biopsy completed within five working days. However, after the third cycle (n = 131), 63.5% of biopsies were done within five working days. ConclusionStructured improvement cycles guided by the PDSA methodology effectively enhanced breast cancer screening outcomes. These cycles led to increased patient attendance, expedited biopsy procedures, and improved access to timely diagnosis. The findings highlight the importance of systematic approaches in optimizing breast cancer screening and improving patient care. MicroAbstractThis study aimed to improve breast cancer screening outcomes using structured Plan-Do-Study-Act (PDSA) cycles. Implementing dedicated screening days, same-day registration, and expedited biopsy procedures. Turnaround improved from 23% to 63.5% within 5 days post-third cycle. PDSA-guided cycles dramatically improved patient attendance, expedited biopsy procedures, and timely diagnosis, optimizing breast cancer screening and patient care.

Evaluating the Impact of a Clinical Breast Examination Screening Program within the IraPEN Project.

Breast cancer is a prevalent global cancer and a leading cause of mortality in developed countries. In 2015, Iran introduced the Package of Essential Noncommunicable Diseases (IraPEN) as a pilot project to tackle prevalent noncommunicable diseases, including breast cancer. However, there is limited research evaluating the implementation, costs, and outcomes of breast cancer screening within IraPEN. Therefore, this study aims to investigate the costs and outcomes of the clinical breast examination screening program in Isfahan from 2017 to 2020. This descriptive cost-outcome study utilized data from 450,876 individuals aged 30 to 69 who participated in clinical breast examination screening. The outcomes assessed in this program encompassed the number of participants, the number of individuals identified with symptoms, referrals to the next level of examination, the number of individuals undergoing mammography, recorded mammography results, and the number of cases of breast cancer identified. Direct costs were estimated, including personnel, infrastructure, equipment, and other related expenses. ‌The findings revealed that the direct costs of the breast cancer screening program in Isfahan between 2017 and 2020 were 310,514,608,558 Rials, equivalent to approximately 15,470,633 PPP$. These expenses led to the identification of 134,508 individuals with symptoms, referrals of 258,599 individuals to the subsequent level of examination, and approximately 55,974 individuals undergoing mammography tests. This study demonstrates that the breast cancer screening program provides a significant number of women in the target age group with breast self-examination education while raising public awareness about this disease.

Enhancing Accuracy in Breast Density Assessment Using Deep Learning: A Multicentric, Multi-Reader Study.

The evaluation of mammographic breast density, a critical indicator of breast cancer risk, is traditionally performed by radiologists via visual inspection of mammography images, utilizing the Breast Imaging-Reporting and Data System (BI-RADS) breast density categories. However, this method is subject to substantial interobserver variability, leading to inconsistencies and potential inaccuracies in density assessment and subsequent risk estimations. To address this, we present a deep learning-based automatic detection algorithm (DLAD) designed for the automated evaluation of breast density. Our multicentric, multi-reader study leverages a diverse dataset of 122 full-field digital mammography studies (488 images in CC and MLO projections) sourced from three institutions. We invited two experienced radiologists to conduct a retrospective analysis, establishing a ground truth for 72 mammography studies (BI-RADS class A: 18, BI-RADS class B: 43, BI-RADS class C: 7, BI-RADS class D: 4). The efficacy of the DLAD was then compared to the performance of five independent radiologists with varying levels of experience. The DLAD showed robust performance, achieving an accuracy of 0.819 (95% CI: 0.736-0.903), along with an F1 score of 0.798 (0.594-0.905), precision of 0.806 (0.596-0.896), recall of 0.830 (0.650-0.946), and a Cohen's Kappa (κ) of 0.708 (0.562-0.841). The algorithm achieved robust performance that matches and in four cases exceeds that of individual radiologists. The statistical analysis did not reveal a significant difference in accuracy between DLAD and the radiologists, underscoring the model's competitive diagnostic alignment with professional radiologist assessments. These results demonstrate that the deep learning-based automatic detection algorithm can enhance the accuracy and consistency of breast density assessments, offering a reliable tool for improving breast cancer screening outcomes.

