Reduction In Breast Cancer Deaths Research Articles

Health literacy and mammography screening behaviors among women living in a rural area of Turkey.

Breast cancer is the most common cause of cancer-related deaths. and early diagnosis could reduce breast cancer deaths. Therefore, health literacy is one of the most important determinants of participation in cancer screening for early diagnosis. This study aimed to determine the relationship between women's mammography screening behaviors and health literacy levels. The cross-sectional study included 312 women aged 40-69 years living in a rural area. Data were collected through face-to-face interviews using a personal information form and the Turkish Health Literacy Scale (THLS-32). Of the women, 28.5% had mammography in the last 2 years. Of concern was the low health literacy levels. In addition, there were significant differences in the THLS-32 subgroup scores, including the THLS-32 total score, among the mammography screening groups. Health literacy levels of women were related to mammography screening rates. For this reason, effective intervention studies aiming to increase society's health literacy levels may contribute to an increase in breast cancer screenings.

Tamoxifen for breast cancer prevention among survivors of pediatric lymphoma previously treated with chest radiation: Clinical benefits, harms and tradeoffs.

10025 Background: Survivors of pediatric lymphoma previously treated with chest radiation are at high risk for subsequent breast cancer. Although early initiation of breast cancer screening is recommended, the clinical benefits and harms of adding tamoxifen to reduce breast cancer deaths among these women are unknown. Methods: We adapted a Cancer Intervention and Surveillance Modeling Network (CISNET) breast model using data from the Childhood Cancer Survivor Study (CCSS) to reflect the elevated risks for breast cancer and competing mortality for 5-year survivors previously treated with chest radiation (RT). Breast cancer risk was based on age, chest RT field, timing of RT relative to menarche, menopause status, anthracycline exposure, and family history. Premature menopause risk varied by cumulative ovarian RT and alkylator dose. Based on the US Preventive Services Task Force 2019 Evidence Summary, we assumed tamoxifen (20mg daily for 5 years) reduced estrogen receptor positive (ER+) breast cancer risk by 42% (RR = 0.58 [0.42-0.81]) for 20 years and increased risks for venous thromboembolism, deep vein thrombosis, coronary heart disease, stroke and endometrial cancer during treatment. Strategies included no screening or tamoxifen, annual screening with mammography and MRI starting at age 25, annual screening with mammography and MRI starting at age 25 with the addition of tamoxifen at ages 25, 30 or 35. Model outcomes included cumulative breast cancer risk, number of childbearing years before age 45 (defined as years menstruating without tamoxifen use or a breast cancer diagnosis or having survived breast cancer for at least 3 years), and number of tamoxifen-related side-effects. Results: Among a cohort of 20-year-old 5-year lymphoma survivors previously treated with mediastinal RT without primary ovarian failure, an estimated 20% were projected to develop breast cancer and 2.6% would die from the disease before age 50 in the absence of screening or tamoxifen use. Survivors would have on average 22 childbearing years before age 45. Early initiation of breast cancer screening at age 25 would reduce breast cancer deaths before age 50 by 56.3%. Depending on age at initiation, tamoxifen would further reduce breast cancer deaths by 8.0 to 9.6 percentage points for an overall 64.3% to 65.9% reduction and reduce the average number of childbearing years by 17% to 21%. For each breast cancer death averted, a reduction of 1950 to 3740 childbearing life years and 11 to 20 side-effects would occur and varied by the tamoxifen start age compared to mammography and MRI screening. Conclusions: Tamoxifen use for primary breast cancer prevention among pediatric lymphoma survivors may further reduce breast cancer deaths but decisions might depend on survivor preferences for side effects vs. avoiding breast cancer and consideration of timing for childbearing.

Trends in breast cancer death by stage at diagnoses in 2000-2018.

