Routine Cancer Screening Research Articles

Knowledge, awareness, and practice of breast self-examination among females in Mosul city, Iraq.

This study is carried out to report on the knowledge and practice regarding breast self-examination (BSE) among women from the city of Mosul in Iraq and to evaluate the prevalence of performing clinical breast examination (CBE) and mammography among them. A descriptive, cross-sectional survey carried out among females working in the University of Mosul, as a sample of the female population of Mosul city. The sample was collected conveniently, and the data were collected from July to November 2018. Data were collected by interviews with 405 participants. Knowledge answers were scored and categorized into two groups: good and poor level of knowledge. A final sample of 384 participants were included in the analysis, with a mean age of 42.58 ± 8.9. Only 39 (10.1%) and 37 (9.6%) participants performed mammographic examination and CBE of their breasts, respectively. Just 100 (30.3%) of the 330 females who knew BSE performed BSE routinely or intermittently. The mean knowledge score was 4.22 ± 1.66, and only 141 females (42.7%) were found to have a good level of knowledge. A statistically significant association of knowledge level with marital status (P = 0.015), perceived benefit of BSE (P = 0.001), previous gain of instructions of BSE (P < 0.05), and the provider (P < 0.05) was found. The performance results of BSE were poor as well as for CBE and mammography among the study participants. There is a need for educational programs to create awareness and improve knowledge about routine breast cancer screening behavior.

Breast Cancer Screening During Lactation: Ensuring Optimal Surveillance for Breastfeeding Women.

Breast cancer is the most common malignancy among reproductive-aged women, and an increasing number of women are breastfeeding at the time of screening initiation. The literature was reviewed to identify evidence-based guidelines for breast cancer screening during lactation. Health care providers should consider routine age-related or high-risk screening; they should also discuss alternate surveillance strategies, including deferment until cessation of breastfeeding. Shared decision-making and individualized patient care should involve consideration of the limitations of current evidence. Lactation-related radiographic changes may make examination interpretation more challenging; preprocedure milk expression and use of particular supplemental imaging modalities can improve examination sensitivity. Despite these strategies, breastfeeding women may have higher rates of false-positive findings and therefore undergo more biopsies. However, given the increased risk of biologically aggressive breast cancers in postpartum women, these risks may be outweighed by the benefits of routine breast cancer screening for breastfeeding women.

Awareness of Routine Breast Screening and Breast Cancer in Jos North Central Nigeria

Background: Despite recent studies showing great improvement in the level of awareness of breast cancer, late presentation by sufferers of this disease still persist. Objective: To determine the level of awareness of routine breast cancer screening modalities and breast cancer amongst women in North Central Nigeria. Methods: This is a cross sectional study conducted using randomly selected consenting women to determine the level of awareness of routine breast cancer screening and breast cancer. Results: Three hundred and ninety-eight women participated in the study with mean age of 41.8±10.5. Majority are married (51.3%) and had attained tertiary education (66.3%). About ninety eight percent (98.5%) of the women are aware of breast cancer and the main sources of information includes health personnel (41.0%) and social media (28.1%). On the overall, knowledge of risk factors and symptoms of breast cancer was poor. Statistically significant relationship between knowledge of risk factors with age and educational level was noted. Conclusion: Study showed high level of awareness of breast cancer with a rather poor knowledge of risk factors and symptoms of the disease

