Screening Of Young Women Research Articles

Screening for persistent high-risk HPV infections may be a valuable screening method for young women; A retrospective cohort study

IntroductionScreening of young women is often discouraged because of the high risk of unnecessary diagnostics or overtreatment. Multiple countries therefore use cytology instead of high risk human papillomavirus (hrHPV)-testing as screening method for young women because of the limited specificity of hrHPV-testing. The objective of this study was to investigate how hrHPV screening before the age of 30, can be used to reduce the future prevalence of high-grade cervical lesions in young women.MethodsWe retrospectively analyzed follow-up data from a cohort study on HPV prevalence in unscreened Dutch women aged 18–29 years. Women performed multiple self-collected cervico-vaginal samples for HPV detection and genotyping. At least one valid cervical pathology result was obtained from 1,018 women. Women were categorized as hrHPV negative, cleared- or persistent hrHPV infection. Anonymized follow-up data for each group was obtained. Composite outcome measures were defined as; normal, low-grade squamous intraepithelial lesion (LSIL) or high-grade squamous intraepithelial lesion (HSIL). The association between prior hrHPV status and cytology and histology outcome was analyzed.ResultsAfter exclusion, a pathology result was registered for 962 women. The prevalence of HSIL was 19.3% in women with a persistent HPV infection at a younger age. This is significantly higher (p<0,001) compared with the HSIL prevalence of 1.5% in HPV-negative women, and 3.1% (n = 8) in women who cleared the hrHPV infection in the past.ConclusionWomen with a persistent hrHPV infection in their 20s, show an increased prevalence of HSIL lesions in their early 30s. Screening for persistent hrHPV infections, instead of cytology screening before the age of 30, can be used to reduce the future prevalence of cervical cancer in young women.

Cervical cancer screening and subsequent procedures in women under the age of 25 years between 2007 and 2013 in France: a nationwide French healthcare database study.

Cervical cancer screening in young women may lead to the detection of lesions with a high potential for spontaneous regression and no benefit of surgery. French guidelines recommend initiating cervical cancer screening by the Pap test from the age of 25 years. To date, no French nationwide study has assessed cervical cancer screening in young women and the related subsequent work-up and surgical procedures among screen-positive women. Using data from the French national healthcare databases (around 50 million beneficiaries), annual and 3-year Pap test screening rates were calculated among women aged 15-24 years between 2007 and 2013. Cervical excisional procedures were assessed during the 15-month period following a first Pap test in women aged 20-24 years in 2007 and 2012. About 10% of the almost six million women aged 15-65 years with at least one annual Pap test were under the age of 25, mainly women aged 20-24 years, in whom the 3-year screening coverage was 35.5% in 2013. In screened women aged 20-24 years, human papillomavirus testing rates increased markedly over the study period (+105%) and surgical management became less conservative with an increased rate of both conization (+16.5%) and other excisional treatments (+74.5%). Nevertheless, because of the overall decrease in screening coverage, the absolute yearly number of women who underwent conization decreased from 1974 to 1766 between 2007 and 2012. Higher adherence to guidelines is needed to reduce the burden of surgical treatment that is potentially associated with adverse obstetric outcomes among women under the age of 25 years.

The Impact of Obesity on Incidence of Type 2 Diabetes Mellitus (T2DM) among Women with Polycystic Ovary Syndrome (PCOS)

