Mammographic Screening For Breast Cancer Research Articles

Mammographic Breast Density, Benign Breast Disease, and Subsequent Breast Cancer Risk in 3.9 Million Korean Women.

Background Mammographic breast density and benign breast disease are strong risk factors for breast cancer. Accordingly, women with both risk factors may have a markedly high risk for developing breast cancer. Purpose To investigate the risk of breast cancer associated with the combination of mammographic density and benign breast disease in Korean women, where population-based mammographic breast cancer screening is provided for all women aged at least 40 years. Materials and Methods This is a retrospective analysis of data from a nationwide breast cancer screening program linked with the national cancer registry. The study included Korean women between 40-74 years of age screened for breast cancer between January 2009 and December 2010 and observed up to December 2020 (median follow-up of 10.6 years). Benign breast disease and breast density were extracted from mammography screening results. Cox proportional hazard regression analysis was used to calculate adjusted hazard ratios (HRs) for breast cancer risk. Results In this study, 3 911 348 women (mean age, 53 years ± 9 [SD]) were analyzed. During follow-up (median, 10.6 years), 58 321 women developed breast cancer. At screening, 10 729 (18.4%) cases of benign breast disease were detected among women who developed breast cancer. Women with extremely dense breasts (Breast Imaging Reporting and Data System [BI-RADS] density category D) and benign breast disease had a greater risk of breast cancer when compared with women presenting with fatty breast (BI-RADS density category A) and those without benign breast disease (HR, 2.75; 95% CI: 2.63, 2.88; P < .001). Women with benign breast disease and fatty breasts (HR, 1.49; 95% CI: 1.40, 1.58; P < .001) and women with extremely dense breasts and without benign breast disease (HR, 2.28; 95% CI: 2.20, 2.35; P < .001) also had an elevated breast cancer risk compared with women with fatty breast tissue. Conclusion Women with dense breasts and benign breast disease at screening mammography had an elevated risk of future breast cancer. © RSNA, 2022 Online supplemental material is available for this article.

Cost-effectiveness of using artificial intelligence versus polygenic risk score to guide breast cancer screening.

BackgroundCurrent guidelines for mammography screening for breast cancer vary across agencies, especially for women aged 40–49. Using artificial Intelligence (AI) to read mammography images has been shown to predict breast cancer risk with higher accuracy than alternative approaches including polygenic risk scores (PRS), raising the question whether AI-based screening is more cost-effective than screening based on PRS or existing guidelines. This study provides the first evidence to shed light on this important question.MethodsThis study is a model-based economic evaluation. We used a hybrid decision tree/microsimulation model to compare the cost-effectiveness of eight strategies of mammography screening for women aged 40–49 (screening beyond age 50 follows existing guidelines). Six of these strategies were defined by combinations of risk prediction approaches (AI, PRS or family history) and screening frequency for low-risk women (no screening or biennial screening). The other two strategies involved annual screening for all women and no screening, respectively. Data used to populate the model were sourced from the published literature.ResultsRisk prediction using AI followed by no screening for low-risk women is the most cost-effective strategy. It dominates (i.e., costs more and generates fewer quality adjusted life years (QALYs)) strategies for risk prediction using PRS followed by no screening or biennial screening for low-risk women, risk prediction using AI or family history followed by biennial screening for low-risk women, and annual screening for all women. It also extendedly dominates (i.e., achieves higher QALYs at a lower incremental cost per QALY) the strategy for risk prediction using family history followed by no screening for low-risk women. Meanwhile, it is cost-effective versus no screening, with an incremental cost-effectiveness ratio of $23,755 per QALY gained.ConclusionsRisk prediction using AI followed by no breast cancer screening for low-risk women is the most cost-effective strategy. This finding can be explained by AI’s ability to identify high-risk women more accurately than PRS and family history (which reduces the possibility of delayed breast cancer diagnosis) and fewer false-positive diagnoses from not screening low-risk women.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12885-022-09613-1.