Factors Associated with Abnormal Mammogram Results Among Low-Income Uninsured Populations in Medically Underserved And Rural Texas Regions.

This study investigated the potential associations between neighborhood characteristics, rurality, ethnicity/race, and breast cancer screening outcomes in designated Health Professional Shortage Areas in Central Texas. Limited access to preventive medical care can impact screening rates and outcomes. Previous research on the effects of factors such as rurality, neighborhood socioeconomic status, and education level on cancer prevention behaviors has yielded inconsistent results. We analyzed data from a state-funded breast and cervical cancer screening programs for disadvantaged and medically underserved individuals. A mixed-effects logistic regression model was used to assess the impact of residency characteristics (rurality, educational attainment, unemployment, and poverty) on abnormal breast cancer screening outcomes, with individual level (age, ethnicity, race, and education) as control variables. During the studied time, there were 1,139 women screened and 134 abnormal mammograms found. Residency characteristics were not significantly associated with abnormal mammography outcomes at 0.05. However, individual factors are strongly associated with abnormal screening results. Non-Hispanic or Latino white women had increased odds of abnormal clinical outcomes compared with Hispanic or Latino women (OR = 2.03, CI 1.25-3.28; p = 0.004). Additionally, women residing in counties with more than 30% of the population completing college had increased odds of abnormal mammogram outcomes compared with counties with less than 15% college attainment (OR = 2.89, CI 0.99-8.38; p = 0.051). This study found a significant correlation between area-level educational characteristics and abnormal mammography outcomes. Future research should explore the contextual risk factors influencing breast cancer occurrence and develop targeted interventions for this population.

Outcomes of Breast Cancer Screening Strategies Based on Cancer Intervention and Surveillance Modeling Network Estimates.

Background There is ongoing debate about recommendations for breast cancer screening strategies, specifically regarding the frequency of screening and the age at which to initiate screening. Purpose To compare estimates of breast cancer screening outcomes published by the Cancer Intervention and Surveillance Modeling Network (CISNET) to understand the benefits and risks of different screening scenarios. Materials and Methods Modeling estimates published by CISNET are based on hypothetical cohorts in the United States and compare women, starting at 40 years of age, who do and do not undergo breast cancer screening with mammography. The four scenarios assessed in this study, of multiple possible scenarios, were biennial screening ages 50-74 years (2009 and 2016 U.S. Preventive Services Task Force [USPSTF] recommendations), biennial screening ages 40-74 years (2023 USPSTF draft recommendation), annual screening ages 40-74 years, and annual screening ages 40-79 years. For each scenario, CISNET estimates of median lifetime benefits were compared. Risks that included false-positive screening results per examination and benign biopsies per examination were also calculated and compared. Results Estimates from CISNET 2023 showed that annual screening ages 40-79 years improved breast cancer mortality reduction compared with biennial screening ages 50-74 years and biennial screening ages 40-74 years (41.7%, 25.4%, and 30%, respectively). Annual screening ages 40-79 years averted the most breast cancer deaths (11.5 per 1000) and gained the most life-years (230 per 1000) compared with other screening scenarios (range, 6.7-11.5 per 1000 and 121-230 per 1000, respectively). False-positive screening results per examination were less than 10% for all screening scenarios (range, 6.5%-9.6%) and lowest for annual screening ages 40-79 years (6.5%). Benign biopsies per examination were less than 1.33% for all screening scenarios (range, 0.88%-1.32%) and lowest for annual screening ages 40-79 years (0.88%). Conclusion CISNET 2023 modeling estimates indicate that annual breast cancer screening starting at 40 years of age provides the greatest benefit to women and the least risk per examination. © RSNA, 2024 See also the editorial by Joe in this issue.