There is controversy surrounding the impact of obesity on the development of type 2 diabetes mellitus (T2DM) among women with polycystic ovary syndrome (PCOS). We aimed to clarify the role of PCOS per se in the development of T2DM by identifying the population-based incidence rate of T2DM among women with PCOS according to risk factors including body-mass index (BMI), ethnicity, and family history of T2DM. We undertook a historical population-based cohort study of women aged 18-23 years followed-up over 15 years (between years 2000 and 2015) using the Australian Longitudinal Study on Women’s Health (ALSWH) database. The study cohort consisted of women with self-reported PCOS and women without a diagnosis of PCOS (controls). We undertook survival analysis to identify potential predictors of T2DM using Cox Proportional Hazard Model and person-time analysis to calculate incidence rates of T2DM per 1000 person-years (PY). During a follow-up of 1,919 years of person-time, 186 women developed T2DM. The incidence rate of T2DM was 4.22 per1000 (PY) in PCOS vs. 1.02 per 1000 PY in controls (p&amp;lt;0.001). The Kaplan-Meier survival probability estimates at 15 years were: 0.952 and 0.988 for women with and without PCOS respectively. On sub-group analyses, BMI categories across lean, overweight, and obese women with PCOS [IRR (incidence rate ratio): 4.68, 3.52 and 2.36)respectively] showed a higher risk for T2DM compared to controls. In the multivariate Cox analysis, PCOS, BMI, education, and family history of T2DM all independently increased the risk for T2DM in all women. PCOS was the strongest predictor [HR: 3.38 (95% CI: 2.21, 5.18), p&amp;lt;0.001] adjusting for BMI, education, and family history of T2DM. PCOS is independently associated with an increased incidence of T2DM among young adult women and this increased risk varies by BMI. Screening of young women for T2DM should be considered, based on their overall diabetes risk taking into account PCOS status, BMI, and other risk factors. Disclosure N. Kakoly: None. A. Earnest: None. H. Teede: None. L. Moran: None. D. Loxton: None. A.E. Joham: None.

Breast cancer screening in young women.

Breast cancer is the leading cause of death by cancer in women aged less than 40. However, organized screening of young healthy women has been recognized as inefficient and even deleterious by most experts [1], and should not been offered. Individualized screening, targeting only some young high-risk women, may be beneficial although no randomized trial has proven an impact on breast cancer mortality. All recommendations are based on expert's opinions. This review offers a toned overview of these recommendations and underlines the need of careful information and shared decision with each patient.

Screening for Mullerian anomalies in patients with unilateral renal agenesis: Leveraging early detection to prevent complications

Mullerian anomalies have a known association with renal agenesis yet, to date, there are no formal recommendations for screening women with certain renal anomalies for associated genital tract disorders. The objective of this study is to review current data regarding the association between renal and Mullerian anomalies, and propose screening recommendations. A comprehensive review of the literature was performed to identify relevant articles using the keywords "unilateral renal agenesis," "renal anomalies," and "Mullerian anomalies." Over 30% of patients with unilateral renal agenesis have an associated Mullerian anomaly. However, diagnosis is frequently delayed in this population until after menarche when complications of retrograde menstruation with obstructive anomalies lead to significant problems including endometriosis, pelvic inflammatory disease, and infertility. No clear guidelines exist for communication among the antenatal sonographer, the obstetrician, the parents, and the child's pediatrician, which creates a barrier to effective screening and follow-up. Further, no current guidelines exist for screening women with certain renal anomalies for Mullerian anomalies. The complications of Mullerian anomalies are easily preventable if identified early. We propose new guidelines for education and screening for Mullerian anomalies in patients with unilateral renal agenesis (URA) and multicystic dysplastic kidney (MCDK) to guide providers, patients, and parents on proper identification and management (Table). Screening young women with URA and MCDK for Mullerian anomalies has the potential to prevent long-term complications from untreated obstructive malformations. Identification of unilateral renal agenesis on antenatal ultrasound must be clearly articulated with parents and the child's pediatrician so that proper screening can be performed before menarche. Pelvic sonography is a low-cost, high-yield screening tool to identify these anomalies.

The Role of Ultrasound as a Diagnostic Tool for Breast Cancer in the Screening of Younger Women (Age 25-38) in Guyana

Objective: Ultrasound is used in many ways, not only as an initial diagnostic tool for confirmation of pathology determined from biopsies of the breast but also staging of breast cancer. Ultrasound is inexpensive and readily available almost all over the country. In a recent publication from the UK, the incidence of breast cancer in women younger than 35 years was 1.4% and in those younger than 30 years it was 0.43%. Breast Cancer is the most commonly diagnosed cancer amongst women worldwide. There were approximately 1.38 million new cases of breast cancer in the year 2008 and by 2020 this figure is anticipated to escalate to 1.7 million. Methodology: This research was a qualitative retrospective study which focused on charts from the Cancer Institute of Guyana that was acquired during the period of January 2010 to December 2016. Triple data entry was done to avoid errors. Data was entered into Microsoft excel 2007. Results: A total of 80 charts were reviewed, with a 95% confidence level and a confidence interval of 9.42. The average age at which women were being screened is 33 from 2010-2016. Ultrasound showed sensitivity was 97% and the specificity 98%. Discussion: Ultrasound was shown to be more sensitive than mammogram. Afro-Guyanese were the majority screened. Most persons had ultrasound done with both malignant and benign diseases being discovered with this modality. The malignant cases were more frequently diagnosed at stage II and the average of detection was 33. Conclusion: Ultrasound is effective and sensitive in the diagnosis of breast cancer. It is also effective in diagnosing benign breast diseases in younger women with dense breast tissue. Ultrasound is cheaper and safer than other imaging modalities for screening and diagnosis.