3043 Not All Bumps Are Equal, Mucosal Schwann Cell Hamartoma a Rare Subtype

INTRODUCTION: Benign mesenchymal polyps are an interesting group of colonic polyps. There has been a surge in the number of these polyps identified since legislation modified Medicare and began reimbursement for screening colonoscopy in patients at an average risk for colorectal carcinoma. It is important to differentiate between the different types of mesenchymal polyps given that some have correlation with hereditary diseases. CASE DESCRIPTION/METHODS: 66 year old male patient with history of hypertension presents for routine colorectal cancer screening colonoscopy. He is asymptomatic and has no family history of cancer including colon cancer. During the colonoscopy a small 5 mm polyp was found in the rectosigmoid which was removed using cold forceps polypectomy. The pathology was read as a benign mesenchymal polyp. Further staining with S-100 and CD 68 was done which revealed that this polyp was in fact a Schwann cell hamartoma. DISCUSSION: There has been 10 reported cases of mucosal schwann cell hamartoma in literature. Using immunohistochemistry for S100 highlights tissue with neural differentiation expanding the lamina propria of the colonic biopsy and CD68 highlights muciphages. These polyps resemble spindle cell proliferation and other neuronal tumors and are usually limited to the mucosa of the colon with no submucosal extension. They are usually solitary and patients do not have symptoms though a couple of cases reported finding them in the process of workup for diarrhea. Gibson and Hornick supplied the necessary name in 2009 in an attempt to differentiate it from other Schwann cell proliferation which is seen in entities like neurofibroma and ganglioneuroma. The importance of this entity is its lack of association with hereditary cancer syndromes, specifically neurofibromatosis type 1 (NF1) and multiple endocrine neoplasia 2B (RET) which is seen with neurofibromas. Also ganglioneuromatous polyposis and diffuse ganglioneuromatosis are seen in Cowden syndrome, Juvenile polyposis syndrome, MEN2B and NF1 however solitiary ganglioneuroma are not associated with hereditary diseases. It is important to differentiate this entity from others to prevent unnecessary and aggressive testing and treatment. Pathologists should include this differential as part of S 100 positive spindle cell proliferative lesions and gastroenterologists should be aware of the benign nature of this pathology.

P2.10-04 Predicting Non-Compliance in Routine Lung Cancer Screening for High-Risk Adults

Lung cancer is the most common cause of cancer-related deaths, which can be effectively reduced by routine screening. To detect lung cancer early, annual screening in high-risk adults aged 55-74 years using low-dose computed tomography (LDCT) is recommended by the Canadian Medical Association guidelines. High-risk adults are recommended an annual screen within 11-15 months of their baseline scan. However, screening compliance is a challenging area influenced by a series of complex biopsychosocial, behavioral and cognitive processes. This study aims to describe the participants and identify predictors of noncompliance in the Lung Cancer Screening Pilot for People at High Risk Program (HR LCSP) conducted in Ontario, Canada. During 2017-18, HR LCSP has recruited over 5,999 high-risk adults from 3 sites in Ontario, with 5,502 adults undergone risk assessment for screening eligibility, and 2,997 baseline scans conducted. Baseline and follow-up participant experience surveys assess satisfaction especially around test result communication. During risk assessment, all individuals who identify as current smokers are referred to smoking cessation services irrespective of their eligibility. The clinical data are collected using an internationally accepted standard, the Resident Assessment Instrument Minimum Data Set at each site. We hypothesize that participant compliance is predicted by the satisfaction of their first screening experience in additional to socio-demographic and clinical factors. A multivariable logistic regression model will be conducted to predict non-compliance, which is defined by a return interval >15 months or missing. The model will contain individual level factors including age, sex, aboriginal status, education, income estimates, geographic distance; system level factor includes physician-referral/ self-referral status; clinical factors include the risk prediction by PLCOm2012, which assesses smoking status including intensity and duration; other clinical factors include personal and family history of cancer, history of lung disease, body mass index; psychosocial/behavioral factors include smoking cessation program participation, baseline screening results including the presence of actionable incidental findings and appropriate follow-up of the abnormal results. Data linkage is under way and results will be presented at the conference. This study will provide a granular view on the predictors of routine screening compliance among high-risk adults, which will be used to improve the program recruitment and retention especially when designing targeted messages. Findings will have implications for health care professionals when communicating with high-risk individuals about routine screening for lung cancer. Section not applicable.

