Routine Screening Mammography Research Articles

Deep learning vs traditional breast cancer risk assessment models: Are we offering supplemental services to those who benefit the most?

1556 Background: Mammography-based deep learning (DL) risk stratification models improve discriminatory accuracy in predicting future breast cancer compared to traditional risk models; however, decisions for and insurance payment of supplemental services such as MRI are driven by traditional scores. The purpose of this study was to compare risk scores and cancer detection rates in patients identified as increased risk by DL vs traditional models in a large screening mammography cohort. Methods: This multisite study included consecutive patients ≥40y undergoing routine bilateral screening mammography from 9/2017 to 1/2022 at five facilities. Tyrer-Cuzick version 8 (TC) and National Cancer Institute Breast Cancer Risk Assessment Tool (BCRAT) 5-year and lifetime models and a DL 5-year model were used to assess risk. The following thresholds were used to define intermediate risk: ≥1.67% for TC and BCRAT 5-year, 2.2 for DL model and high risk: ≥20% for TC and BCRAT lifetime, ≥6.0 for DL model. Patients were included if all risk scores were available. Patient demographics were retrieved from electronic medical records and cancer outcomes through regional tumor registry linkage. The proportion of increased-risk patients and cancer detection rates (CDR [cancers per 1000 women screened]) across models were compared using Pearson’s Chi-square test. Results: 148476 exams in 69464 patients (mean age 58.0y [IQR: 50.0-67.0]) were performed. 81.7% (119386/146075) of exams were in White patients and 18.3% (26689/146075) in races other than White. CDR of those classified as intermediate risk by DL was 7.1 (450/63109) vs 4.7 (320/68545; P<0.001) by TC and 4.2 (300/70831; P<0.001) by BCRAT, and as high risk was 20.6 (305/14772) by DL vs 3.9 (64/16442; P<0.001) by TC and 5.0 (29/5782; P<0.001) by BCRAT. 13.0% (19248/148476) were classified as intermediate risk by DL but not by TC or BCRAT, with a CDR of 6.0 in this cohort. 32.0% (47435/148476) were classified as intermediate risk by TC or BCRAT but not by DL with a CDR of 1.1. 8.5% (12577/148476) were classified as high risk by DL but not by TC or BCRAT with a CDR of 20.8. 11.1% (16451/148476) were classified as high risk by TC or BCRAT but not by DL with a CDR of 1.9. Conclusions: A significant proportion of patients identified as increased risk by DL model are not assessed as increased risk by commonly used risk models, effectively excluding them from accessing potentially life-saving supplemental services. DL scores met the American College of Radiology's acceptable CDR on screening mammography (≥2.5) regardless of traditional scores, however, elevated traditional scores in the absence of elevated DL scores did not meet acceptable standards. Risk assessment guidelines incorporating DL models are necessary to capture patients who benefit the most.

Status of breast cancer detection in young women and potential of liquid biopsy.

Young onset breast cancer (YOBC) is an increasing demographic with unique biology, limited screening, and poor outcomes. Further, women with postpartum breast cancers (PPBCs), cancers occurring up to 10 years after childbirth, have worse outcomes than other young breast cancer patients matched for tumor stage and subtype. Early-stage detection of YOBC is critical for improving outcomes. However, most young women (under 45) do not meet current age guidelines for routine mammographic screening and are thus an underserved population. Other challenges to early detection in this population include reduced performance of standard of care mammography and reduced awareness. Women often face significant barriers in accessing health care during the postpartum period and disadvantaged communities face compounding barriers due to systemic health care inequities. Blood tests and liquid biopsies targeting early detection may provide an attractive option to help address these challenges. Test development in this area includes understanding of the unique biology involved in YOBC and in particular PPBCs that tend to be more aggressive and deadly. In this review, we will present the status of breast cancer screening and detection in young women, provide a summary of some unique biological features of YOBC, and discuss the potential for blood tests and liquid biopsy platforms to address current shortcomings in timely, equitable detection.