Prevalent vs Incident Screen: Why Does It Matter?

There are important differences in the performance and outcomes of breast cancer screening in the prevalent compared to the incident screening rounds. The prevalent screen is the first screening examination using a particular imaging technique and identifies pre-existing, undiagnosed cancers in the population. The incident screen is any subsequent screening examination using that technique. It is expected to identify fewer cancers than the prevalent screen because it captures only those cancers that have become detectable since the prior screening examination. The higher cancer detection rate at prevalent relative to incident screening should be taken into account when analyzing the medical audit and effectiveness of new screening technologies.

Breast cancer screening outcomes and risk assessment among women of Abha city, Saudi Arabia

Breast cancer is one of the most common cancers among women and the leadingcause of death related to cancers. This study focuses on the screening of breast cancer for earlydetection of breast cancer and identification of risk factors for the development of breast cancer. This cross-sectional study was conducted among the female participants who were registered for the breast cancer screening program conducted by King Khalid University, Abha under the supervision of Family and Community Medicine, Department of College of Medicine. Convenience sampling was done and a total of 331 patients were selected for the study. The collected data were coded and entered into an Excel software (Microsoft Office Excel 2010) database. Data was analyzed using Statistical Package for Social Sciences, version 16 (SPSS, Inc., Chicago, IL, USA). p < 0.05 was considered statistically significant. Out of 331 individuals only 3 (0.9%) were diagnosed with breast cancer. Three cases ofinvasive ductal carcinoma were identified among individuals with breast cancer. While 4 (1.2%) individuals had benign findings, such as fibroadenoma, ductal ectasia, sclerosing adenosis, andtissue fibrosis. Past surgical history, past radiotherapy/chemotherapy, and maternal problemsduring pregnancy were significantly associated with varying levels of breast cancer risk. Breastcomplaints show a significant association with breast cancer indicating the need for furtherinvestigation. Findings from physical examinations, mammography reports, breast ultrasound, biopsy referrals, biopsy results, and management plans all show significant relationships withbreast cancer risk. Our study findings indicate the need for health education for the prevention of breastcancer risk factors and the implementation of regular screening programs for the early detectionof the disease in the community.

Digital Breast Tomosynthesis versus Digital Mammography Screening Performance on Successive Screening Rounds from the Breast Cancer Surveillance Consortium.

Background Prior cross-sectional studies have observed that breast cancer screening with digital breast tomosynthesis (DBT) has a lower recall rate and higher cancer detection rate compared with digital mammography (DM). Purpose To evaluate breast cancer screening outcomes with DBT versus DM on successive screening rounds. Materials and Methods In this retrospective cohort study, data from 58 breast imaging facilities in the Breast Cancer Surveillance Consortium were collected. Analysis included women aged 40-79 years undergoing DBT or DM screening from 2011 to 2020. Absolute differences in screening outcomes by modality and screening round were estimated during the study period by using generalized estimating equations with marginal standardization to adjust for differences in women's risk characteristics across modality and round. Results A total of 523 485 DBT examinations (mean age of women, 58.7 years ± 9.7 [SD]) and 1 008 123 DM examinations (mean age, 58.4 years ± 9.8) among 504 863 women were evaluated. DBT and DM recall rates decreased with successive screening round, but absolute recall rates in each round were significantly lower with DBT versus DM (round 1 difference, -3.3% [95% CI: -4.6, -2.1] [P < .001]; round 2 difference, -1.8% [95% CI: -2.9, -0.7] [P = .003]; round 3 or above difference, -1.2% [95% CI: -2.4, -0.1] [P = .03]). DBT had significantly higher cancer detection (difference, 0.6 per 1000 examinations [95% CI: 0.2, 1.1]; P = .009) compared with DM only for round 3 and above. There were no significant differences in interval cancer rate (round 1 difference, 0.00 per 1000 examinations [95% CI: -0.24, 0.30] [P = .96]; round 2 or above difference, 0.04 [95% CI: -0.19, 0.31] [P = .76]) or total advanced cancer rate (round 1 difference, 0.00 per 1000 examinations [95% CI: -0.15, 0.19] [P = .94]; round 2 or above difference, -0.06 [95% CI: -0.18, 0.11] [P = .43]). Conclusion DBT had lower recall rates and could help detect more cancers than DM across three screening rounds, with no difference in interval or advanced cancer rates. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Skaane in this issue.