1625 Colonic Schwannoma Identified in Asymptomatic Middle-Aged Female

INTRODUCTION: Schwannomas are typically benign tumors of the neural sheath. Schwannomas of the colon are extremely rare entities; in fact, when schwannomas occur in the gastrointestinal tract, the colon is considered the least likely site. Schwannomas of the colon were previously misdiagnosed as gastrointestinal stromal tumors; however, with advances in immunohistochemical staining, the number of cases of intestinal schwannomas has gradually increased. Colorectal schwannomas can be divided into three clinicopathologic types: spindle cell, epithelioid, and plexiform. Here, we present a unique case of a colonic spindle cell schwannoma encountered in an asymptomatic patient on routine colonoscopy. CASE DESCRIPTION/METHODS: A 50-year-old female with no significant past medical history presented to gastroenterology clinic for routine colorectal cancer screening. The patient denied abdominal pain, nausea, vomiting, diarrhea, constipation, rectal bleeding, or weight loss. She also denied family history of neurofibromatosis. Physical examination was unremarkable. Laboratory studies showed that the patient had microcytic anemia (hemoglobin 10.9 g/dl, MCV 59 fL) but were otherwise unremarkable. A colonoscopy was subsequently performed and revealed a 6 mm sub-epithelial lesion in the sigmoid colon. Biopsy showed colonic mucosa with mild chronic inflammation and multiple spindle cell aggregates confined to the lamina propria (Figure 1). Cytological atypia, mitoses, and necrosis were identified in the biopsied specimen (Figure 2). Immunohistochemical assays demonstrated lack of reactivity to CD68, CD117, and DOG-1. The spindle cells were strongly positive for S100, confirming the diagnosis of mucosal Schwann cell hamartoma. DISCUSSION: Rectal bleeding, colonic obstruction, and abdominal pain are the three most common presenting symptoms for colorectal schwannoma; however, our patient denied any of these symptoms. The management of intestinal schwannomas remains controversial. Surgical resection with adequate margins remains the treatment of choice. Several sources question whether radical resection based on oncologic principles is necessary given the benign nature of these tumors. Our patient was managed conservatively with routine surveillance. Repeat colonoscopy performed approximately 3 months after the initial colonoscopy revealed no signs of recurrence or metastases. This case supports the notion that these rare mesenchymal tumors are commonly benign and aggressive therapeutic interventions are likely unnecessary.

1607 The Hidden Parasite

INTRODUCTION: Parasite identification during routine colon cancer screening is unexpected and rather unusual. Schistosoma is a tropical parasite associated to freshwater snails; among which S. mansoni and S. japonicum species have been associated with intestinal tract infection. Although most patients are asymptomatic, identification is crucial to avoid possible complications like chronic intestinal schistosomiasis or hepatosplenic schistosomiasis. CASE DESCRIPTION/METHODS: A 57-year-old Puerto Rican Vietnam veteran with history of schizophrenia and chronic liver disease secondary to Hepatitis C underwent colonoscopy for average-risk colorectal cancer screening. During colonoscopy, a one-centimeter polyp at 15cm was completely removed by hot snare and six additional small sessile polyps in the rectum by cold forceps. Pathology was remarkable for a tubular adenoma, while one of the rectal polyps identified a non-necrotizing granuloma suggestive of schistosoma parasite. Patient had shown no GI symptoms or complaints and was treated with Praziquantel. DISCUSSION: Puerto Rico is an endemic area for schistosoma. Schistosomiasis is a chronic parasitic disease with significant cause of morbidity and mortality. Intestinal polyps and dysplasia can arise due to granulomatous inflammation surrounding eggs deposited in the bowel wall. Gastrointestinal manifestations may result in chronic abdominal pain, poor appetite, and diarrhea for which early identification is necessary for treatment even in the asymptomatic setting.

2548 Jejunal Perforation: A Very Rare Presentation of Jejunal Adenocarcinoma

INTRODUCTION: Small bowel malignancies constitute less than 5% of all gastrointestinal malignancies. The most common histological types of small bowel cancer are adenocarcinoma, neuroendocrine cancer, lymphoma and sarcoma. Adenocarcinoma represents 25-40% of primary small bowel malignancies, with the highest incidence in the duodenum and the incidence progressively decreasing down the small intestine. CASE DESCRIPTION/METHODS: A 69 year old previously healthy women presented with periumbilical pain for four weeks. She also reported early satiety but no weight loss. The night prior to presentation abdominal pain became severe with one episode of vomiting. There was no history of chronic NSAIDs use. She had a 40 pack-years smoking history. She had two cesarean sections and a total abdominal hysterectomy with bilateral salpingo-opherectomy. She did not have routine colorectal cancer screening. On abdominal examination she had a distended abdomen and mild periumbilical tenderness. Laboratory testing revealed leukocytosis of 15000/µL and a hemoglobin level of 10.2 g/dl with a low MCV 78.6 fl. Noncontrast CT of the abdomen showed wall thickening and focal perforation in a loop of jejunum. There was no bowel obstruction and no free intraperitoneal air seen. Exploratory laparotomy revealed a large inflammatory mass in the proximal jejunum densely adherent to the mid-transverse colon. There was a large perforation (3.5 cm of greatest dimension) of a jejunal mass. The mucosa surrounding the defect was hyperemic and thickened. Microscopic examination showed a well-differentiated adenocarcinoma invading into muscularis propria. There was no lymphovascular invasion and no metastasis were identified in 13 excised regional lymph nodes. Immunostains were negative for cytokeratin 7 (expressed in lung and pancreatic adenocarcinomas), focally positive for cytokeratin 20 (colorectal adenocarcinoma) and were positive for CDX2. CDX2 is a highly sensitive and specific marker of adenocarcinoma of intestinal origin. DISCUSSION: Jejunal adenocarcinoma is an extremely rare GI malignancy. The clinical presentation is often with abdominal pain and distension; only 10% present as a bowel perforation. Surgical resection is considered curative treatment for localized adenocarcinoma. Oxaliplatin-based adjuvant chemotherapy is suggested for patients with lymphovascular invasion. In our patient perforation per se was considered a high-risk feature and the patient was advised to have post-operative adjuvant chemotherapy.