Harms and Benefits of Mammography Screening

Mammography is one of the most technically challenging areas of radiography, required high spatial resolution, excellent soft tissue contrast and low radiation dose. Mammography screening for breast cancer is worldwide available. Early detection of breast cancer through screening can lower breast cancer mortality rate and reduce the burden of this disease in the population, the benefits and harms of mammography screening have been debated in the past years. This review discuss the benefits and harms of mammography screening in light of findings from randomized trials and more recent observational studies performed in the era of modern diagnosis. The main benefit for mammography screening is reduces the risk of dying from breast cancer. Reduction vary from 15 to 20% in randomized trials to more recent estimates of 13 to 17% in analyses of observational studies. UK data of 2007 shows that for 1,000 women invited to biennial mammography screening for 20years to 50years age, 2-3 women’s are prevented from breast cancer. Main harm of mammography screening is the over diagnosis of breast cancer. 15 women’s over diagnosis for every 1000 women invited to biennial screening for 20 years from 50 years age. In an era of limiting health care services, screening services need to scrutinized and compared with each other regard to effectiveness, cost effectiveness and harms.

Inclusion of the US Preventive Services Task Force Recommendation for Mammography in State Comprehensive Cancer Control Plans in the US

The recommendations for the age and frequency that women at average risk for breast cancer should undergo breast cancer mammography screening have been a matter of emotional, political, and scientific debate over the past decades. Multiple national organizations provide recommendations for breast cancer screening age and frequency. US Centers for Disease Control and Prevention (CDC) funding for state comprehensive cancer control (CCC) planning requires compliance with stated objectives for attaining goals. US Preventive Services Task Force (USPSTF) recommendations on cancer prevention and control are currently used to require coverage of prevention services. To evaluate the consistency of state CCC plan objectives compared with the most current (2016) USPSTF recommendations for the age and frequency that individuals should undergo mammography screening and to make recommendations for improvement of state CCC plans. This cross-sectional study used a descriptive, point-in-time evaluation and was conducted from November 1, 2019, to June 30, 2021. In November 2019, the most recent CCC plans from 50 US states and the District of Columbia were downloaded from the CDC website. The recommended ages at which to begin and end mammography examinations and the frequency of mammography examinations were extracted from plan objectives. The recommendations found in CCC plan objectives regarding the ages at which to begin and end mammography examinations and the frequency of mammography examinations for women with average risk for breast cancer were compared with USPSTF recommendations. Of the 51 CCC plans, 16 (31%) were consistent with all USPSTF recommendations for age and frequency that women at average risk should undergo mammography. Twenty-six plans (51%) were partially consistent with recommendations, and 9 plans (18%) were not consistent with any of the 3 guideline components. Compared with the USPSTF recommendation, state CCC plans are not homogenous regarding the age and frequency that women at average risk for breast cancer should undergo mammography. This variation is partially due to differences in state-specific planning considerations and discretion, variations in recommendations among national organizations, and publication of plans prior to the most current USPSTF recommendation (2016). Specifying the concept that high-risk populations need different age and frequency of screening recommendations than the general population may reduce heterogeneity among plans.

Should tomosynthesis replace mammography for breast cancer screening?