Abstract PO1-10-02: Breast cancer among transgender and non-binary patients on gender affirming hormone therapy: a single institution experience

Abstract Background: Estrogen exposure is a known risk factor for the development of breast cancer in women. Less clear is the risk posed by gender affirming hormone therapy (GAHT) in both transgender men and transgender women. We aimed to characterize the breast cancers that have arisen in our institution’s transgender patient population including biomarker profile, method of diagnosis, and stage at diagnosis. Methods: For this retrospective cohort study, patients from the Mount Sinai Health System were identified using the electronic medical record from 2016-2023. A cohort of transgender or non-binary patients with breast cancer was established by using ICD-10 codes for carcinoma in situ of breast (D-05) and malignant neoplasm of breast (C-50) and a diagnosis or medical history encompassing gender identity disorders (ICD-10-CM: F64) or a chief complaint related to transgender health. Chart review enabled selection of patients who have a history of GAHT. Patients with incomplete medical records were excluded from analysis. Results: 14 patients met criteria and were included for final analysis. Mean age at diagnosis was 51.7 (31-65) years and 86% (12/14) were at or above 40 years of age at diagnosis and eligible for routine screening mammography. The cohort encompassed six trans men (assigned female at birth), seven trans women (assigned male at birth), and one genderqueer person (assigned female at birth). Family history was not significant for most of the cohort. Two patients had a first-degree relative with a history of breast cancer; both were BRCA negative. Four patients (29%) were diagnosed via screening mammography; six patients (43%) were diagnosed after palpating a breast or axillary mass; and four patients (29%) had not undergone screening but were diagnosed via breast imaging mandated prior to planned chest masculinization surgery. At time of initial presentation, the diagnostic stage was DCIS in five patients (36%); LCIS in one patient (7%); stage 1 cancer in four patients (29%); stage 2 cancer in three patients (21%); and breast implant-associated anaplastic large cell lymphoma in one patient (7%). 50% (7/14) of patients had an active or past prescription for testosterone-based GAHT, and 50% (7/14) patients had an active or past prescription for estrogen-based GAHT. Mean duration of all GAHT prior to diagnosis was 16.6 years (mean duration of estrogen-based GAHT was 27.6 years and mean duration for testosterone-based GAHT was 5.7 years). Biomarker profiles were available for twelve patients; 8/12 (67%) patients were diagnosed with estrogen receptor (ER) positive cancer, four (33%) with ER negative cancers. Of patients on estrogen-based GAHT, three presented with ER+ and four presented with ER- cancers. 10/14 patients had bilateral mastectomies and 4/14 had lumpectomies. Discussion/Conclusion: The mode of cancer detection suggests that screening mammography is under-utilized among transgender and non-binary patients who use GAHT. This represents a health care disparity involving a vulnerable patient population. The biomarker profile among this population demonstrates that both estrogen-responsive and estrogen-nonresponsive cancers can arise in the setting of prior or ongoing gender affirming estrogen or testosterone. Citation Format: Nithya Krishnamurthy, Ethan Ravetch, Christina Weltz. Breast cancer among transgender and non-binary patients on gender affirming hormone therapy: a single institution experience [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-10-02.

Radiation exposure in routine mammography screening: a large observational cross-sectional study in Morocco

This observational cross-sectional study aims to assess the exposure levels during mammography examinations in Morocco and provide an international comparative analysis. Patient data from 1100 mammographic examinations conducted in five units, comprising both digital radiography (DR) and computed radiography (CR) systems from various brands and models in the Rabat-Salé-Zemmour-Zaër region, were collected. The mean glandular dose (MGD) and technical parameters, including exposure factors and breast thickness, were analyzed. The collected data were compared with findings from international studies to provide valuable context. The overall median MGD was 1.34 ± 0.36 mGy for craniocaudal (CC) and 1.48 ± 0.38 mGy for mediolateral oblique (MLO) incidences. It’s essential to note that these values were calculated based on the median compressed breast thickness. The MGD varied among different units and anode/filter combinations. The Rh/Rh anode/filter combination was most commonly used, resulting in the lowest radiation dose. The study findings also highlighted the relationship between MGD and breast thickness, with higher doses observed for thicker breasts. This study provides valuable insights into radiation exposure during mammography breast cancer screening in Morocco. The results underscore the importance of future dose optimization strategies to ensure patient safety without compromising diagnostic image quality. Implementing optimized technical parameters, conducting regular quality assurance programs, and promoting education and awareness are essential in achieving dose reduction and minimizing radiation risks. Collaboration among healthcare professionals, regulatory bodies, and international organizations is crucial for sharing best practices and advancing radiation dose optimization in mammography.

Asymptomatic marginal zone lymphoma detected on routine mammogram, an unusual presentation

A patient in her 60 years presented for routine mammographic screening. A lesion was identified, which on biopsy was proven to be marginal zone lymphoma (MZL). MZL is a group of indolent non-Hodgkin’s B-Cell lymphomas. Involvement of breast tissue is rare and can mimic more common breast pathology. In addition, the patient had widespread subcutaneous lesions which is also atypical of the cutaneous form of MZL lymphoma. This case describes the multi-modality radiological findings of this uncommon presentation of diffuse cutaneous MZL.

Reducing Barriers and Strategies to Improve Appropriate Screening Mammogram Attendance in Women 75 Years and Older.