A Breast Cancer Detection using Image Processing and Machine Learning Techniques

Routine breast cancer screening allows the disease to be diagnosed and treated prior to it causing noticeable symptoms. During the diagnosis process there are chances of wrong detection hence a less human interfaced system has to be developed, hence the goal of breast cancer detection using machine learning techniques is used to find it before it spreads to the larger extent. Screening refers to tests and exams used to find a disease in people who don’t have any symptom. Early detection means finding and diagnosing a disease earlier than waiting for symptoms to start causing the effect on the neighboring cells. The breast cancer is the second most death causing cancer in humans, one in every ten women are affected by the breast cancer. Breast cancer is not only affecting the women. Men are also prone to get affected by the breast cancer but in smaller rates because of the absence of milk ducts and other lobules related to women. Early detection of the breast cancer helps in reducing the death rates if treated earlier and by proper diagnosis. In this paper the discussion of the various image processing technique done on the image and the CNN, SVM algorithm implementation on dataset images for the classification of malignant and non malignant cells are used and various tests were performed using different other machine learning algorithms and there level of accuracy and difference of various parameters are discussed for image processing MATLAB coding is used.

Multidisciplinary selection of pulmonary nodules for surgical resection: Diagnostic results and long-term outcomes

ObjectivePulmonary nodules found incidentally or by lung cancer screening differ in prevalence, risk profile, and diagnostic intervention. The results of surgical intervention for incidental versus screening lung nodules during multidisciplinary Pulmonary Nodule and Lung Cancer Screening Clinic (PNLCSC) follow-up have not been reported. MethodsAll patients evaluated at a PNLCSC from 2012 to 2018 following referral by primary care physicians, specialist physicians, or self-referral after computed tomography (CT) identified nodules on routine diagnostic CT (incidental group) or lung cancer screening CT (screening group) were included. Follow-up interval, invasive intervention, histology, postoperative events, survival, and recurrence were compared. ResultsOf 747 patients evaluated in the PNLCSC, 129 (17.2%) underwent surgical intervention. The surgical cohort consisted of 104 (80.6%) incidental and 25 (19.3%) screening patients followed over a mean of 122 and 70 days, respectively. More benign lesions were excised in the incidental group (20.2%, 21/104)—representing 3.3% (21/632) of all incidental nodules evaluated—than in the screening group (4%, 1/25) (P = .038). Operative mortality was zero. Among 99 patients with primary lung cancer, 87% (screening) and 86.8% (incidental) were pathologic stage Ia. Complete follow-up was available in 725 of 747 (97%), and no patient developed progressive disease. Disease-free survival at 5 years was 74.9% (incidental) and 89.3% (screening) (P = .48). ConclusionsA unique multidisciplinary PNLCSC for incidental and lung cancer screening–detected nodules with individualized risk assessment reliably identifies primary and metastatic tumors while exposing few patients to diagnostic excision for benign disease. Longer-term outcomes, strategies to limit radiation exposure, and cost control need further study.

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.