e18855 Background: Approximately 40-45,000, women die from breast cancer each year, most of which are due to metastatic recurrence of stage I-III cancers. Stage I and II cancers are considered highly curable, but they also include most patients. The goal of this analysis is to examine the contribution of stage I, II, III, and IV disease to annual breast cancer-specific death and assess time trends. Methods: Data from patients diagnosed with stage I-IV breast cancer between 1975-2018 (N = 1,545,502) were obtained from The Surveillance, Epidemiology, and End Results (SEER) Program. After filtering for the female sex, one primary site only, surgery performed, known AJCC stage > 0, and survival data available we included N = 1,018,331 patients. We estimated the year of breast cancer-specific death (BCSD) by adding time to BCSD to a year of diagnosis for each patient. We summarized the proportion of BCSD by stage at diagnosis in each year between 2000 and 2017. All temporal trends were assessed by fitting the linear model with interactions between stage and year, then running the ANOVA to test model coefficient significance. For each year of diagnosis, Kaplan-Meier curves were fitted to patient data grouped by stage, and 5-year survival was estimated. Results: The study population included 24% ER-, 73% ER+ (the rest unknown) cancers; 35% HER2-, 6% HER2+ (the rest unknown); 24% were < 50 and 76% > 50 years of age; 60% received adjuvant chemotherapy. Over time, the frequency of stage I cancers increased from 49% in 2000 to 54% by 2017 (slope = 0.37 [95% CI: 0.32; 0.42]), and stage II and III decreased from 35.2% to 34.9% (slope = - 0.09 [-0.15; -0.04]) and from 14% to 10% (slope = -0.23 [-0.29; -0.18]), respectively. Five-year breast cancer-specific survivals remained stable for stage I cancers and increased significantly for stage II (slope = 0.002 [0.001;0.003]), stage III (slope = 0.006 [0.005;0.007]) and IV cancers (slope = 0.011 [0.010; 0.012]). The contribution of stage I cancers to annual breast cancer death increased and reached 23% in 2017, while death from stage III disease decreased to 30%. Since 2003, > 50% of breast cancer deaths are from stage I-II cancers. Conclusions: The prevalence of stage I breast cancers increased in the past 20 years, and despite excellent overall prognosis, stage I-II cancers account for over 60% of all BCSD. To substantially reduce breast cancer death, we need to better identify the minority of Stage I-II patients who remain at risk for recurrence and death. [Table: see text]

20 Discovery of Novel African American Genetic Risk Factors for Breast Cancer by Analyzing Whole Genome Sequencing Data of the Alabama Hereditary Cancer Cohort

OBJECTIVES/GOALS: My research aims to discover African American breast cancer genetic risk factors. Interested in genetic predisposition, I search for inherited variants that could explain why African American women are disparately diagnosed at younger ages and with aggressive subtypes compared to other ethnicities. METHODS/STUDY POPULATION: Our study cohort, the Alabama Hereditary Cancer Cohort (AHCC), consists of African Americans that have had a breast cancer diagnosis indicative of hereditary breast cancer. Whole genome sequencing is conducted for AHCC breast cancer cases. Hypothesizing that African American-specific protein-truncating variants explain inherited risk, our control cohort consists of whole exome sequencing data of (~2500) African Americans from the Type 2 Diabetes Exome Sequencing Project on dbGAP. Single variant and gene-based association tests are being conducted to identify risk variants/genes. Prime editing is conducted to introduce risk variants into cancer cell lines for functional analyses. RESULTS/ANTICIPATED RESULTS: Preliminary studies, involving 60 breast cancer cases, have already revealed multiple African American-specific genetic variants in the nuclear and mitochondrial genome that are statistically linked to breast cancer risk. We are in the process of increasing our breast cancer sample size, aiming for significantly higher confidence. Prime editing for selected novel variants has begun in breast cancer cell lines. Functional assays will then be carried out to observe differences in cell proliferation, cell migration, and spheroid formation in the genetically edited compared to unedited cell lines. DISCUSSION/SIGNIFICANCE: African Americans are underrepresented in breast cancer research. This study reduces research participation gaps and identifies genetic risk variants, leading to better risk assessments and screening methods. Such discoveries can also lead to new therapeutic targets, reducing breast cancer deaths.

Improved classification of breast cancer data using hybrid techniques

Breast cancer is the second leading cancer for women in developed countries including India. Many new cancer detection and treatment approaches were developed. The most effective way to reduce breast cancer deaths is detect it earlier. The frequent occurrence of breast cancer and its serious consequences have attracted world wide attention in recent years. Problems such as low rate of accuracy and poor self-adaptability still exist in traditional diagnosis. In order to solve these problems, an Ada Boost-SVM classification algorithm, Combined with k-means is proposed in this research for the early diagnosis of breast cancer. The effectiveness of the proposed methods are examined by calculating its accuracy, confusion matrix which give important clues to the physicians for early diagnosis of breast cancer

Breast Cancer Screening Recommendations Inclusive of All Women at Average Risk: Update from the ACR and Society of Breast Imaging.