Although breast cancer death rates have persistently declined over the last 3 decades, older women have not experienced the same degree in mortality reduction as younger women despite having more favorable breast cancer phenotypes. This occurrence can be partially attributed to less robust mammographic screening in older women, the propensity to undertreat with advancing age, and the presence of underlying comorbidities. With recent revisions to breast cancer screening guidelines, there has been a constructive shift toward more agreement in the need for routine mammographic screening to commence at age 40. Unfortunately, this shift in agreement has not occurred for cutoff guidelines, wherein the recommendations are blurred and open to interpretation. With increasing life expectancy and an aging population who is healthier now than any other time in history, it is important to revisit mammographic screening with advanced age and understand why older women who should undergo screening are not being screened as well as offer suggestions on how to improve screening mammogram attendance in this population.

Unmet Social Needs and Breast Cancer Screening Utilization and Stage at Presentation

Unmet social needs in local populations may hinder the development of targeted cancer control interventions aimed at improving screening utilization and early-stage breast cancer diagnosis to ultimately improve breast cancer survival disparities. To evaluate if (1) city-funded screening mammography is associated with utilization of screening mammography, (2) unmet social needs are associated with utilization of screening mammography, and (3) unmet social needs are associated with later-stage disease at diagnosis. This cohort study included patients with stages I-IV invasive ductal or lobular carcinoma treated at an academic medical center (including both an underserved safety-net hospital [SNH] and a National Cancer Institute-designated academic cancer center [ACC]) from 2020 to 2023. Eligible patients were aged 18 years or older and able to consent. Data were analyzed between July 2023 and September 2023. The Health Leads Social Needs Screening Toolkit, a screening tool that gathers information on the most common social need domains affecting patient health. Univariable and multivariable logistic regression was utilized to evaluate the following primary outcomes: (1) routine screening mammography and (2) American Joint Committee on Cancer 8th edition clinical stage at presentation. Of the 322 women who completed the Health Leads Social Needs Screening Toolkit, 201 (62%) self-identified as Hispanic, 63 (19%) as non-Hispanic Black, and 63 (19%) as non-Hispanic White. Two hundred fifty-five (76%) patients with access to city-funded screening mammography completed a screening mammogram. Patients who presented to the SNH were more likely to present with late-stage disease compared with early-stage disease (15 of 48 [31%] vs 50 of 274 [18%]; P = .04). On multivariable logistic regression, not completing a screening mammography was associated with having an increasing number of unmet social needs (OR, 0.74; 95% CI, 0.55-0.99; P = .047) and an increasing age at diagnosis (OR, 0.92; 95% CI, 0.89-0.96; P < .001). Moreover, increasing unmet social needs was significantly associated with late-stage diagnosis above and beyond screening mammography (OR, 1.38; 95% CI, 1.01-1.89; P = .04). In this cohort study, access to screening mammography did not translate to utilization of screening mammography, increasing unmet social needs were significantly associated with lower rates of screening mammography, and those with increasing unmet social needs were more likely to present with late-stage disease. This association transcended recruitment site (SNH vs ACC), indicating that patients in either hospital setting may benefit from unmet social needs screening to overcome access to care barriers associated with late-stage disease at diagnosis.

Abstract B078: Artificial-intelligence-driven breast density assessment in the transition from full-field digital mammograms to digital breast tomosynthesis