A decade has passed since the first prospective trials showed that the mammography technology, digital breast tomosynthesis, increased the rate of cancer detection compared with digital mammography. 1 Ciatto S Houssami N Bernardi D et al. Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study. Lancet Oncol. 2013; 14: 583-589 Summary Full Text Full Text PDF PubMed Scopus (608) Google Scholar , 2 Skaane P Bandos AI Gullien R et al. Prospective trial comparing full-field digital mammography (FFDM) versus combined FFDM and tomosynthesis in a population-based screening programme using independent double reading with arbitration. Eur Radiol. 2013; 23: 2061-2071 Crossref PubMed Scopus (170) Google Scholar A large body of evidence, comprising prospective non-randomised studies and retrospective studies, 3 Marinovich ML Hunter KE Macaskill P Houssami N Breast cancer screening using tomosynthesis or mammography: a meta-analysis of cancer detection and recall. J Natl Cancer Inst. 2018; 110: 942-949 Crossref PubMed Scopus (108) Google Scholar has since accumulated; however, evidence from randomised controlled trials is scarce. In The Lancet Oncology, Walter Heindel and colleagues report the results of the TOmosynthesis plus SYnthesised MAmmography Study (TOSYMA), 4 Heindel W Weigel W Gerß J et al. Digital breast tomosynthesis plus synthesised mammography versus digital screening mammography for the detection of invasive breast cancer (TOSYMA): a multicentre, open-label, randomised, controlled, superiority trial. Lancet Oncol. 2022; (published online April 12.)https://doi.org/10.1016/S1470-2045(22)00194-2 Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar a multicentre trial embedded in the German population-wide mammography screening programme. TOSYMA is the largest of three randomised controlled trials providing evidence on breast tomosynthesis versus mammography screening. 4 Heindel W Weigel W Gerß J et al. Digital breast tomosynthesis plus synthesised mammography versus digital screening mammography for the detection of invasive breast cancer (TOSYMA): a multicentre, open-label, randomised, controlled, superiority trial. Lancet Oncol. 2022; (published online April 12.)https://doi.org/10.1016/S1470-2045(22)00194-2 Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar , 5 Hofvind S Holen AS Aase HS et al. Two-view digital breast tomosynthesis versus digital mammography in a population-based breast cancer screening programme (To-Be): a randomised, controlled trial. Lancet Oncol. 2019; 20: 795-805 Summary Full Text Full Text PDF PubMed Scopus (38) Google Scholar , 6 Pattacini P Nitrosi A Giorgi RP et al. A randomized trial comparing breast cancer incidence and interval cancers after tomosynthesis plus mammography versus mammography alone. Radiology. 2022; (published online Feb 1.)https://doi.org/10.1148/radiol.211132 Crossref PubMed Scopus (3) Google Scholar Heindel and colleagues persevered with TOSYMA despite the COVID-19 pandemic stalling recruitment, resulting in a marginally lower sample size than planned in their adaptive design. 4 Heindel W Weigel W Gerß J et al. Digital breast tomosynthesis plus synthesised mammography versus digital screening mammography for the detection of invasive breast cancer (TOSYMA): a multicentre, open-label, randomised, controlled, superiority trial. Lancet Oncol. 2022; (published online April 12.)https://doi.org/10.1016/S1470-2045(22)00194-2 Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar Digital breast tomosynthesis plus synthesised mammography versus digital screening mammography for the detection of invasive breast cancer (TOSYMA): a multicentre, open-label, randomised, controlled, superiority trialThe results from this study indicate that the detection rate for invasive breast cancer was significantly higher with digital breast tomosynthesis plus s2D mammography than digital mammography alone. Evaluation of interval cancer rates in the follow-up study will further help to investigate incremental long-term benefits of digital breast tomosynthesis screening. Full-Text PDF

Knowledge, Practice, Preferences and Willingness-to-Pay for Mammographic Screening Tests among Iranian Women: A Contingent Valuation Method.

Objective:This study sought to investigate Iranian women’s preferences and willingness-to-pay (WTP) based on the level of breast self-examination and mammography screening practice and knowledge, including risk factors, signs and symptoms, and early detection methods via mammography screening.Methods: This is a descriptive, cross-sectional, population-based study conducted from October to March 2020 on over 35-year-old women living in Mashhad, selected through the convenient sampling method applied in health centers of Mashhad city. To measure the willingness to pay, the study participants were asked for their preferred choices concerning out-of-pocket payment for screening. Results:More than one-half (58.6%) of the study’s sample size had an intermediate level of knowledge regarding breast cancer’s risk factors, and only 12.7% of them had an unsatisfactory level of knowledge. However, most of the participants had a poor level of practice towards breast self-examination and mammography screening. The results of measuring the willingness to pay (WTP) indicated that 11.5% of the participants were not willing to pay at all for mammography breast cancer screening, while 53.3% of the participants were willing to pay 2.27 to 3.41 $U.S, and 35.2% of the participants were willing to pay more than 3.41 $U.S for mammography breast cancer screening. Conclusion:Any attempt to promote breast cancer screening among Iranian women should primarily focus on increasing such indices as awareness, education, health status, and household income. It should be noted that the majority of the participants possessed an average level of knowledge. Moreover, women lack appropriate information about breast cancer and its’ early detection measures. However, it was found that self-employed women were more likely to practice breast self-examination than the women employed in governmental organizations, which could be attributed to the fact that self-employed women could dedicate more time to checking their breasts and practicing breast self-examination.