Breast cancer remains the most common nonskin cancer, the second leading cause of cancer deaths, and the leading cause of premature death in US women. Mammography screening has been proven effective in reducing breast cancer deaths in women age 40 years and older. A mortality reduction of 40% is possible with regular screening. Treatment advances cannot overcome the disadvantage of being diagnosed with an advanced-stage tumor. The ACR and Society of Breast Imaging recommend annual mammography screening beginning at age 40, which provides the greatest mortality reduction, diagnosis at earlier stage, better surgical options, and more effective chemotherapy. Annual screening results in more screening-detected tumors, tumors of smaller sizes, and fewer interval cancers than longer screening intervals. Screened women in their 40s are more likely to have early-stage disease, negative lymph nodes, and smaller tumors than unscreened women. Delaying screening until age 45 or 50 will result in an unnecessary loss of life to breast cancer and adversely affects minority women in particular. Screening should continue past age 74 years, without an upper age limit unless severe comorbidities limit life expectancy. Benefits of screening should be considered along with the possibilities of recall for additional imaging and benign biopsy and the less tangible risks of anxiety and overdiagnosis. Although recall and biopsy recommendations are higher with more frequent screening, so are life-years gained and breast cancer deaths averted. Women who wish to maximize benefit will choose annual screening starting at age 40 years and will not stop screening prematurely.

Breast Cancer Screening Among Childhood Cancer Survivors Treated Without Chest Radiation: Clinical Benefits and Cost-Effectiveness.

Early initiation of breast cancer screening is recommended for high-risk women, including survivors of childhood cancer treated with chest radiation. Recent studies suggest that female survivors of childhood leukemia or sarcoma treated without chest radiation are also at elevated early onset breast cancer risk. However, the potential clinical benefits and cost-effectiveness of early breast cancer screening among these women are uncertain. Using data from the Childhood Cancer Survivor Study, we adapted 2 Cancer Intervention and Surveillance Modeling Network simulation models to reflect the elevated risks of breast cancer and competing mortality among leukemia and sarcoma survivors. Costs and utility weights were based on published studies and databases. Outcomes included breast cancer deaths averted, false-positive screening results, benign biopsies, and incremental cost-effectiveness ratios. In the absence of screening, the lifetime risk of dying from breast cancer among survivors was 6.8% to 7.0% across models. Early initiation of annual mammography with breast magnetic resonance imaging screening between ages 25 and 40 years would avert 52.6% to 64.3% of breast cancer deaths. When costs and quality-of-life impacts were considered, screening starting at age 40 years was the only strategy with an incremental cost-effectiveness ratio below the $100 000 per quality-adjusted life-year (QALY) gained cost-effectiveness threshold ($27 680 to $44 380 per QALY gained across models). Among survivors of childhood leukemia or sarcoma, early initiation of breast cancer screening at age 40 years may reduce breast cancer deaths by half and is cost-effective. These findings could help inform screening guidelines for survivors treated without chest radiation.

Efforts to Prevent Breast Cancer Through BSE

Breast cancer is one of the most common types of cancer in Indonesia. Based on Pathological Based Registration in Indonesia, breast cancer ranks first with a relative frequency of 18.6%. More than 80% of cases are found to be at an advanced stage, in addition as many as 60-70% of breast cancer treatment seekers are already in an advanced stage so treatment is difficult. Therefore it is necessary to understand prevention efforts and early diagnosis so that patient detection can be carried out at an early stage so that it can reduce breast cancer deaths. Breast cancer screening is an examination or attempt to find abnormalities that lead to breast cancer in a person or group of people who have no complaints. The initial attempt to screen for breast cancer is BSE. The purpose of this community service activity is to hold BSE training at SMA Setia Budi Semarang to improve student skills in independent breast examination. The BSE training activities for SMA Setia Budi Semarang students were carried out by providing counseling using the lecture and demonstration method which was held on October 15, 2019. The attendance of participants at the counseling was 47 people. The results of the activities of SMA Setia Budi Semarang students not only require information about breast cancer but also require information on women's reproductive health as a whole.