Abstract Introduction: To enhance reproducibility and robustness in mammographic density assessment, various artificial intelligence (AI) models have been proposed to automatically classify mammographic images into BI-RADS density categories. Despite their promising performances, so far density AI models have been assessed primarily in traditional full-field digital mammography (FFDM) images. Our study aims to assess the potential of AI in breast density assessment in FFDM versus the newer synthetic mammography (SM) images acquired with digital breast tomosynthesis. Methods: We retrospectively analyzed negative (BI-RADS 1 or 2) routine mammographic screening exams (Selenia or Selenia Dimensions; Hologic) acquired at sites within the Barnes-Jewish/Christian (BJC) Healthcare network in St. Louis, MO from 2015 to 2018. BI-RADS breast density assessments of radiologists were obtained from BJC’s mammography reporting software (Magview 7.1). For each mammographic imaging modality, a balanced dataset of 4,000 women was selected so there were equal numbers of women in each of the four BI-RADS density categories, and each woman had at least one mediolateral oblique (MLO) and one craniocaudal (CC) view per breast in that mammographic imaging modality. Previously validated pre-processing steps were applied to all FFDM and SM images to standardize image orientation and intensity. Images were then split into training, validation, and test sets at ratios of 80%, 10%, and 10%, respectively, while maintaining the distribution of breast density categories and ensuring that all images of the same woman appear only in one set. Our AI model was based on the widely used ResNet50 architecture and was designed to accept as an input a mammographic image and predict the BI-RADS breast density category that the image belongs to. Our AI model was optimized, trained, and evaluated separately for each mammographic imaging modality. We report on the AI model’s predictive accuracy on the test set for each mammographic imaging modality, for both views as well as separately for CC and MLO; accuracy differences in FFDM versus SM were assessed via bootstrapping. Results: A batch size of 32, learning rate of e-6, and Adam optimizer were chosen as the optimal hyperparameters for our AI model. Using the same hyperparameters, the AI model demonstrated substantially higher accuracy on the test set for FFDM than for SM (FFDM: accuracy = 71% ± 4.5% versus SM: accuracy = 66% ± 4.2%; p-value&amp;lt;0.001 for comparison). Similar conclusion held when CC and MLO views were evaluated separately (accuracy = 72% ± 4.6% versus 66% ± 4.3% for CC; accuracy = 69% ± 4.5% versus 62% ± 4.3% for MLO; p-value&amp;lt;0.001 for both comparisons). Conclusions: AI performance in BI-RADS breast density assessment was significantly higher on FFDM versus SM, even under the same AI model design, dataset size and training process. Our preliminary findings suggest that further AI optimizations and adaptations may be needed as we translate AI models from FFDM to the newer SM format acquired with digital breast tomosynthesis. Citation Format: Krisha Anant, Juanita Hernandez Lopez, Debbie Bennett, Aimilia Gastounioti. Artificial-intelligence-driven breast density assessment in the transition from full-field digital mammograms to digital breast tomosynthesis [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Breast Cancer Research; 2023 Oct 19-22; San Diego, California. Philadelphia (PA): AACR; Cancer Res 2024;84(3 Suppl_1):Abstract nr B078.

Abstract C127: Strategies to improve breast cancer screenings among uninsured individuals post COVID-19

Abstract MD Anderson Cancer Center at Cooper (Cooper) is located in Camden, NJ, one of the poorest cities in the nation. The Camden County Cancer Screening Project (CCCSP) is a state and federally funded program out of Cooper which provides breast, cervical, prostate and colorectal cancer screening at no cost for uninsured and underinsured individuals. This target group is particularly difficult to screen due to a variety of social determinants of health and other barriers. Like other national sites, routine screenings stopped at Cooper for approximately four months in 2020. This quality improvement project focused on several initiatives to return insured and uninsured vulnerable patients back to mammography screening over the past two years. We also looked to understand barriers to screening prevalent in the community. Cooper undertook a multi-level approach to return our communities to their routine mammography screening. These included opportunities during the pandemic when screenings froze, opportunities when screenings resumed, outreach efforts through CCCSP, and special events with community partners. Efforts included screening postcards, advertisements, letters and phone calls to current patients, email blasts, virtual education, opening evening and weekend hours for mammograms, promoting screenings at vaccine sites, and in-reach to women who were due for screening. In 2020, mammography screenings decreased to 11% less for all of Cooper patients and to 37% for CCCSP compared to 2019 (pre-pandemic levels). In 2021, screenings increased higher than pre-pandemic levels at Cooper by 15% but stayed 25% lower for CCSP. In 2022, screenings increased higher than pre-pandemic levels at Cooper by 25% but stayed 22% lower for CCSP. A survey of 367 Camden community women 40 and older on barriers to screening noted that of the women who never had been screened (25) or had not gotten screened in over 2 years (118), health insurance, perceptions of mammography and transportation were the top barriers to screening. Institutional efforts at Cooper to return women to breast cancer screenings were successful for insured individuals but did not return to the pre-pandemic screening rate for uninsured individuals. A recent internal study noted that fear of screening, compounded by the pandemic, is a major reason for lack of screening for this community. A survey of our community noted insurance, beliefs and transportation as major barriers. As such, as we continue to encourage women back to screening, efforts need to focus on resources to support our underserved community’s concerns. Citation Format: Evelyn Robles-Rodriguez, Plyshette Wiggins, Tondalya DeShields. Strategies to improve breast cancer screenings among uninsured individuals post COVID-19 [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C127.