Cutaneous melanoma—The benefit of screening and preventive measures

The incidence rates of cutaneous melanoma are continually rising in the Caucasian population with the highest rates in Australia and New Zealand. The genesis of melanoma is a complex interplay between genetic predisposition and exogenous factors. The major known exogenous risk factor of this potentially lethal malignancy is ultraviolet (UV) radiation. In the last decades diverse prevention strategies have been developed which in case of primary prevention are aimed to protect the skin from high-dose UV radiation. Although its effect is only visible after a long period of time and despite the growing awareness in the general population, it seems that primary prevention interventions are often not carried out as recommended. It was proposed that particularly in Europe where incidence rates are still increasing, the development and implementation of primary prevention campaigns should be pursued further. Secondary prevention implies early detection of melanoma by using skin cancer screenings. However, according to recent reviews there is only limited evidence on impact and benefit of routine skin cancer screenings in the adult general population. Thus, it was suggested that future research should focus on effects of targeted screening in population subgroups with increased risk for melanoma.

Visit-to-Visit Hemoglobin A1c Variability Is Associated With Later Cancer Development in Patients With Diabetes Mellitus.

Recent studies have shown that patients with diabetes mellitus have a higher risk of tumorigenesis. However, the effect of glycemic variability on tumorigenesis among diabetic patients has not been well investigated. Hence, we performed a retrospective cohort study to analyze the effect of visit-to-visit hemoglobin A1c (HbA1c) variability and later onset of malignancies. This study included 2640 patients with diabetes mellitus 50 years or older. To analyze visit-to-visit glycemic activity, we calculated intrapersonal SD of all recorded HbA1c and used SD-HbA1c as a measure of glycemic variability. Because the number of individual visits varied, we divided SD-HbA1c by visit times in order to adjust for the potential influence of visit time difference between individuals. Patients were divided into quartiles according to their HbA1c variability, and Cox regression models were used to evaluate the association between glycemic variability and later onset of tumorigenesis. Three hundred thirty patients (12.5%) developed malignancy during follow-up. The median follow-up period was 1511 days (4.1 years; interquartile range, 2487.5 days). Relative to the group with the lowest glycemic variability (first quartile), the groups with higher glycemic variability showed a dose-dependent association with tumorigenesis. The odds ratios for the second, third, and fourth quartiles were 1.20 (95% confidence interval, 0.88-1.65), 1.43 (1.02-2.00), and 2.19 (1.52-3.17), respectively. The mean HbA1c and diabetes mellitus duration periods were not significantly associated with tumorigenesis. This result was consistent when limiting the number of covariates. These results demonstrated that visit-to-visit HbA1c variability is a potential risk factor for later tumorigenesis. The association may be mediated by oxidative stress or hormone variability. Routine cancer screening may be suggested for diabetic patients with unstable glycemic control.

Neutrophil-to-Lymphocyte Ratio in Ovarian Cancer Patients with Low CA125 Concentration

Ovarian cancer cases with low CA125 concentration are problematic and increase the high false negative results ratio during routine physical examination testing. Unfortunately, patients without early discovery have very low survival rates. In our study, we investigated the possible role of differential leukocyte counts and the neutrophil-to-lymphocyte ratio (NLR) in ovarian cancer patients to identify an additional discriminative marker to avoid missing diagnoses in normal physical examinations. One hundred seventy-three patients with epithelial ovarian cancer and 70 healthy controls were involved in our study. Based on the results, compared with the healthy controls, NLR was significantly different both in the low CA125 concentration group and in the complete patient group, indicating that NLR could be an effective marker for ovarian cancer screening. According to ROC, sensitivity, specificity, and NPV results, CA125 >35 U/ml is a good indicator for cancer in routine physical examination. However, in patients with low CA125 concentration, the CA125>7.65 U/ml and NLR >1.72 group yielded increased sensitivity with appropriate specificity and higher NPV results than the CA125 >35 U/ml group. We believe CA125>7.65 U/ml and NLR >1.72 should be effective makers for patients with low CA125 concentration. As a more sensitive and cost-effective strategy, this method could be conducted during routine ovarian cancer screening.