Cancer Screening Practices Among Healthcare Workers During the COVID-19 Pandemic.

The COVID-19 pandemic has the potential to impact long-standing efforts to increase adherence to cancer screening guidelines. Healthcare workers (HCWs) experienced significant hardship, but generally have greater access to preventive services, making them a particularly relevant population in which to understand cancer screening behaviors during the pandemic. We report data from 794 HCWs enrolled in the NCI-funded Serological Sciences Network for Coronavirus Associations and Longitudinal Evaluation Study from December 2020 to April 2021. Participants reported lifestyle and screening behaviors during relevant look-back periods which included the pandemic timeframe. Among women between the ages of 40 and 74, 25.7% were overdue for mammographic breast cancer screening. Among participants 50–75 years old, 38.9% were overdue for colorectal cancer screening. The proportion over-due varied according to race/ethnicity. Lifetime low-dose computed tomography lung cancer screening among HCWs age 50–80 years who were smokers was 10.9%. Strategies to address screening disruptions are needed to minimize the impact of later stage of diagnosis.

Current status of breast cancer undetected by mammography in population-based breast cancer screening and associated factors

Objective This study aimed to promote the application of mammography (MMG) screening without performing a clinical breast examination (CBE). It examined population-based screening data, including history taking findings, to elucidate the status of breast cancer cases, detected solely by CBE, and to reveal the factors associated with breast cancer. Through this, it explored alternative methods for evaluating breast cancer cases, undetected by MMG, when CBE is omitted.Methods The linked anonymized data from women, who underwent breast cancer screening in 2014, 2016, or 2017, were prepared. The data were obtained from the Nishinomiya City database. Breast cancer, undetected by MMG, were defined as breast cancer cases diagnosed by close examination based on CBE only (MMG findings were category 2 or lower, with no abnormalities). To assess the quality of breast cancer screening, process indices were calculated for the overall population, and for patients indicated for close examination based on CBE but not MMG. The association of breast cancer with each factor was statistically analyzed (χ2 test, etc.).Results In total, 13,504 women underwent breast cancer screening. Close examination was required in 1,247 women (9.2%). Breast cancer was diagnosed in 44 women (3.5%), including four, who had breast cancer undetected by MMG. All of the process indices satisfied the acceptable values. Three of the four women with breast cancer, undetected by MMG, noticed a lump. Breast cancer was significantly associated with "subjective symptoms". The presence of a "lump" and "nipple discharge" were significantly more common in breast cancer patients.Conclusion Three of the four breast cancer cases, undetected by MMG screening, had a subjective symptom (lump). There was a significant association between subjective symptoms (lump and nipple discharge) and breast cancer. To avoid missing breast cancer, undetected by MMG alone, these symptoms should be especially evaluated in women to compensate for the omission of a CBE. This can be achieved by encouraging women experiencing symptoms to seek consult, performing a thorough history-taking and observation, engaging in multidisciplinary collaboration (communication from medical staff to physicians), and promoting breast awareness.

Do women living in northeast Anatolia get mammography screening? A hospital-focused cross-sectional study

Background/Aim: In Turkey, women between 40–69 years of age are routinely subjected to mammography screening for breast cancer. Despite this, the mammography rate is only 28.9% in women aged 15 years and above. This is an indication that women in Turkey are not sufficiently interested in mammography screenings. This study aimed to determine the factors that affect the decision to not have mammography screening for women aged 40 and above. Methods: The study was designed as a hospital-focused cross-sectional study. The population of the study comprised 7,239 women aged 40 years and above. The sample size that would represent the population was calculated as 365 women with 50% prevalence, 95% confidence interval, and 5% deviation in the Epi Info program. A Chi-square test used in the binary analysis (P

A novel sophisticated form of DMAS beamformer: Application to breast cancer detection