Evaluation of the relationship between digital mammography radiation dose and patient age, breast volume and density

Aims: To determine the average radiation dose values in patients who underwent routine screening mammography in our hospital, establish the relationship between breast density and volume, and investigate other factors affecting radiation dose.&#x0D; Methods: Screening bilateral mammography was retrospectively evaluated within the specified period of 2 months. Patient age, breast density ratio, mammographic size of the breast, calculated breast volume, tube voltage, current, exposure time (ms), compression force (kg), compression thickness (mm), and radiation dose (mGy) given in each projection were recorded separately for each patient. According to the BI-RADS, breast densities classified as types A-B were considered non-dense, while types C-D were considered dense breasts. The 75th percentile dose value (mGy) was chosen as the cutoff for high dose group. Logistic regression analyses were used to examine the factors affecting radiation dose.&#x0D; Results: 1720 mammograms from 430 patients were studied. 276 (64.2%) breasts were non-dense, while 154 (35.8%) breasts were dense. The mean total breast volume was 595±334 ml, compression thickness was 36.5±12.0 mm, and radiation dose was 2.04±0.75 mGy. There was a negative correlation between radiation dose and age (r=-0.330, p

A Clinico-Pathological Correlation of Breast Lumps in a Tertiary Care Centre

BACKGROUND&#x0D; Breast lump is one of the most prevalent ailments that women face. Mostly these lumps are benign, but breast malignancy is the most common form of cancer and is the second leading cause of malignancy deaths in women. Fibroadenoma is the most common benign breast mass and invasive ductal carcinoma is the most common malignancy. Delay in the detection causes the malignancy to progress to an advanced stage. Early detection of malignancies in initial stages is done using triple test to decrease mortality. Incidence of breast cancer can be reduced by 30% by the routine mammographic screening of healthy women. We wanted to correlate the clinical and pathological diagnosis in patients presenting with palpable breast lumps and assess the reliability of clinical examination as a pre-procedural diagnostic tool in this study.&#x0D; METHODS&#x0D; A prospective observational study was done in a total of 100 women. Detailed clinical history and examination were done and then compared to histopathological results. The final results were statistically analyzed.&#x0D; RESULTS&#x0D; The clinical examination exhibited a sensitivity of 97.96% and a specificity of 96.08% for the identification of cancer when the data were considered collectively. The clinical examination's positive predictive value was 95.84%, and its negative predictive value was 98.08%.&#x0D; CONCLUSIONS&#x0D; A significant correlation was also observed between the clinical diagnosis and final pathological diagnosis. So routine clinical examination would definitely be helpful in early diagnosis.

Testing Theory-Based Messages to Encourage Women at Average Risk for Breast Cancer to Consider Biennial Mammography Screening.

The US Preventive Services Task Force does not recommend routine annual mammography screening for women aged 40-49 at average risk. Little research has been done to develop theory-based communication interventions to facilitate informed decision-making about reducing potentially low-value mammography screening. Evaluate the effects of theory-based persuasive messages on women's willingness to consider delaying screening mammography until age 50 or have mammograms biennially. We conducted a randomized controlled communication experiment online with a population-based sample of U.S. women aged 40-49 (N = 383) who screened to be at average risk for breast cancer. Women were randomly assigned to the following messaging summaries: annual mammography risks in 40s (Arm 1, n = 124), mammography risks plus family history-based genetic risk (Arm 2, n = 120), and mammography risks, genetic risk, and behavioral alternatives (Arm 3, n = 139). Willingness to delay screening or reduce screening frequency was assessed post-experiment by a set of 5-point Likert scale items. Women in Arm 3 reported significantly greater willingness to delay screening mammography until age 50 (mean = 0.23, SD = 1.26) compared with those in Arm 1 (mean = -0.17, SD = 1.20; p = .04). There were no significant arm differences in willingness to reduce screening frequency. Exposure to the communication messages significantly shifted women's breast cancer-related risk perceptions without increasing unwarranted cancer worry across all three arms. Providing women with screening information and options may help initiate challenging discussions with providers about potentially low-value screening.

Experience of Pain and Unpleasantness during Mammography Screening: A Cross-Sectional Study on the Roles of Emotional, Cognitive, and Personality Factors.

Breast cancer is the most frequent cause of malignant tumors among women worldwide. Its successful prevention depends on the degree of participation in screening programs, which can be influenced by psychological factors, including fear. A cross-sectional study was conducted according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement. Twenty-six healthy women aged 50-69 years took part in this study, all of whom were summoned for routine mammography screening and were randomly selected. Prior mammography screening, breast pain intensity, unpleasantness (visual analog scale), and psychological (catastrophizing, state anxiety, and fear of pain) and personality (neuroticism, psychoticism, and extraversion) variables were evaluated. Pain, unpleasantness, and state anxiety were further evaluated pre- and post-mammography screening. During the mammography screening, pain and unpleasantness levels were higher than those observed pre- and post-screening. Residual unpleasantness remained post-screening. State anxiety was positively associated with pain, and psychoticism with unpleasantness, as reported by participants during the mammography screening. Anxiety levels influence the pain experienced in association with the mammography procedure. Women subjected to mammography screenings might benefit from relaxation strategies aimed at reducing anxiety to pre-mammography levels and, by extension, pain and unpleasantness during mammography. The inclusion of these strategies in breast cancer prevention campaigns could improve the rates of mammography reattendance, and therefore, benefit cancer prevention efforts.