Early screening for Chlamydia trachomatis in young women for primary prevention of pelvic inflammatory disease (i-Predict): study protocol for a randomised controlled trial

BackgroundGenital infection with Chlamydia trachomatis (Ct) is the most common bacterial sexually transmitted infection, especially among young women. Mostly asymptomatic, it can lead, if untreated, to pelvic inflammatory disease (PID), tubal factor infertility and ectopic pregnancy. Recent data suggest that Ct infections are not controlled in France and in Europe. The effectiveness of a systematic strategy for Ct screening in under-25 women remains controversial. The main objective of the i-Predict trial (Prevention of Diseases Induced by Chlamydia trachomatis) is to determine whether early screening and treatment of 18- to-24-year-old women for genital Ct infection reduces the incidence of PID over 24 months.Methods/designThis is a randomised prevention trial including 4000 eighteen- to twenty-four-year-old sexually active female students enrolled at five universities. The participants will provide a self-collected vaginal swab sample and fill in an electronic questionnaire at baseline and at 6, 12 and 18 months after recruitment. Vaginal swabs in the intervention arm will be analysed immediately for Ct positivity, and participants will be referred for treatment if they have a positive test result. Vaginal swabs from the control arm will be analysed at the end of the study. All visits to general practitioners, gynaecologists or gynaecology emergency departments for pelvic pain or other gynaecological symptoms will be recorded to evaluate the incidence of PID, and all participants will attend a final visit in a hospital gynaecology department. The primary endpoint measure will be the incidence of PID over 24 months. The outcome status (confirmed, probable or no PID) will be assessed by two independent experts blinded to group assignment and Ct status.DiscussionThis trial is expected to largely contribute to the development of recommendations for Ct screening in young women in France to prevent PID and related complications. It is part of a comprehensive approach to gathering data to facilitate decision-making regarding optimal strategies for Ct infection control. The control group of this randomised trial, following current recommendations, will allow better documentation of the natural history of Ct infection, a prerequisite to evaluating the impact of Ct screening. Characterisation of host immunogenetics will also allow identification of women at risk for complications.Trial registrationClinicalTrials.gov, NCT02904811. Registered on September 14, 2016.World Health Organisation International Clinical Trials Registry, NCT02904811.AOM, 15-0063 and P150950. Registered on September 26, 2016. A completed Standard Protocol Items : Recommendations for International Trials (SPIRIT) Checklist is available in additional file 1.

Factors Associated with Routine Recommendation of Mammography for Women Aged 40-49: Provider Characteristics and Screening Influences.

Despite the US Preventive Services Task Force recommendation against screening mammography in women younger than 50 years, rates remain high, suggesting that screening recommendations may be motivated by other factors. The objective of this study was to understand provider-reported influences on screening recommendations for women 40 to 49 years old at average risk for breast cancer. An online survey of primary care providers was conducted at four health centers in Cleveland, Ohio in 2015. Provider-reported routine recommendation of mammography for women aged 40 to 49 at average risk for breast cancer was the primary outcome. The independent measures included influence of electronic health records, national guidelines, institutional policy, patient preferences, concerns about overtreatment, concerns about false-positives, and interest in early detection on screening recommendations. We used multivariable logistic regression to estimate the odds of recommending screening by potential influences, controlling for provider characteristics and provider-assessed balance of harms and benefits of screening in this age group. Of 612 providers invited, 220 completed the survey (response rate 36%); 69% routinely recommended screening and 24% believed that the harms of screening in younger women outweighed the benefits. Being influenced by institutional policy was associated with higher odds of recommending screening (odds ratio [OR] 4.19, 95% confidence interval [CI] 1.35-12.9), as was interest in early detection (OR 4.19, 95% CI 1.31-12.9). Conversely, strong influence of national guidelines was associated with a lower odds of recommending screening (OR 0.25, 95% CI 0.09-0.71). The influence of patient preferences was not associated with screening recommendation. Providers face competing influences on screening recommendations for younger patients, some of which may be at odds with their beliefs. Institutional policy change allowing individually tailored screening discussions may improve patient-centered care.