New Horizons: Artificial Intelligence for Digital Breast Tomosynthesis.

The use of digital breast tomosynthesis (DBT) in breast cancer screening has become widely accepted, facilitating increased cancer detection and lower recall rates compared with those achieved by using full-field digital mammography (DM). However, the use of DBT, as compared with DM, raises new challenges, including a larger number of acquired images and thus longer interpretation times. While most current artificial intelligence (AI) applications are developed for DM, there are multiple potential opportunities for AI to augment the benefits of DBT. During the diagnostic steps of lesion detection, characterization, and classification, AI algorithms may not only assist in the detection of indeterminate or suspicious findings but also aid in predicting the likelihood of malignancy for a particular lesion. During image acquisition and processing, AI algorithms may help reduce radiation dose and improve lesion conspicuity on synthetic two-dimensional DM images. The use of AI algorithms may also improve workflow efficiency and decrease the radiologist's interpretation time. There has been significant growth in research that applies AI to DBT, with several algorithms approved by the U.S. Food and Drug Administration for clinical implementation. Further development of AI models for DBT has the potential to lead to improved practice efficiency and ultimately improved patient health outcomes of breast cancer screening and diagnostic evaluation. See the invited commentary by Bahl in this issue. ©RSNA, 2022.

Review of the scientific literature on the use of automated breast ultrasound for screening

Several technological developments have been carried out recently to improve the effectiveness of breast cancer screening. Most of them have emerged as a complementary method to mammography. Automated breast ultrasound is one of these technologies. The objective of this study is to provide an overview on guidelines and recommenda-tions related to the application of automated breast ultrasound as a screening modality and to summarize the scien-tific literature. Targeted literature review was performed to collect information. We searched in publicly available databases for guidelines and recommendations as well as scientific publications on screening and early detection. We found substantial amount of information about automated breast ultrasound mainly for patients with dense breast; however, breast cancer screening guidelines have not yet incorporated this technology. 9 clinical studies were in-cluded in the review, most of them were single-arm studies with relatively short follow-up time. Most of them were performed in the USA. Results were presented mainly for short-term outcomes of breast cancer screening: sensitiv-ity, specificity, tumor detection rate and recall rate. The opportunity for retrospective evaluation of the images and the reproducibility are considered the most important advantages. Evidence suggest that the cancer detection rate can be improved compared to mammography alone in women with dense breast. The main disadvantages of this technology are the high recall and false positive rates. Further scientific evidence is required to reduce uncertainty related to the use of automated breast ultrasound for breast cancer screening.

Disparate access to breast cancer screening and treatment

BackgroundBarriers to breast cancer screening remain despite Medicaid expansion for preventive screening tests and implementation of patient navigation programs under the Affordable Care Act. Women from underserved communities experience disproportionately low rates of screening mammography. This study compares barriers to breast cancer screening among women at an inner-city safety-net center (City) and those at a suburban county medical center (County). Inner city and suburban county medical centers’ initiatives were studied to compare outcomes of breast cancer screening and factors that influence access to care.MethodsWomen 40 years of age or older delinquent in breast cancer screening were offered patient navigation services between October 2014 and September 2019. Four different screening time-to-event intervals were investigated: time from patient navigation acceptance to screening mammography, to diagnostic mammography, to biopsy, and overall screening completion time. Barriers to complete breast cancer screening between the two centers were compared.ResultsWomen from lowest income quartiles took significantly longer to complete breast cancer screening when compared to women from higher income quartiles when a barrier was present, regardless of barrier type and center. Transportation was a major barrier to screening mammography completion, while fear was the major barrier to abnormal screening work up.ConclusionDisparity in breast cancer screening and management persists despite implementation of a patient navigation program. In the presence of a barrier, women from the lowest income quartiles have prolonged breast cancer screening completion time regardless of center or barrier type. Women who experience fear have longest screening time completion. Future directions aim to increase resource allocation to ameliorate wait times in overburdened safety-net hospitals as well as advanced training for patient navigators to alleviate women’s fears.