Abstract P6-05-38: Breast Density Notification: Impact on anxiety, breast cancer worry, and self-perceived risk among Latinas at a federally qualified medical center

Abstract Mammographic breast density (MBD) has been shown to be a strong, independent risk factor for breast cancer (BC) irrespective of race/ethnicity. Given the risk association of MBD and its potential to mask tumors on a mammogram, state and federal laws have mandated that women receive information regarding their personal MBD in their mammography reports. However, concerns have been raised regarding the impact of MBD notification on patient anxiety, especially written information for women who experience health disparities such as racial/ethnic minorities, lower health literacy, limited English proficiency and lower socioeconomic status. We performed a randomized controlled clinical trial to examine the impact of three different written and interpersonal approaches to MBD notification on patient anxiety, BC worry, and self-perceived BC risk, among Latinas receiving routine mammography screening at a federally qualified medical center (FQHC). We hypothesized that interpersonal education would reduce anxiety and worry, relative to the written notifications alone. The study was performed at the Baseline Clinic of Mountain Park Health Center, a FQHC in Phoenix, AZ. Women between ages 40 and 74 years presenting for screening mammogram were eligible. After providing signed informed consent, participants were randomized equally to usual care (UC- mailed notification letter); enhanced care (notification letter and MBD educational brochure designed for this study): interpersonal care (notification letter, brochure, promotora education via telephone). A stratified block randomization procedure was used with age &amp;gt; 50 years (yes vs no), ethnicity (Hispanic vs non-Hispanic), and language preference (Spanish vs. English) as strata. Study participants completed surveys at the time of enrollment/pre-intervention (T0), at two weeks to six months after intervention was delivered (T1), and about one year after randomization (T2). Anxiety state was measured using the state anxiety subscale of the State-Trait Anxiety Inventory scale (STAI-S) (range from 20-80). BC worry was probed using the question: “How frequently do you worry about getting breast cancer someday”. The self-perceived lifetime risk of BC was rated between 0% (no chance of BC) to 100% (definitely will get BC). The proportion of participants with an increase or persistence of higher level for each outcome between time points was compared between the three study groups. The study was approved by the Mayo Clinic Institutional Review Board. 1332 Latina women were enrolled and randomized between October 2016 and October 2019. All completed the baseline (T0) survey, 928 completed T1, 632 completed T2, and 516 completed both T1 and T2 surveys. At study entry, majority of the participants were young (64.1% between age 40-49 years), had no family history of breast cancer (81.0%), had less than high school education (68.8%), and were married or partnered (67.8%). At T0, the mean (SD) anxiety STAI score was 32.5 (11.1); 51.8% with moderate or severe anxiety (score &amp;gt; 30). With regard to BC worry, 41.3% reported worrying “sometimes”, “often”, or “almost all the time”. Further, 25.4% reported a self-perceived lifetime risk of developing BC of &amp;gt;10% while only 6.6% had a Gail model estimated lifetime risk score of &amp;gt;10%. There was no significant difference in changes in anxiety, BC worry or self-perceived risk from T0 to either T1 or T2 surveys between the intervention groups. In summary, this study found high levels of baseline anxiety and BC worry (despite the majority being 40-49 years old and having no family history of BC) which persisted regardless of how notification and education were delivered. Future work is needed to improve the understanding of factors that could lower anxiety and BC worry and improve risk perception in this population. Citation Format: Karthik Ghosh, Sarah Jenkins, Jennifer Ridgeway, Jessica D. Austin, Bijan Borah, Bhavika K. Patel, Deborah Rhodes, Aaron Norman, Edna P. Ramos, Matt Jewett, Crystal Gonzalez, Valentina Hernandez, Davinder Singh, Vera Suman, Celine Vachon. Breast Density Notification: Impact on anxiety, breast cancer worry, and self-perceived risk among Latinas at a federally qualified medical center. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-38.