Assessment of Adaptive Breast Cancer Screening Policies for Improved Mortality Reduction in Low to Middle Income Countries

Objective:To investigate adaptive breast cancer screening policies using clinical breast examination for early detection and mortality reduction in low to middle income countries like India.Methods:Using published data from the Mumbai randomized cluster control trial (1998-2006), we first estimated the mean sojourn time at 5.9 years (95% Confidence Interval: 5.3-6.5) assuming 52% sensitivity of the test. The estimated mean sojourn time was used as a “silent interval” in time varying cellular kinetics with the two stage deterministic clonal expansion model, and we found age specific sojourn times in years as follows: 35-39. 0.8; 40-44, 1.0; 45-49, 1.8; 50-54, 3.2; and 55+, 5.9. Equipped with age specific sojourn times and sensitivity, we investigate adaptive screening policies for various year age groups using different screening intervals, maintaining a constant screen count of 10 and a 6 state Markov transition model. The rationale for using a fixed number of screens was to benchmark the effect of the screening interval.Result:We found that annual screening at ages 35-39 and biennial from 41-49 would achieve a mortality reduction of 27.9%, while annual screening from 38-42 and triennial from 43-58 would achieve a mortality reduction of 25.5%. Biennial screening from 40-60 years of age showed a mortality reduction of 23.6%, indicating inclusion of annual screening might be effective. We demonstrated a modelling framework that could be applied to the final data of randomized controlled trials, such as the ongoing Mumbai and Trivandrum trials in India, for assessing efficacy of annual screening in younger women.Conclusion:The framework could be useful to decide age groups that would yield maximal effectiveness in screening trials with selected screening intervals. Further, the framework could be adapted in other low to middle income countries for designing either screening trials or adaptive screening policies.

Practice-Based Quality Improvement Collaborative to Increase Chlamydia Screening in Young Women.

Chlamydia trachomatis infections are common among sexually active young women. We developed a practice-based quality improvement (QI) collaborative to increase Chlamydia screening in at-risk young women. Structured data fields were integrated into the electronic record for practices affiliated with Boston Children's Hospital. A learning community (LC) was developed. Content included the adolescent well visit, assessment of sexual/risk behaviors, epidemiology of sexually transmitted diseases, and screening methods. The QI initiative effectiveness was assessed by comparing preintervention and postintervention rates of Chlamydia screening by using statistical process control analyses and logistic regressions. LC participants demonstrated significant increases in recommended Chlamydia screening, as illustrated by using Healthcare Effectiveness Data and Information Set (HEDIS) screening rates (LC1: 52.8% preintervention vs 66.7% postintervention [P < .0001]; LC2: 57.8% preintervention vs 69.3% postintervention [P < .0001]). Participating practices reported total improvements larger than nonparticipating practices (13.9% LC1, 11.5% LC2, and 7.8% nonparticipants). QI and LC efforts also led to increased documentation of sexual activity status in the record (LC1: 61.2% preintervention to 91.2% postintervention [P < .0001]; LC2: 43.3% preintervention to 61.2% postintervention [P < .0001]). Nonparticipating practices were more likely to perform indiscriminate screening. Through our QI and LC efforts, statistically and clinically meaningful improvements in Chlamydia screening rates were attained. Differences in rates of improvement indicate that LC participation likely had effects beyond electronic medical record changes alone. During the project time frame, national HEDIS screening rates remained unchanged, suggesting that the observed improvements were related to the interventions and not to a national trend. As a result of QI tools provided through the LCs, HEDIS screening goals were achieved in a primary care setting.