Assessing the impact of the COVID-19 pandemic on breast cancer screening and diagnosis rates: A rapid review and meta-analysis.

ObjectiveThe ongoing COVID-19 pandemic has caused an indefinite delay to cancer screening programs worldwide. This study aims to explore the impact on breast cancer screening outcomes such as mammography and diagnosis rates.MethodsWe searched Ovid MEDLINE, Ovid Embase, medRxiv and bioRxiv between January 2020 to October 2021 to identify studies that reported on the rates of screening mammography and breast cancer diagnosis before and during the pandemic. The effects of ‘lockdown’ measures, age and ethnicity on outcomes were also examined. All studies were assessed for risk of bias using the Newcastle-Ottawa Scale (NOS). Rate ratios were calculated for all outcomes and pooled using standard inverse-variance random effects meta-analysis.ResultsWe identified 994 articles, of which 7 registry-based and 24 non-registry-based retrospective cohort studies, including data on 4,860,786 and 629,823 patients respectively across 18 different countries, were identified. Overall, breast cancer screening and diagnosis rates dropped by an estimated 41–53% and 18–29% respectively between 2019 and 2020. No differences in mammogram screening rates depending on patient age or ethnicity were observed. However, countries that implemented lockdown measures were associated with a significantly greater reduction in mammogram and diagnosis rates between 2019 and 2020 in comparison to those that did not.ConclusionThe pandemic has caused a substantial reduction in the screening and diagnosis of breast cancer, with reductions more pronounced in countries under lockdown restrictions. It is early yet to know if delayed screening during the pandemic translates into higher breast cancer mortality.

Abstract P2-10-05: The estimated impact of COVID-19 on population breast cancer screening outcomes, and options for risk-based recovery