Confocal microwave imaging (CMI) has the potential to be an alternative or complementary method for mammography in breast cancer screening. Data acquisition in CMI is very fast, safe, and comfortable for patients, but the reconstructed images are not always of high quality. High level of artifacts and poor resolution cause impaired quality. In this work, a novel, fast and robust beamformer, DMAS-D4 is presented. Delay-multiply-and-sum-degree-4 (DMAS-D4) is a next generation beamformer that expands the two-dimensional summations in delay-multiply-and-sum (DMAS) to four-dimensional summations in which all possible fourth degree terms are summed to increase robustness and resolution. A computationally-efficient implementation is presented which mitigates the additional computation required by DMAS. Furthermore, the proposed method can run iteratively which makes the ability to update the result using new observations. An idealized simulation compares basic performance of the proposed method with two other beamformers: (1) DAS, which is the gold standard, and (2) DMAS, which has been reported as the best beamformer so far. The results demonstrate that the DMAS-D4 achieves higher contrast and finer resolution. The proposed method increased the signal-to-max-ratio (SMXR) from 3.1 dB using DMAS to 5.7 dB in the heterogeneous breast mimicking phantom which illustrates the higher tumor detectability using the proposed method. Similarly, the Signal-to-Clutter Ratio (SCR) is 23.9 dB higher using the proposed method. By exploiting DMAS-D4 these benefits and potentially enhancing clinical decisions are attainable by the same computational load order as DAS. These results may be useful to inform future microwave breast imaging beamformer design.

Digital Breast Tomosynthesis and Digital Mammography Recall and False-Positive Rates by Time of Day and Reader Experience.

Background Digital breast tomosynthesis (DBT) image interpretation might be more cognitively demanding than interpretation of digital mammography (DM) images. The time of day of interpretation might affect recall and false-positive (FP) rates, especially for DBT. Purpose To determine whether recall and FP rates vary by time of day of interpretation for screening mammography for breast cancer performed with DM and DBT. Materials and Methods This is a retrospective study examining 97 671 screening mammograms interpreted by 18 radiologists between January 2018 and December 2019 at one of 12 community radiology sites. The association between the time of day of interpretation, the type of image interpreted (DM vs DBT), and radiologist experience (≤5 posttraining years vs >5 posttraining years) and the likelihood of a patient being recalled from screening mammography and the likelihood of whether the interpretation was FP or true positive were analyzed. Analyses were conducted using generalized linear mixed modeling with a binary distribution and sandwich estimation where observations were nested by radiologist. Results Screening mammograms interpreted by 18 radiologists were reviewed (40 220 DBTs, 57 451 DMs). Nine radiologists had 5 or fewer posttraining years of experience, and nine had more than 5 posttraining years of experience. The overall recall rates for DM (10.2%) and DBT (9.0%) were different (P = .006); FP rate also differed (9.8% DM, 8.6% DBT; P = .004). For radiologists with 5 or fewer posttraining years of experience, odds of recall increased 11.5% (odds ratio [OR] = 1.12, P = .01) with every hour when using DBT, but this was not found for DM (OR = 1.09, P = .06); DBT and DM were different (OR = 1.12 vs 1.09, P = .02). For radiologists with more than 5 posttraining years of experience, no evidence of increase in recall was observed for DBT (OR = 1.02, P = .27) or DM (OR = 1.0, P = .80), and there was no evidence that these were different (OR = 1.02 vs 1.0, P = .13). Conclusion Patients were more likely to be recalled when their screening digital breast tomosynthesis images were interpreted later in the day by less-experienced radiologists. © RSNA, 2022 Online supplemental material is available for this article.