Cervical Cytology Screening - Is the Change of Policy Risk Free?

Objective: With the change in the cervical cancer screening guidelines, women younger than 21 will not be routinely screened and the screening interval is extended to three years. In spite of the well-received newly recommended guidelines on cervical cancer screening, how many patients will be excluded by the guidelines that may have otherwise benefited from the screening? It is important to look at the trends in the screened population in order to answer this question. Our aim was to determine the effectiveness of the previous policy on cervical cancer screening in terms of incidence of cervical cancer and rates of dysplasia in the population of a tertiary hospital gynecology outpatient clinic. Materials and Methods: This is a retrospective analysis conducted at Rambam Health Care Campus’ gynecology outpatient clinic. Chart-review of all cytology reports of PAP smears performed between the years 2004 and 2010 were evaluated. Data were compared to measure the screening methods and changes to the screening method including the trends in PAP smear testing, results, persistence, and the trends in progression and regression in disease based on pre-determined age groups. Results: The rate of atypical PAP smear test results was 10.92% which was broken down in a rate of atypia of 7.66%, the rate of low grade squamous intraepithelial lesion [LGSIL] was 2.93%, and high grade SIL [HGSIL] was 0.338%.The highest incidence of atypical PAP smear results was seen in the age group 21-25. The highest incidence of LGSIL was seen in under 21 years and 21-25 years. The highest incidence of HGSIL was seen under 21 years. In the under 21 y’s group, there was a wide disparity between those who regressed (14%) and those who progressed (3%). On the other hand, in the 26-30 years group and the 41-50 years group, the trend was towards progression of disease (19.4% and 27%, respectively). Conclusions: Through the results of this study, it seems that not testing women under 21 years old would result in missed diagnoses of potentially treatable precancerous cervical lesions. It is important to factor in the harms of excessive PAP smears and subsequent follow up procedures in order to get a more accurate net benefit from the screening of young women.

Does Cervical Screening in Young Women Aged 20-25 Years Lead to Unnecessary and Harmful Interventions?

Cervical human papillomavirus (HPV) infection among young women (20-25 years of age) is common and normally transient. There are growing concerns that referral to a colposcopy clinic may lead to unnecessary treatment with an increased risk of obstetric complications. Therefore, the purpose of this study was to determine the level of intervention for cervical abnormalities in this age group of the Northern Ireland population. A review of all serial new patients under 25 years of age, who were referred to colposcopy clinics in Northern Ireland between January 1, 2009 to June 30, 2009 formed the basis of this study. During the study period, a total of 4,767 women under 25 years of age were screened. Two-hundred-and- thirty-four (4.9%) cases were referred to the colposcopy clinics. The cervical cytology results were: high-grade abnormality in 35%, and low-grade abnormality in 31% of these cases. One-hundred-and-seventy-eight (76%) of the referred women received at least one treatment. One-hundred-and-twenty-one of 234 (51.5%) women underwent an excisional treatment with histology showing the presence of high-grade abnormalities (CIN2-3) in 52%, CIN1 in 28%, and Koilocytosis or normal tissue in 20% of this sub-group of cases. Screening women under the age of 25 years cause unnecessary referral for colposcopy. This may also result in considerable anxiety and psychosexual morbidity. It leads to an over-treatment with a potential of negative impact on the future pregnancy outcomes (including pre-term delivery, low birth weight, and pre-term premature rupture of membranes).

Neisseria gonorrhoeae and Chlamydia trachomatis among women reporting extragenital exposures.