Abstract 1150: Targeting PI3K inhibits ER-mammary tumor initiation and early dissemination

Abstract Despite recent advances in cancer treatment, including targeted therapies and immunotherapies, many women still die of breast cancer. To ultimately reduce breast cancer death, it is of urgent need to develop more effective prevention and early intervention strategies. Although tamoxifen and aromatase inhibitors decrease incidences of estrogen receptor positive (ER+) breast cancer, there is no effective agent for prevention of ER negative (ER-) breast cancer. In this study, we identified that PI3K pathway is significantly activated in premalignant ER- breast lesions compared to paired normal tissue from breast cancer patients. We therefore tested whether blocking PI3K pathway by genetic knockdown or using a clinically applicable PI3K inhibitor (GDC0941) can inhibit ER- tumor initiation and progression. Indeed, both genetic knockdown of PI3K and low dose GDC0941 intervention reversed the disorganized three-dimensional growth of semi-transformed human ER- mammary epithelial cells in vitro. More importantly, low dose GDC0941 treatment significantly delayed the tumor initiation in MMTV-neu mouse model which develops ER-HER2+ mammary tumors. Notably, low dose GDC0941 treatment did not show discernable adverse effects, including no significant changes in body weight and liver functions, no immuno-toxicity. Since PI3K activation is crucial for early disseminated tumor cells, we collected bone marrow from treated mice versus vehicle control group, and examined the impact of GDC0941 treatment on early dissemination of tumor cells into the bone marrow. Excitingly, we found that administration of low dose GDC0941 significantly decreased CD45-ErBb2+/CK8/18+ early disseminated mammary tumor cells into the bone marrow, indicating that low dose PI3K inhibitor not only delayed primary tumor initiation but also prevented tumor cell early dissemination in the bone marrow. Taken together, these data support the notion that using low dose targeting drug to block PI3K pathway is safe and promising for ER- breast cancer prevention. Citation Format: Yuan Zhang, Jingyang Wang, Yi Xiao, Victoria Seewaldt, Dihua Yu. Targeting PI3K inhibits ER-mammary tumor initiation and early dissemination [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1150.

Abstract A025: Community breast health outreach and navigation in medically underserved communities: Insurance status of participants

Abstract Introduction: Breast cancer is the most commonly diagnosed cancer among nearly every racial and ethnic group. With almost 40,000 fatalities every year, breast cancer is the second leading cause of death among women. Better care in the past 25 years has reduced breast cancer deaths by up to 34% in certain communities, but not all communities are benefiting equally from these improvements. To address these disparities, we launched a navigation-based program as a model to improve outcomes for medically underserved women with breast cancer by reducing barriers to quality care and advancing pioneering treatments for breast cancer. We look at the insurance status of the women educated and navigated over the past two years. Methods: The program has three objectives: (1) advance an effective and scalable community-based navigation model for reducing disparities in screening and diagnostic follow-up care in medically underserved women; (2) improve access to and use of high-quality breast cancer care and supportive services at Bellevue, Tisch, and NYU Brooklyn hospitals among underserved woman utilizing patient navigation; and (3) increase access to, and participation in, clinical trials for the most promising and innovative therapies for breast cancers among underserved women. Preliminary data were collected between August 2016 and April 2018 from women on their first encounter with the navigator. Results: Our community navigators have provided outreach to 144 unique sites in New York City, primarily in Brooklyn and lower Manhattan. Community navigators provided health outreach to 8,304 women, of whom 2071 were eligible but not up to date on screening. 887 of these women enrolled in patient navigation and 711 women provided insurance information. 69% of our clients are AA, 25% Hispanic. 24% of our clients were uninsured, 19% had Medicaid, 10% had Medicare, and the remaining women had private insurance. The most salient reported barriers to screening addressed by our navigators included lack of adequate insurance, immigration status, housing and food insecurity, and lack of transportation and child care. Discussion: Through a combination of outreach, education, and navigation, we have developed a novel interdisciplinary model to reduce barriers for screening and treatment for breast cancer. While many of our clients and patients had insurance, many still had formidable financial challenges. In our experience, comprehensive assessment of financial, social, and logistical barriers is an integral component of the navigation process, and is necessary to overcome the significant roadblocks to high-quality breast cancer screening, diagnosis, and treatment that underserved women face. Citation Format: Margaret Cheng, Anita McFarlane, Joseph Ravenell, Kathie-Ann Joseph. Community breast health outreach and navigation in medically underserved communities: Insurance status of participants [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A025.

Mammography adherence among medically underserved women undergoing cancer genetic risk assessment.