Trends in incidence, molecular diagnostics, and treatment of patients with breast cancer in Kazakhstan, 2014-2019

Relevance: Globocan reported 4,390 new breast cancer cases and 1,654 deaths from breast cancer in the Republic of Kazakhstan (RK) in 2020. Molecular diagnostics of breast cancer includes the determination of Hormone Receptor (HR), HER2, and Ki-67 status to detect patients&#x0D; with HR-positive tumors and administer effective treatment.&#x0D; Methods: This observational study included a retrospective analysis of incidence, molecular diagnostics, and treatment regimens in women with a confirmed breast cancer diagnosis aged 18 years old and older, registered in the RK Electronic Registry of Cancer Patients (ERCP) from 1 January 2014 till 31 December 2019.&#x0D; Results: In the study period (2014 to 2019), the number of breast cancer cases registered annually has doubled. The incidence increased by 46.9%. The share of locally advanced and advanced forms of breast cancer has decreased. The proportion of Luminal type A (HR+/HER2-)&#x0D; among newly diagnosed patients ranged from 17.9% to 30%. Chemotherapy and endocrine therapy with goserelin, buserelin, leuprorelin, and fulvestrant are standard first- and second-line treatments for HR+ breast cancer. Since fulvestrant indications have been expanded, more&#x0D; than 50% of patients with HR-positive advanced breast cancer receive fulvestrant as the first-line therapy.&#x0D; Conclusion: Breast cancer incidence growth and a decrease in the share of locally advanced and advanced breast cancer cases in the RK could be attributed to increased coverage of eligible women aged 40 to 70 with breast cancer mammographic screening. Although international guidelines support the administration of hormone therapy with or without targeted therapy in women with HR-positive, HER2-metastatic breast cancer, upfront use of chemotherapy remains common in the RK even in the absence of visceral crisis. The use of CDK4/6 inhibitor palbociclib in combination with hormone therapy has become routinely available since 2019

Trends in incidence, molecular diagnostics, and treatment of patients with breast cancer in Kazakhstan, 2014-2019

Relevance: Globocan reported 4,390 new breast cancer cases and 1,654 deaths from breast cancer in the Republic of Kazakhstan (RK) in&#x0D; 2020. Molecular diagnostics of breast cancer includes the determination of Hormone Receptor (HR), HER2, and Ki-67 status to detect patients&#x0D; with HR-positive tumors and administer effective treatment.&#x0D; Methods: This observational study included a retrospective analysis of incidence, molecular diagnostics, and treatment regimens in&#x0D; women with a confirmed breast cancer diagnosis aged 18 years old and older, registered in the RK Electronic Registry of Cancer Patients&#x0D; (ERCP) from 1 January 2014 till 31 December 2019.&#x0D; Results: In the study period (2014 to 2019), the number of breast cancer cases registered annually has doubled. The incidence increased&#x0D; by 46.9%. The share of locally advanced and advanced forms of breast cancer has decreased. The proportion of Luminal type A (HR+/HER2-)&#x0D; among newly diagnosed patients ranged from 17.9% to 30%. Chemotherapy and endocrine therapy with goserelin, buserelin, leuprorelin,&#x0D; and fulvestrant are standard first- and second-line treatments for HR+ breast cancer. Since fulvestrant indications have been expanded, more&#x0D; than 50% of patients with HR-positive advanced breast cancer receive fulvestrant as the first-line therapy.&#x0D; Conclusion: Breast cancer incidence growth and a decrease in the share of locally advanced and advanced breast cancer cases in the RK&#x0D; could be attributed to increased coverage of eligible women aged 40 to 70 with breast cancer mammographic screening. Although international guidelines support the administration of hormone therapy with or without targeted therapy in women with HR-positive, HER2-metastatic breast cancer, upfront use of chemotherapy remains common in the RK even in the absence of visceral crisis. The use of CDK4/6 inhibitor&#x0D; palbociclib in combination with hormone therapy has become routinely available since 2019.