The Centers for Disease Control and Prevention recommends pharyngeal screening of Neisseria gonorrhoeae (GC) and rectal screening of GC and Chlamydia trachomatis (CT) in HIV-infected and at-risk men who have sex with men (MSM). There are currently no recommendations to routinely screen women at extragenital sites. We define the prevalence of extragenital GC and CT in women attending 2 urban sexually transmitted disease clinics in Baltimore City and compare it with the prevalence of extragenital infections in MSM and men who have sex with women. All patients who reported extragenital exposures in the preceding 3 months, who presented for care between June 1, 2011, and May 31, 2013, and who were tested for GC and CT using nucleic acid amplification tests at all sites of exposure were included in the analyses. We used logistic regression models to identify risk factors for extragenital infections. A total of 10,389 patients were included in this analysis (88% African American; mean age, 29 years; 42% women; 7% MSM; 2.5% HIV infected). The prevalence estimates of any extragenital GC and CT were as follows: 2.4% GC and 3.7% CT in women, 2.6% GC and 1.6% CT in men who have sex with women, and 18.9% GC and 11.8% CT in MSM. Among women, 30.3% of GC infections and 13.8% of CT infections would have been missed with urogenital-only testing. Unlike MSM, age ≤ 18 years was the strongest predictor of extragenital infections in women. Although the prevalence of extragenital gonorrhea and chlamydia is highest in MSM, a significant number of GC and CT infections in young women would be missed with genital-only testing. Cost-effectiveness analyses are needed to help inform national guidelines on extragenital screening in young women.

Cervical cancer screening in young and elderly women of the Xingu Indigenous Park: evaluation of the recommended screening age group in Brazil.

Objective To analyze the occurrence of atypia in the cytology/histology examinations of young women under the age of 25 years and of elderly women aged over 64 years, in the Xingu Indigenous Park and to evaluate, in a subjective manner, if the age range for screening established by the Ministry of Health and the Instituto Nacional de Câncer is appropriate for this population.Methods The Xingu/UNIFESP Project, in partnership with the Center for Gynecological Disease Prevention, develops programs to prevent cervical cancer. The exploratory, retrospective and descriptive study of cytological and histopathological examinations of young (12-24 years) and elderly (aged 64 and over) women of the Xingu Indigenous Park, between 2005 and 2011.Results There was low occurrence of cytological atypia in the elderly female population, but there were occasional high-grade lesions in the indigenous youth.Conclusion Interrupting screening at the limit age of 64 years, as established by the Ministry of Health and the Instituto Nacional de Câncer is justified. However, screening of young women should begin at an earlier age.

Expanding the indications for MRI in the diagnosis and treatment of breast cancer: what is best practice?

Breast magnetic resonance imaging (MRI) now has an accepted place in screening younger women at high risk of breast cancer, and is increasingly used in a number of other settings including assessment of response to neo-adjuvant therapy and local staging of cancer. Although the evidence for its general use in these settings is very limited, in highly selected patients, especially where discordance with conventional measurements occurs, MRI can have a place in assessing extent of disease, both whether operable and how operable, and guiding surgery. These scenarios and future indications and alternative technologies are explored in this paper.

Screening for Gonorrhea and Chlamydia: A Systematic Review for the U.S. Preventive Services Task Force

Previous research has supported screening for gonorrhea and chlamydia in asymptomatic, sexually active women (including pregnant women) who are younger than 25 years or at increased risk but not in other patient populations. To update the 2005 and 2007 systematic reviews for the U.S. Preventive Services Task Force on screening for gonorrhea and chlamydia in men and women, including pregnant women and adolescents. MEDLINE (1 January 2004 to 13 June 2014), Cochrane databases (May 2014), ClinicalTrials.gov, and reference lists. English-language trials and observational studies about screening effectiveness, test accuracy, and screening harms. Extracted study data were confirmed by a second investigator, and study quality and applicability were dual-rated using prespecified criteria. Screening a subset of asymptomatic young women for chlamydia in a good-quality trial did not significantly reduce the incidence of pelvic inflammatory disease over the following year (relative risk, 0.39 [95% CI, 0.14 to 1.08]); however, 1 previous trial reported a reduction. An observational study evaluating a risk prediction tool to identify persons with chlamydia in high-risk populations had low predictive ability and applicability. In 10 new studies of asymptomatic patients, nucleic acid amplification tests demonstrated sensitivity of 86% or greater and specificity of 97% or greater for diagnosing gonorrhea and chlamydia, regardless of specimen type or test. There were few relevant studies of screening benefits and harms. Only screening tests and methods cleared by the U.S. Food and Drug Administration for current clinical practice were included to determine diagnostic accuracy. Chlamydia screening in young women may reduce the incidence of pelvic inflammatory disease. Nucleic acid amplification tests are accurate for diagnosing gonorrhea and chlamydia in asymptomatic persons. Agency for Healthcare Research and Quality.