Abstract OBJECTIVES AND RATIONALE Estimating the impact of COVID-19 on cancer screening programs and related outcomes can help health services prepare for potential delays in diagnoses and different demands on treatment services and plan for best approaches to recovery. Simulation modelling enables estimation of outcomes for a range of scenarios. In this study, we estimate the impact of various disruptions and recovery strategies for the Australian biennial mammographic breast screening program (BreastScreen). METHOD Policy1-Breast is a continuous-time, multiple-cohort micro-simulation model that simulates the whole Australian female population, incorporating breast cancer risk and natural history, breast density, menopause, hormone therapy use and breast cancer screening. Firstly, in the early stages of the COVID pandemic we used Policy1-Breast to evaluate how 3, 6, 9 and 12-month pauses to BreastScreen would impact on population-level breast cancer diagnoses, tumour staging, and breast cancer survival, compared to business-as-usual (BAU) outcomes. Secondly, to explore options for recovery after an actual one-month screening pause in April 2020, we evaluated a range of assumed throughput levels following screening resumption (50% or 80% up to December, then 100% to 120% from Jan 2021), comparing various protocols where specific sub-groups of clients were prioritised for screening during the recovery period. Outcomes are reported for the target age range for the BreastScreen program (50-74 years). RESULTS For 3- to 12-month pauses, we estimated a slight reduction in 5-year survival following diagnosis for women directly affected by a pause, but no discernible changes to population-level breast cancer mortality rates up to 2023. We estimated marked fluctuations in population rates of invasive breast cancer diagnoses with a 10% increase in cancer diagnoses between 2020-2021 and 2022-2023. For a 12-month pause to screening we estimate that population-level breast cancers would increase in size (with an additional 4% &amp;gt;15mm at diagnosis) and be more likely to involve the nodes (increasing from 26% to 30% of all cancers). We estimate that median screening intervals during 2020-2021 would increase from 104 weeks under BAU up to 130 weeks with a 12-month pause, and BreastScreen recall rates and false positive recall rates would fluctuate markedly over time. For the second evaluation of a one-month pause followed by various throughput and prioritisation scenarios, we estimated that screen-detected cancer rates would vary markedly with throughput but interval cancer rates would not, leading to fluctuations in program sensitivity of up to 6%. Reflecting the periodic nature of screening participation, we estimated the extent to which longer-term future screening participation rates are expected echo the peaks and troughs in participation due to the impacts of the COVID pandemic in 2020. We estimate that for a given throughput assumption, client prioritisation could lead to different rescreening rates, screening intervals, and time required for prioritisation protocols, with little change to cancer outcomes. CONCLUSION These modelled evaluations estimate short and longer-term effects of COVID-19 on the impact of population breast cancer screening in Australia. The estimated changes in breast cancer rates and characteristics would be expected to have a flow-on effect on the demand for treatment services in terms of throughput and case-mix. Preparing for such outcomes is critical given that treatment services are also directly impacted by the pandemic. The modelled outcomes are likely to be relevant to other high-income settings with established population breast cancer screening programs. Citation Format: Pietro Procopio, Sabine Deij, Louiza S Velentzis, Amanda Tattam, Lara Petelin, Carolyn Nickson. The estimated impact of COVID-19 on population breast cancer screening outcomes, and options for risk-based recovery [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-10-05.

Breast cancer screening outcomes among Mexican-origin Hispanic women participating in a breast cancer screening program

Breast cancer is the commonest occurring cancer and the leading cause of cancer death among Hispanic women in the USA. Although their overall breast cancer incidence and mortality is lower, incidence rates are rising faster and mortality declines are lower than other groups. It is expected that the breast cancer burden will rise as this population ages and becomes more acculturated. It is therefore important to better characterize their screening outcomes. This is an observational study of socioeconomically disadvantaged Hispanic women participating in a community-based breast cancer screening program that offered no-cost testing and navigation services in two US-Mexico border counties. Outcomes include results of screening mammograms, diagnostic tests and breast findings. Of 1,966 eligible women, 1,675 (85%) completed a screening mammogram and were included in this analysis. Mean age was 56 years (SD: 6.8 years, range 50 to 75.6 years); 99% were Hispanic and 83.6% had less than high school education. 19.3% of the initial mammogram results were abnormal (BIRADS 0, 3, 4, or 5); a diagnostic mammogram was indicated in 12.2% (n = 205), a diagnostic ultrasound in 26.4% (n = 443), and biopsies in 3.0% (n = 51) of the total. Eleven women (0.66%) had breast cancer diagnosed. Mexican-origin Hispanic women had higher recall rates, but similar biopsy and cancer rates to general screening populations despite their overall lower incidence and mortality in the USA. This suggests that the expected rise in future breast cancer burden among US Hispanics due to aging and acculturation could occur sooner than expected.

Comparative Effectiveness of Digital Breast Tomosynthesis for Breast Cancer Screening Among Women 40-64 Years Old.