Abstract P2-05-03: Perceived Guideline Clarity &amp; Deferral to Patient Preferences impact guideline concordant care for breast cancer screening in women age 40-49

Abstract Background: Canadian and US Task Forces recommend against routine mammography screening for women age 40-49 at average breast cancer risk on the basis that harms outweigh the benefits. Both cite the importance of supporting women’s individualized decisions based on the relative value placed on potential benefits and harms of screening (2, 4). Population-based data reveal that screening rates in this age group are influenced by the woman’s primary care provider (PCP), suggesting some providers refer more often than others. This highlights the need to explore PCP perspectives on screening and how this informs clinical behaviour. Methods: Qualitative semi-structured interviews were performed by phone with PCPs in Ontario, Canada. Interviews were structured using the Theoretical Domains Framework (TDF) to explore determinants (barriers/facilitators) of three screening-related behaviours: 1) conducting a risk assessment; 2) discussion regarding benefits and harms; and 3) making a decision regarding referral for mammographic screening. Analysis: Interviews were transcribed and analyzed iteratively until saturation was reached. Two independent researchers coded all transcripts deductively both by behaviour and according to TDF domain. Findings that did not fit within a TDF code were coded inductively. Data were then grouped by screening behaviour and the associated codes were used to generate descriptive narratives of the determinants influencing PCP behaviour. Results: Eighteen physicians (mean age 48, 72% identified female) were interviewed. Table 1 outlines the determinants of the three screening behaviours. Analysis of inductive codes revealed two key contextual themes that influenced behaviours and moderated TDF codes: perceived guideline clarity (a lack of clarity on which behaviours (if any) were guideline-concordant) and deferral to patient preference (patient decision regarding screening without a complete discussion of benefits and harms). PCPs who perceived that the guidelines stated definitively that screening was not recommended had improved knowledge of harms and stronger beliefs about capabilities to educate patients about why screening was not recommended routinely. Deferral to patient preference seemed to occur when PCP’s knowledge was low and/or if they were impacted by experience of a younger woman diagnosed with breast cancer, which often led to anticipated regret (TDF domain: emotion). Discussion/Conclusion: Low knowledge related to formal breast cancer risk assessment, combined with a tendency to over-estimate benefits of screening relative to harms could explain some inappropriate variation in practice. All 3 PCP screening behaviours appeared to be affected by both perceived guideline clarity and deferral to patient preferences. These may all be effective targets for future interventions to address variation in care. Table 1: Unique Barriers and Facilitators of Three Screening Behaviours Citation Format: Michelle Nadler, Ann Marie Corrado, Brooke E. Wilson, Alexandra Desnoyers, Eitan Amir, Noah Ivers, Laura Desveaux. Perceived Guideline Clarity &amp; Deferral to Patient Preferences impact guideline concordant care for breast cancer screening in women age 40-49 [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-05-03.

Perceived guideline clarity impacts guideline-concordant care for breast cancer screening in women age 40–49

BackgroundCanadian and US Task Forces recommend against routine mammography screening for women age 40–49 at average breast cancer risk as harms outweigh benefits. Both suggest individualized decisions based on the relative value women place on potential screening benefits and harms. Population-based data reveal variation in primary care professionals (PCPs) mammography rates in this age group after adjusting for sociodemographic factors, highlighting the need to explore PCP screening perspectives and how this informs clinical behaviours. Results from this study will inform interventions that can improve guideline concordant breast screening for this age group.MethodsQualitative semi-structured interviews were performed with PCPs in Ontario, Canada. Interviews were structured using the theoretical domains framework (TDF) to explore determinants of breast cancer screening best-practice behaviours: (1) risk assessment; (2) discussion regarding benefits and harms; and (3) referral for screening.AnalysisInterviews were transcribed and analyzed iteratively until saturation. Transcripts were coded deductively by behaviour and TDF domain. Data that did not fit within a TDF code were coded inductively. The research team met repeatedly to identify potential themes that influenced or were important consequences of the screening behaviours. The themes were tested against further data, disconfirming cases, and different PCP demographics.ResultsEighteen physicians were interviewed. The theme of perceived guideline clarity (a lack of clarity on guideline-concordant practices) influenced all behaviours and moderated the extent to which the risk assessment and discussion occurred. Many were unaware of how risk-assessment factored into the guidelines and/or did not perceive that a shared-care discussion was guideline-concordant. Deferral to patient preference (screening referral without a complete discussion of benefits and harms) occurred when the PCPs had low knowledge regarding harms and/or if they experienced regret (TDF domain: emotion) resulting from prior clinical experiences. Older providers described patient’s influence impacting their decisions and physicians trained outside Canada, practicing in higher-resourced areas, and female physicians described being influenced by beliefs about consequences of benefits of screening.ConclusionPerceived guideline clarity is an important driver of physician behaviour. Improving guideline concordant care should start by clarifying the guideline itself. Thereafter, targeted strategies include building skills in identifying and overcoming emotional factors and communication skills important for evidence-based screening discussions.