Complex multimorbidity, perceived life expectancy, and routine cancer screening receipt: Differences between older women and men.

e13071 Background: Complex multimorbidity (MM) predicts poor health outcomes. How MM predicts preventive health services receipt, such as cancer screening, is less clear. Yet cancer screening decision making involves not only clinical presentation (MM) and age, but also patients’ perceptions about need. We hypothesize that patients’ perceived life expectancy (PLE) moderates the effect of MM and age on cancer screening receipt (mammography for women and prostate screening for men). Methods: Data came from 20,705 women and men, ages 52-90, from the 2002-2012 waves of the U.S. Health and Retirement Study. Receipt of screening mammogram (women) or “examination of [the] prostate to screen for cancer” (men) in the last two years were binary (0/1) measures. MM was an ordinal count (0-3) of the co-occurrence of any chronic conditions, functional limitations, and geriatric syndromes. Age was measured in years. PLE was the chance respondents’ thought they would live 10-15 more years (0 = 0% - 10 = &gt; 90%). Additional control variables included self-rated health, race/ethnicity, socioeconomic status, marital status, smoking, BMI, and other preventive services (e.g., flu shot) receipt. We used survey-adjusted repeated measures logistic regression to predict screening receipt separately by gender. Results: Women reported higher MM and PLE than men. Greater MM reduced the likelihood of mammography receipt. However, women with MM who had greater PLE had an increased likelihood of mammography receipt. Furthermore, mammography receipt decreased more slowly with age for women with high PLE. For men, greater MM did not lead to reduced prostate screening. Men’s PLE was not associated with screening nor did it modify the effects of MM or age. Conclusions: Greater PLE increases likelihood of cancer screening for women even when MM and advanced age would recommend against. Men’s clinical presentation and subjective perceptions of longevity are not associated with prostate screening receipt. We speculate that the differences in the nature of the screening tests combined with greater public awareness of breast cancer create conditions where subjective perceptions are more likely to affect mammography decision-making.

Oncology in nephrology comes of age: A focus on chronic dialysis patients.

Dialysis is the commonest modality of renal replacement therapy for patients suffering from end-stage kidney disease. Different registry studies showed that the risks of overall cancer occurrence were significantly higher in chronic dialysis patients than in the age-matched general population. However, the frequency and pattern of different cancers may vary among different geographical areas. Since chronic dialysis patients tend to have multiple comorbidities and a shorter life expectancy, routine cancer screening in all dialysis patients may not be cost-effective; rather screening should be personalized according to the patient's expected survival, candidacy for kidney transplant together with patient preferences.

U.S. women's perceived importance of the harms and benefits of mammograms and associations with screening ambivalence: Results from a national survey

The American Cancer Society and the U.S. Preventive Task Force recently recommended that women initiate routine breast cancer screening at older ages (45 and 50, respectively) than previously recommended, and both organizations emphasize the importance of weighing the harms of mammograms against the benefits in making informed decisions. However, little is known from national samples about how women perceive the harms and benefits of mammograms, and how these perceptions relate to their attitudes about getting mammograms. To fill this gap, we surveyed a nationally representative sample of 557 U.S. women aged 30–59 about their perceptions of harms and benefits and their attitudinal ambivalence toward mammograms. We found that respondents overall perceived the benefits as more important than harms, but those who were aware of recent recommendations perceived mammogram harms as more important than those who were unaware. Women who had a mammogram within one year perceived the harms as less important and the benefits as more important, compared to those who had not had a mammogram in the past year. Those who perceived the harms as important were more ambivalent about screening than those who perceived harms as less important. We conclude that if the public health goal is to prevent the population harms from overuse of mammograms (e.g., overdiagnosis, false positives), simply providing women with information about harms and benefits may not lead to this outcome, since women are likely to perceive the benefits as more important than harms, and thus make an informed choice to obtain screening.

A novel method of determining breast cancer risk using parenchymal textural analysis of mammography images on an Asian cohort

Historically, breast cancer risk prediction models are based on mammographic density measures, which are dichotomous in nature and generally categorize each voxel or area of the breast parenchyma as ‘dense’ or ‘not dense’. Using these conventional methods, the structural patterns or textural components of the breast tissue elements are not considered or ignored entirely. This study presents a novel method to predict breast cancer risk that combines new texture and mammographic density based image features. We performed a comprehensive study of the correlation of 944 new and conventional texture and mammographic density features with breast cancer risk on a cohort of Asian women. We studied 250 breast cancer cases and 250 controls matched at full-field digital mammography (FFDM) status for age, BMI and ethnicity. Stepwise regression analysis identified relevant features to be included in a linear discriminant analysis (LDA) classifier model, trained and tested using a leave-one-out based cross-validation method. The area under the receiver operating characteristic (AUC) and adjusted odds ratios (ORs) were used as the two performance assessment indices in our study. For the LDA trained classifier, the adjusted OR was 6.15 (95% confidence interval: 3.55–10.64) and for Volpara volumetric breast density, 1.10 (0.67–1.81). The AUC for the LDA trained classifier was 0.68 (0.64–0.73), compared to 0.52 (0.47–0.57) for Volpara volumetric breast density (p < 0.001). The regression analysis of OR values for the LDA classifier also showed a significant increase in slope (p < 0.02). Mammographic texture features derived from digital mammograms are important quantitative measures for breast cancer risk assessment based models. Parenchymal texture analysis has an important role for stratifying breast cancer risk in women, which can be implemented to routine breast cancer screening strategies.