PB.7. Large-volume biopsy for B3 lesions without atypia: is once enough?

B3 lesion incidence has increased with digital mammography and screening of younger women. In January 2012 we changed management of B3 lesions, following pathways published by Rajan and colleagues. This study reviews the outcome of vacuum-assisted biopsy (VAB) in all patients with a B3 diagnosis, comparing initial core and subsequent VAB for concordance.

Effectiveness of population-based service screening with mammography for women ages 40 to 49 years with a high or low risk of breast cancer: socioeconomic status, parity, and age at birth of first child.

Invitation to mammography screening of women aged 40 to 49 years is a matter of debate in many countries and a cost-effective alternative in countries without screening among women aged 40 to 49 years could be inviting those at higher risk. The relative effectiveness of mammography screening was estimated for subgroups based on the breast cancer risk factors parity, age at time of birth of first child, and socioeconomic status (SES). The SCReening of Young Women (SCRY) database consists of all women aged 40 to 49 years in Sweden between 1986 and 2005 and was split into a study and control group. The study group consisted of women residing in areas in which women aged 40 to 49 years were invited to screening and the control group of women in areas in which women aged 40 to 49 years were not invited to screening. Rate ratio (RR) estimates were calculated for 2 exposures: invitation and attendance. There were striking similarities noted in the RR pattern for women invited to and attending screening and no statistically significant difference or trend in the RR was noted by risk group. The RR estimates increased by increasing parity for parity of 0 to 2 and ranged from 0.55 (95% confidence interval [95% CI], 0.38-0.79) to 0.79 (95% CI, 0.65-0.95) for attending women. The RR for women with high SES was lower than that for women with low SES (RR, 0.72 [95% CI, 0.60-0.86] and RR, 0.79 [95% CI, 0.63-0.99], respectively). For women aged 20 to 24 years at the time of the birth of their first child, the RR was 0.73 (95% CI, 0.58-0.91) and estimates for other ages were similar. There was no statistically significant difference noted in the relative effectiveness of mammography screening by parity, age at the time of birth of the first child, or SES.

Application analysis of ultrasound in diagnosis of early-onset breast cancer

Objective To observe the early onset breast cancer（EOBC） sonographic performance characteristics and explore the diagnostic value of ultrasonography in EOBC. Methods 60 cases EOBC patients younger than 35 years old were seclected as the observation group. Older than 35 years of 50 patients with breast cancer were seclected as the control group. Two groups were underwent breast color Doppler ultrasound. Results 59 cases in 60 patients with preoperative ultrasound diagnosis of breast cancer, one case was misdiagnosed as mastitis pseudotumor infiltrating ductal carcinoma, lobular carcinoma, ductal carcinoma in ultrasound showed more direct signs, medullary carcinoma showed more indirect signs. Clumps were main types of breast cancer of the observation group and control group, respectively, accounted for 72.9 % and 87.5 %, the difference was statistically significant （ X2 = 6. 293, P 〈 0.05 ）. Two groups of color Doppler richness, lesion shape, boundary definition, without hyperechoic halo, calcification and glitches levy or levy Crab compared were not significant（ P 〉 0.05 ） ;Compared with the control group, heterogeneous internal echo, rear attenuation of observation group had significant differences （ P 〈 0.05 ）. Foci were observed group EOBC anteroposterior diameter and aspect ratio were significantly lower than that of the control group, the difference was statistically significant（t = 6. 720,9. 285, all P 〈 0.05 ） ; diameter was significantly higher （ t = 34. 962, P 〈 0. 05）. Conclusion Early-onset breast cancer at diagnosis with color Doppler ultrasound large diameter aspect ratio is small, and the rear common heterogeneous internal echo attenuation less characteristic features, screening younger women for breast cancer is important. Key words: Early Diagnosis; Ultrasonography ; Breast Neoplasms

Biology dictates the fate of young women with breast cancer

Controversy surrounds the use of mammography for breast cancer screening. This commentary explains why retrospective analyses of women who die from breast cancer do not add to the body of knowledge about the value of screening in young women. Mammographic screening alone cannot be expected to overcome aggressive biology.