Digital breast tomosynthesis (DBT) may have a higher cancer detection rate and lower recall compared with 2-dimensional (2 D) mammography for breast cancer screening. The goal of this study was to evaluate screening outcomes with DBT in a real-world cohort and to characterize the population health impact of DBT as it is widely adopted. This observational study evaluated breast cancer screening outcomes among women screened with 2 D mammography vs DBT. We used deidentified administrative data from a large private health insurer and included women aged 40-64 years screened between January 2015 and December 2017. Outcomes included recall, biopsy, and incident cancers detected. We used 2 complementary techniques: a patient-level analysis using multivariable logistic regression and an area-level analysis evaluating the relationship between population-level adoption of DBT use and outcomes. All statistical tests were 2-sided. Our sample included 7 602 869 mammograms in 4 580 698 women, 27.5% of whom received DBT. DBT was associated with modestly lower recall compared with 2 D mammography (113.6 recalls per 1000 screens, 99% confidence interval [CI] = 113.0 to 114.2 vs 115.4, 99% CI = 115.0 to 115.8, P < .001), although younger women aged 40-44 years had a larger reduction in recall (153 recalls per 1000 screens, 99% CI = 151 to 155 vs 164 recalls per 1000 screens, 99% CI = 163 to 166, P < .001). DBT was associated with higher biopsy rates than 2 D mammography (19.6 biopsies per 1000 screens, 99% CI = 19.3 to 19.8 vs 15.2, 99% CI = 15.1 to 15.4, P < .001) and a higher cancer detection rate (4.9 incident cancers per 1000 screens, 99% CI = 4.7 to 5.0 vs 3.8, 99% CI = 3.7 to 3.9, P < .001). Point estimates from the area-level analysis generally supported these findings. In a large population of privately insured women, DBT was associated with a slightly lower recall rate than 2 D mammography and a higher cancer detection rate. Whether this increased cancer detection improves clinical outcomes remains unknown.

Breast Cancer Screening in Inner City and County Populations: A Tale of Two Centers.

New York's statewide "Get Screened, No Excuses" campaign has been one of the nation's most aggressive actions to improve access to breast cancer screening. Inner city and suburban county medical centers' initiatives were studied to compare outcomes of breast cancer screening and factors that influence access to care. Women delinquent in breast cancer screening one year or greater were offered patient navigator services to aid in timely breast cancer screening. Time-to-event completion rates among different stages of breast cancer screening stages in City and County women were compared. Time-to-event completion rates among different stages of breast cancer screening stages. 2505 women aged ≥40years accepted PN services. Mean (SD) age of patients was 56.2 (10) years. The mean (SD) age of those who completed breast screening vs. those who did not was 56.8 (10) and 52.5 (.9) years, respectively (P < .01). The rates of screening completion during physical examination, mammography and biopsy stages were 74%, 78% and 100% in City vs. 98%, 85% and 100% in County, respectively (P < .001). Screening phase was the significant predictor of time to completion for breast cancer screening in Cox regression analysis. Over 85% of women completed the breast cancer screening, 74% in City and 97.6% in County (P < .001). Screening phase is an important predictor of time-to complete breast cancer screening. Center location served as the effect modifier of the relationship. The rate of completing the screening was significantly higher and faster among Suburban County compared to Inner City women.

The impact of adjunctive tomosynthesis on screening mammography outcomes in two widely diverse radiology practices.

To determine the effect of adjunctive digital breast tomosynthesis screening on dissimilar mammography practices. We compared the outcomes of breast cancer screening with digital mammography versus digital mammography combined with tomosynthesis in two independent breast imaging practices from June 1, 2015, to May 31, 2016. Institution one was a hospital-based academic practice of breast imaging specialists and institution two was a community-based practice with academic affiliation served by general radiologists. Screening mammography was linked to subsequent diagnostic imaging and pathology. Subject characteristics and performance metrics were compared via t test for continuous variables and the chi-square test for categorical variables. A two-sided z test was performed to test modality differences for assessment and pathology subtype. Of the 54638 women, 54% (n=29295) were from institution one and 55% (n=30013) underwent digital mammography alone. Women undergoing mammography with tomosynthesis were older (60.8years vs 56.9years, P<.001) and had slightly less dense breast composition (P=.001). Performance metrics varied substantially between institutions. At both institutions the biopsy rate, positive predictive value of screening (PPV1 ), and invasive cancer detection rate increased significantly with adjunctive tomosynthesis. At institution one, the biopsy rate increased from 1.4% to 1.9%, the PPV1 from 6.0% to 8.2%, and the invasive cancer detection rate from 3.4 to 4.9/1000 women screened. At institution two, the respective increases were from 0.7% to 1.0%, 5.5% to 11.0%, and 2.3% to 4.1/1000. Tomosynthesis recalled asymmetry less and mass more and resulted in fewer BI-RADS 1 and 2 assessments than screening with mammography alone. Adjunctive tomosynthesis appears to have a consistent impact on breast cancer screening performance metrics despite marked variation in breast imaging practice. Combined tomosynthesis screening has a significantly higher PPV1 , leads to a greater number of biopsies, and detects more invasive cancer than screening with digital mammography.