1554 Background: Medically underserved women bear a disproportionate burden of breast cancer (BC) mortality. Early detection is vital for reducing BC deaths. Cancer genetic risk assessment (CGRA) provides an opportunity to identify women at highest risk so that risk-adapted screening can be implemented. The effect of CGRA on mammography adherence among underserved women is unknown. Methods: We conducted a study to test the feasibility of performing cancer genetic risk assessment (CGRA) as part of standard primary healthcare at two Federally Qualified Health Centers in Chicago, IL. Racial/ethnically diverse women age 25-69 without a personal history of BC underwent CGRA at the time of an annual well-visit and received the result from their PCP. Medical record review provided data on mammography adherence. Demographic data and measures of perceived BC risk, BC cultural beliefs, fatalism, and BC worry were collected with an enrollment survey. McNemar’s test compared the rate of adherence to screening mammography before and after implementation of CGRA, defined as completing a screening mammogram within 18 months prior to or following CGRA, resp., among women eligible for screening (age > 40 at study enrollment). Logistic regression models tested for associations between mammography adherence and demographic characteristics/health beliefs. Results: Data was available for 90 participants with increased BC risk (IR) who were eligible for screening and 98 eligible, average risk (AR) participants (in total, 61% black and 37% Latina). Overall, adherence improved from 38% at baseline to 49% following CGRA (p = 0.03). Adherence increased from 35% to 51% among IR participants (p = 0.04), and from 40% to 47% among AR participants (p = 0.39). Data on predictors of adherence will be presented. Conclusions: Implementing CGRA as a standard component of primary healthcare improved adherence to screening mammography among racial/ethnically diverse underserved women. The effect was seen primarily in those with increased risk. This intervention could be used to improve uptake of mammography in the subgroup of underserved women who benefit the most from screening.

Novel Mathematical Model of Breast Cancer Diagnostics Using an Associative Pattern Classification.

Breast cancer is a disease that has emerged as the second leading cause of cancer deaths in women worldwide. The annual mortality rate is estimated to continue growing. Cancer detection at an early stage could significantly reduce breast cancer death rates long-term. Many investigators have studied different breast diagnostic approaches, such as mammography, magnetic resonance imaging, ultrasound, computerized tomography, positron emission tomography and biopsy. However, these techniques have limitations, such as being expensive, time consuming and not suitable for women of all ages. Proposing techniques that support the effective medical diagnosis of this disease has undoubtedly become a priority for the government, for health institutions and for civil society in general. In this paper, an associative pattern classifier (APC) was used for the diagnosis of breast cancer. The rate of efficiency obtained on the Wisconsin breast cancer database was 97.31%. The APC’s performance was compared with the performance of a support vector machine (SVM) model, back-propagation neural networks, C4.5, naive Bayes, k-nearest neighbor (k-NN) and minimum distance classifiers. According to our results, the APC performed best. The algorithm of the APC was written and executed in a JAVA platform, as well as the experimental and comparativeness between algorithms.

Telemammography: Technical Advances Improve Patient Access in Breast Care.

Screening mammography's efficacy in reducing breast cancer deaths depends on patient compliance with screening recommendations and the radiologist's interpretative skills. Reasons for suboptimal screening compliance may be multifactorial, including possible limitations in access. Additionally, while studies show experienced breast radiologists are more accurate in their mammographic interpretation, only a minority of the nation's mammograms are interpreted by breast imaging specialists. To simultaneously optimize the benefit of early breast cancer detection while minimizing the harms associated with a false positive interpretation, delivery models that help improve access to breast expertise should be considered. Telemammography is one such delivery model that may be underutilized in current practice. While radiologists and other stakeholders of healthcare have accepted teleradiology interpretation of non-mammography studies as routine, telemammography use and acceptance is less well known. In this article, we review the operational components of a telemammography practice in today's information- and technology-dependent society. Current use of telemammography and remaining potential challenges are discussed. Telemammography can improve healthcare delivery and access by bringing together patients and breast expertise. If accepted, use of telemammography can help meet Centers for Disease Control's Healthy People 2020 goals related to breast cancer.