Comparison of phenomics and cfDNA in a large breast screening population: the Breast Screening and Monitoring Study (BSMS)

To assess their roles in breast cancer diagnostics, we aimed to compare plasma cell-free DNA (cfDNA) levels with the circulating metabolome in a large breast screening cohort of women recalled for mammography, including healthy women and women with mammographically detected breast diseases, ductal carcinoma in situ and invasive breast cancer: the Breast Screening and Monitoring Study (BSMS). In 999 women, plasma was analyzed by nuclear magnetic resonance (NMR) and Ultra-Performance Liquid Chromatography-Mass Spectrometry (UPLC-MS) and then processed to isolate and quantify total cfDNA. NMR and UPLC-MS results were compared with data for 186 healthy women derived from the AIRWAVE cohort. Results showed no significant differences between groups for all metabolites, whereas invasive cancers had significantly higher plasma cfDNA levels than all other groups. When stratified the supervised OPLS-DA analysis and total cfDNA concentration showed high discrimination accuracy between invasive cancers and the disease/medication-free subjects. Furthermore, comparison of OPLS-DA data for invasive breast cancers with the AIRWAVE cohort showed similar discrimination between breast cancers and healthy controls. This is the first report of agreement between metabolomics and plasma cfDNA levels for discriminating breast cancer from healthy subjects in a true screening population. It also emphasizes the importance of sample standardization. Follow on studies will involve analysis of candidate features in a larger validation series as well as comparing results with serial plasma samples taken at the next routine screening mammography appointment. The findings here help establish the role of plasma analysis in the diagnosis of breast cancer in a large real-world cohort.

Difference-of-Gaussian generative adversarial network for segmenting breast arterial calcifications in mammograms

Breast arterial calcifications (BACs) are amongst the different types of benign calcifications observed on mammograms. BACs have been found to correlate with cardiovascular risk factors, cardiovascular mortality, and coronary artery disease (CAD). Considering that women are recommended to undergo routine screening mammography for the early detection of breast cancer, identifying BACs on mammograms could help identify women at risk of cardiovascular diseases (CVD) without the additional cost or radiation of other tests, such as coronary artery computed tomography (CT). In this paper, we present a difference of Gaussian generative adversarial network (DoG-GAN) model for segmenting BACs in mammograms. It combines the multi-scale difference of Gaussian (DoG) pyramid with the U-net as a generator of the GAN. This approach allows the model to explore image details at each scale and exploit the edge information to effectively segment BACs. We evaluated the performance of our model on a set of synthetic 2D images from digital breast tomosynthesis exams (DBT) collected and prepared for this task. The experimental results show that our model outperforms the state-of-the-art methods.

Screeningul cancerului de sân pentru femeile cu implant mamar

Brest cancer represents the most common cancer world­wide, being the second deadliest cancer in women. There is no doubt regarding the importance of breast cancer scre­ening. Mammography represents the primary imaging tech­nique used to detect suspicious lesion for breast cancer. This ima­gistic method has been found to decrease the mortality related to breast cancer. Mammography may detect evi­dence of cancer one and a half to four years before cancer be­comes clinically obvious. Patients with breast tissue aug­­men­ta­tion need a routine screening mammography in or­der to evaluate the native breast tissue. The indications for breast cancer screening are the same as in women without im­plants, the only difference being that women with breast im­plants should be approached differently from a clinical point of view. Standard imaging technique for this type of pa­tients involves four sections in alternative of the usual two sections per breast. In conclusion, women with breast aug­men­ta­tion should not be neglected and should undergo breast cancer screening alongside the targeted po­pu­la­tion, even though the required technique is more laborious and requires a more experienced eye.

Mammographic breast density status in women aged more than 40 years in Sulaimaniyah, Iraq: a cross-sectional study.

Mammography is the gold standard screening procedure for the early diagnosis of breast cancer. This study aimed to determine the distribution of breast density among women older than 40 years in Sulaimaniyah, Iraq, and to examine the correlations between breast density and various risk factors. This cross-sectional study included 750 women who received routine mammographic breast screening at Sulaimaniyah Breast Center. Bilateral standard two-view mammographic images (craniocaudal and mediolateral oblique projections) were acquired and reported using a picture archiving and communication system. American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BI-RADS) assessment categories C and D were considered as dense. A total of 54.3% of breasts were classified as dense, with ACR-BI-RADS categories C or D. Breast density was significantly associated with age, body mass index, a family history of breast cancer, and pre-menopause, and women with no history of breastfeeding were more likely to have dense breasts than those with partial or complete breastfeeding. This study revealed that women from Sulaimaniyah with a distinct breast-density profile at mammographic screening may have a significantly increased risk of breast cancer.