Cell phone usefulness to improve the skin cancer screening: preliminary results and critical analysis of mobile app development.

The high incidence of skin cancer in Brazil has resulted in an urgent need for more efficient methods of reducing the time between initial diagnosis and therapy. Such delays are significant in large countries like Brazil, where a considerable proportion of the population live in remote areas with limited access to specialized medical care. To address this problem the use of mobile phones as screening devices for suspicious skin lesions has been incorporated as long-distance teledermatology services. Digital photography is now a convenient ancillary option to minimize treatment delays caused by the distance between the specialist doctor and patients. The authors have developed a friendly mobile application and website to take high quality digital images of suspicious lesions, and to capture patient data easily and quickly to be analyzed by skin cancer professionals at another location. This was a prospective study of a population of 39 individuals monitored by routine skin cancer screening by the Cancer Prevention Department at Barretos Cancer Hospital during 2016. All patients were evaluated in the dermatology clinic, where a differential diagnosis was made based on the clinical information and direct examination of suspicious lesions. A second dermatologist assessed the same clinical information and digital images of all lesions captured by teledermatology, and provided an independent diagnostic opinion on the likelihood of the lesions being benign or suggestive of malignancy. The diagnostic efficiencies of teledermatology and standard dermatology were then compared to the histopathological findings of each biopsy as the diagnostic gold standard, and then statistical parameters of each approach were evaluated. The lesions studied in this comparison were mostly found on the face (69%), followed by upper limbs (15%), scalp (8%), trunk (6%) and lower limbs (2%). Final histopathological analyses of the biopsies in the study group showed that 71% of lesions were malignant, with 32% being squamous cell carcinoma and 68% being classified as basal cell carcinoma, and 29% were considered benign lesions. The overall sensitivities of teledermatology in comparison to face-to-face evaluation in the clinic were similar (clinic, 80.0%; teledermatology, 80.8%). Other comparisons including accuracy (clinic, 78.9%; teledermatology, 79.5%); specificity (clinic, 76.9%; teledermatology, 76.9%); positive predictive value (clinic, 87.0%; teledermatology, 87.5%); and negative predictive value (clinic, 66.7.0%; teledermatology, 66.7%) all showed equivalence. The inter-observer kappa value between face-to-face examination and teledermatology showed excellent agreement at 0.958. These preliminary findings indicate that the cell phone application developed to aid the diagnosis of skin cancer showed great potential and reliability, and can therefore be considered as an ancillary option in countries like Brazil, with isolated communities that have limited access to dermatology clinics.

Hypofractionated radiation therapy for durable palliative treatment of bleeding, fungating breast cancers

In the era of routine breast cancer screening, the rate of locally advanced breast cancer (LABC) has decreased; however, LABC still occurs in approximately 30% to 60% of all new breast cancers worldwide and 10% to 20% of breast cancers in the United States. 1 Valero V. Buzdar A. Hortobagyi G. Locally advanced breast cancer. Oncologist. 1996; 1: 8-17 PubMed Google Scholar Often, these cases arise in the setting of delayed presentation to medical care, in some instances as a result of psychosocial factors, as opposed to aggressive biology of the cancer itself. Some patients with LABC present with skin involvement of their tumor, classified as T4b disease according to the American Joint Committee on Cancer, 8th edition. 2 Amin M. Edge S. Greene F. et al. AJCC Cancer Staging Manual. 8th edition. Springer, New York, NY2018 Google Scholar Different palliative measures can be used to treat these patients. We present the case of a woman with a bleeding, fungating breast cancer treated with hypofractionated radiation therapy.