PEDULI KESEHATAN PEREMPUAN DENGAN DETEKSI DINI DAN UPAYA PENCEGAHAN KANKER PAYUDARA PADA REMAJA PUTRI DI PONDOK PESANTREN WIDHATUL ULUM

Islamic boarding schools are a form of religious education institutions. In Indonesia, the prevalence of cancer is 1.4 per 1,000 population and is the 7th cause of death (5.7%) of all causes of death. The estimated incidence of breast cancer in Indonesia is 40 per 100,000 women. The highest type of cancer in hospitalized patients in hospitals throughout Indonesia in 2010 was breast cancer (28.7%). Therefore it is necessary to understand prevention efforts and early diagnosis so that patient detection can be carried out at an early stage so that it can reduce breast cancer deaths. Breast cancer screening is an examination or attempt to find abnormalities that lead to breast cancer in a person or group of people who have no complaints. The initial attempt to screen for breast cancer is SADARI. One of the health problems in Wihdatul Ulum Islamic boarding school, Bontokassi village, Parangloe district, Gowa district is the lack of knowledge of students on reproductive health problems, especially those related to breast cancer. The result that has been generated is an increase in knowledge where the results of the pre-test were carried out on 20 students consisting of tsnawiyah and madrasah students who were given a questionnaire with 14 questions with pre-test results, namely, 0% had good knowledge, 85% had sufficient knowledge, 5% who have less knowledge. After being given education and training at the level of natural knowledge, that is, 85% have good knowledge, 15% are sufficient and there is no one else who lacks knowledge about breast cancer.

Screening for Breast Cancer in Average-Risk Women

Letters17 September 2019Screening for Breast Cancer in Average-Risk WomenKelly W. Biggs, MDKelly W. Biggs, MDTyrone Hospital, Tyrone, Pennsylvania (K.W.B.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0470 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The American College of Physicians (ACP) guidance statement on screening for breast cancer in average-risk women (1) concludes that “the potential harms of screening for breast cancer with mammography before age 50 years outweigh the benefits in most women.” Among the chief harms of screening that ACP cites are “distress, anxiety, and worry.” Women should know that these “harms” must be measured against evidence accrued over decades that proves that mammography saves lives in women aged 40 to 49 years. Randomized controlled trials show a reduction in breast cancer deaths for women in this age group who ...

Long-Term Outcomes and Cost-Effectiveness of Breast Cancer Screening With Digital Breast Tomosynthesis in the United States.

Digital breast tomosynthesis (DBT) is increasingly being used for routine breast cancer screening. We projected the long-term impact and cost-effectiveness of DBT compared to conventional digital mammography (DM) for breast cancer screening in the United States. Three Cancer Intervention and Surveillance Modeling Network breast cancer models simulated US women ages 40 years and older undergoing breast cancer screening with either DBT or DM starting in 2011 and continuing for the lifetime of the cohort. Screening performance estimates were based on observational data; in an alternative scenario, we assumed 4% higher sensitivity for DBT. Analyses used federal payer perspective; costs and utilities were discounted at 3% annually. Outcomes included breast cancer deaths, quality-adjusted life-years (QALYs), false-positive examinations, costs, and incremental cost-effectiveness ratios (ICERs). Compared to DM, DBT screening resulted in a slight reduction in breast cancer deaths (range across models 0-0.21 per 1000 women), small increase in QALYs (1.97-3.27 per 1000 women), and a 24-28% reduction in false-positive exams (237-268 per 1000 women) relative to DM. ICERs ranged from $195026 to $270135 per QALY for DBT relative to DM. When assuming 4% higher DBT sensitivity, ICERs decreased to $130533-$156624 per QALY. ICERs were sensitive to DBT costs, decreasing to $78731 to $168883 and $52918 to $118048 when the additional cost of DBT was reduced to $36 and $26 (from baseline of $56), respectively. DBT reduces false-positive exams while achieving similar or slightly improved health benefits. At current reimbursement rates, the additional costs of DBT screening are likely high relative to the benefits gained; however, DBT could be cost-effective at lower screening costs.

A random initialization deep neural network for discriminating malignant breast cancer lesions.

Breast cancer is one of the most common cancer in women, with more than 1,300,000 cases and 450,000 deaths each year worldwide. Recent studies show that early breast cancer detection, along with suitable treatment, could significantly reduce breast cancer death rates in the long-term. While the consequences of a false positive diagnosis can be psychologically and socioeconomically burdensome, the result of a false negative diagnosis can be devastating, especially in terms of health detriment. In this context, the false positive and false negative rates commonly achieved by radiologists are extremely arduous to estimate and control, and some authors have estimated figures of up to 20% of total diagnoses or more. Novel ideas in computer-assisted diagnosis have been prompted by the introduction of deep learning techniques in general and of convolutional neural networks (CNN) in particular. In this paper, we design and validate an ad-hoc CNN architecture specialized in breast lesion classification and heuristically explore possible parameter combinations and architecture styles in order to propose a model selection criterion which can pose the emphasis on reducing false negatives while still retaining acceptable accuracy. We achieve good classification performance on the validation and test set, demonstrating how an ad-hoc, random initialization CNN architecture can provide practical aid in the classification and staging of breast cancer.