The Cost and Outcomes of Breast Cancer Screening for Women 40-49 Years Old in Russia

In Russia screening for breast cancer (BC) is recommended for women 39-75 years old, though WHO recommends starting BC screening at the age of 50 in the limited resource settings. To assess the cost and outcomes of BC screening in women 40-49 years old in Russia. Using published data on BC screening in Russia, we estimated the number of women, who underwent screening in 2014 in age groups 40-49 and 50-69 and respective number of BC cases detected. Also for every age group we calculated expected numbers of false positive results based on published data on sensitivity and specificity of mammography. Costs of screening were estimated using the average public health insurance tariffs for mammography in the frames of screening and biopsy. In 2014 1.72 million women underwent screening in the age group 40-49, with the total cost of screening €6.01 million and 1,287 BC cases detected. In the age group 50-69 3.74 million women were screened, total cost of screening was €12.8 million and 5,568 BC cases were diagnosed. Thus, the average cost of BC case detected was €4,671 in age group 40-49 and €2,298 in age group 50-69. The number of false positive results of mammography per BC case detected was also twice higher in age group 40-49 than in 50-69 years old – 45 vs 21. BC screening in the age group 40-49 results not only in higher cost per BC case detected, but also in higher numbers of false positive results, thus questioning the expected benefits of existing screening program for the society.

Cumulative risk of breast cancer screening outcomes according to the presence of previous benign breast disease and family history of breast cancer: supporting personalised screening

Background:Our aim was to assess the cumulative risk of false-positive screening results, screen-detected cancer, and interval breast cancer in mammography screening among women with and without a previous benign breast disease and a family history of breast cancer.Methods:The cohort included 42 928 women first screened at the age of 50–51 years at three areas of the Spanish Screening Programme (Girona, and two areas in Barcelona) between 1996 and 2011, and followed up until December 2012. We used discrete-time survival models to estimate the cumulative risk of each screening outcome over 10 biennial screening exams.Results:The cumulative risk of false-positive results, screen-detected breast cancer, and interval cancer was 36.6, 5.3, and 1.4 for women with a previous benign breast disease, 24.1, 6.8, and 1.6% for women with a family history of breast cancer, 37.9, 9.0, and 3.2%; for women with both a previous benign breast disease and a family history, and 23.1, 3.2, and 0.9% for women without either of these antecedents, respectively.Conclusions:Women with a benign breast disease or a family history of breast cancer had an increased cumulative risk of favourable and unfavourable screening outcomes than women without these characteristics. A family history of breast cancer did not increase the cumulative risk of false-positive results. Identifying different risk profiles among screening participants provides useful information to stratify women according to their individualised risk when personalised screening strategies are discussed.

Breast cancer screening: Does tomosynthesis augment mammography?

Digital breast tomosynthesis (DBT) is a relatively new imaging technology that is being adopted widely for breast cancer screening. Initial evidence suggests that it may reduce recall rates and increase cancer detection rates when added to digital mammography screening. However, more rigorous, prospective studies are needed to determine whether it improves long-term clinical outcomes of breast cancer screening.