Knowledge and practice of breast self-examination among undergraduate students in Bahir Dar University, North-West Ethiopia, 2016: A cross-sectional study.

Breast cancer is the most common cancer in women worldwide, with nearly 1.7 million new cases diagnosed each year which accounts 12% of all new cancer cases and 25% of all cancers in women. Breast self-examination offers women the best opportunity for reducing breast cancer deaths. From a total of 222 respondents about 190 (85.6%) heard about breast selfexamination. One hundred forty-three (75.3%) had good knowledge about sign and symptoms of breast cancer and 47 (24.7%) had poor knowledge about the sign and symptoms of breast cancer. From total respondents of the study 120 (54.1%) practiced breast self-examination. Breast selfexamination practice is relatively frequent problem in Bahir Dar University, health science students. Negligence, forgetfulness and lack of knowledge are the main factors for poor practice of breast self-examination. Public health education using the media, clubs and leaflet could significantly reduce poor practice of breast self-examination and increases early detection of breast lump.

An Ad Hoc Random Initialization Deep Neural Network Architecture for Discriminating Malignant Breast Cancer Lesions in Mammographic Images.

Breast cancer is one of the most common cancers in women, with more than 1,300,000 cases and 450,000 deaths each year worldwide. In this context, recent studies showed that early breast cancer detection, along with suitable treatment, could significantly reduce breast cancer death rates in the long term. X-ray mammography is still the instrument of choice in breast cancer screening. In this context, the false-positive and false-negative rates commonly achieved by radiologists are extremely arduous to estimate and control although some authors have estimated figures of up to 20% of total diagnoses or more. The introduction of novel artificial intelligence (AI) technologies applied to the diagnosis and, possibly, prognosis of breast cancer could revolutionize the current status of the management of the breast cancer patient by assisting the radiologist in clinical image interpretation. Lately, a breakthrough in the AI field has been brought about by the introduction of deep learning techniques in general and of convolutional neural networks in particular. Such techniques require no a priori feature space definition from the operator and are able to achieve classification performances which can even surpass human experts. In this paper, we design and validate an ad hoc CNN architecture specialized in breast lesion classification from imaging data only. We explore a total of 260 model architectures in a train-validation-test split in order to propose a model selection criterion which can pose the emphasis on reducing false negatives while still retaining acceptable accuracy. We achieve an area under the receiver operatic characteristics curve of 0.785 (accuracy 71.19%) on the test set, demonstrating how an ad hoc random initialization architecture can and should be fine tuned to a specific problem, especially in biomedical applications.

Should women with a BRCA1/2 mutation aged 60 and older be offered intensified breast cancer screening? – A cost-effectiveness analysis

ObjectivesThis study aimed to investigate the cost-effectiveness of intensified breast cancer (BC) screening for women with a BRCA1/2 mutation aged 60–74. Simulated strategies were: (0) annual mammography as reference, (1) alternating annual mammography and MRI for women with dense breasts only; (2) addition of annual MRI for women with dense breasts only; (3) addition of annual MRI for all women. Materials and methodsA validated micro-simulation model of invasive BC was updated and validated for interval BC rates and tumor size distribution. Incremental cost-effectiveness ratios (ICER) of all three intensified strategies were compared to the next best strategy and stratified for BRCA1 and BRCA2. Discount rates for costs and life years gained (LYG) were 1.5% and 4% for the Dutch situation; 3% and 3% for international comparison. A threshold of €20,000 per LYG was applied. ResultsAll intensified strategies showed more detected BCs and LYG, reduced BC deaths, and increased false positives. The Dutch discounted ICER of intensified strategy 1 compared to annual mammography was €38,000 per LYG in BRCA1 mutation carriers and €18,000 per LYG in BRCA2 mutation carriers. Further intensified strategies showed an ICER above the threshold when compared to this strategy. With international discount rate, the ICERs of all intensified strategies were above the threshold. ConclusionOf the three alternative strategies, only alternating annual MRI and mammography for BRCA2 mutation carriers and dense breasts aged 60–75 is cost-effective compared to annual mammography. For BRCA1 mutation carriers, none of the alternative strategies is cost-effective compared to the next best strategy.