Evaluation of the Knowledge Level of Family Medicine Residents about Mammography and Breast Cancer Screening Programs

Aim: It was aimed to evaluate the level of knowledge of family medicine residents about breast cancer screening program national standards and mammography. Methods: In this cross-sectional study, an online questionnaire was used to measure the knowledge level of family medicine resident doctors about breast cancer and mammography. In addition to demographic information, the questionnaire included questions about the diagnostic advantages of radiological breast imaging methods, the age of onset of breast cancer screening in different risk groups, and the national breast cancer screening program. The questionnaire, prepared through Google forms, was announced on social media channels used by family physicians and kept open for three months. Results: The mean age of 151 physicians was 30.4±4.3. 61.6% of the physicians were female and 38.4% were male. Only 11.9% (n=18) of the participants had previously attended a training/course on mammography. The mean correct answer score was 4.58±1.50 for 9 questions. The test scores of the residents who received specialized training in the education and research hospital were statistically significantly higher than those who received training in the university hospital (4.77±1.86 and 3.64±1.63). The mean score of residents who received previous mammography education was significantly higher than others. Conclusion: Awareness and knowledge levels of family medicine residents about breast cancer screening methods and programs should be increased with multidisciplinary training programs. Keywords: mammography, breast cancer, screening, family practice

Investigating attitudinal barriers to breast cancer mammography screening among women in Zabol city

Investigating attitudinal barriers to breast cancer mammography screening among women in Zabol city

Benefits and harms of annual, biennial, or triennial breast cancer mammography screening for women at average risk of breast cancer: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC)

BackgroundAlthough mammography screening is recommended in most European countries, the balance between the benefits and harms of different screening intervals is still a matter of debate. This review informed the European Commission Initiative on Breast Cancer (BC) recommendations.MethodsWe searched PubMed, EMBASE, and the Cochrane Library to identify RCTs, observational or modelling studies, comparing desirable (BC deaths averted, QALYs, BC stage, interval cancer) and undesirable (overdiagnosis, false positive related, radiation related) effects from annual, biennial, or triennial mammography screening in women of average risk for BC. We assessed the certainty of the evidence using the GRADE approach.ResultsWe included one RCT, 13 observational, and 11 modelling studies. In women 50–69, annual compared to biennial screening may have small additional benefits but an important increase in false positive results; triennial compared to biennial screening may have smaller benefits while avoiding some harms. In younger women (aged 45–49), annual compared to biennial screening had a smaller gain in benefits and larger harms, showing a less favourable balance in this age group than in women 50–69. In women 70–74, there were fewer additional harms and similar benefits with shorter screening intervals. The overall certainty of the evidence for each of these comparisons was very low.ConclusionsIn women of average BC risk, screening intervals have different trade-offs for each age group. The balance probably favours biennial screening in women 50–69. In younger women, annual screening may have a less favourable balance, while in women aged 70–74 years longer screening intervals may be more favourable.

ASO Visual Abstract: A Single Center Study of Adherence to Breast Cancer Screening Mammography Guidelines by Transgender and Non-Binary Patients

ASO Visual Abstract: A Single Center Study of Adherence to Breast Cancer Screening Mammography Guidelines by Transgender and Non-Binary Patients

Evaluation of Different Breast Cancer Screening Strategies for High-Risk Women in Beijing, China: A Real-World Population-Based Study.

BackgroundMammography-based breast cancer screening has been widely implemented in many developed countries. Evidence was needed on participation and diagnostic performance of population-based breast cancer screening using ultrasound in China.MethodsWe used data from the Cancer Screening Program in Urban China in Beijing from 2014 to 2019 and was followed up until July 2020 by matching with the Beijing Cancer Registry database. Eligible women between the ages of 45 and 69 years were recruited from six districts and assessed their risk of breast cancer through an established risk scoring system. Women evaluated to be at high risk of breast cancer were invited to undergo both ultrasound and mammography. Participation rates were calculated, and their associated factors were explored. In addition, the performance of five different breast cancer screening modalities was evaluated in this study.ResultsA total of 49,161 eligible women were recruited in this study. Among them, 15,550 women were assessed as high risk for breast cancer, and 7,500 women underwent ultrasound and/or mammography as recommended, with a participation rate of 48.2%. The sensitivity of mammography alone, ultrasound alone, combined of ultrasound and mammography, ultrasound for primary screening followed by mammography for triage, and mammography for preliminary screening followed by ultrasound for triage were19.2%, 38.5%, 50.0%, 46.2%, and 19.2%, and the specificity were 96.1%, 98.6%, 94.7%, 97.6%, 95.7%, respectively. The sensitivity of combined ultrasound and mammography, ultrasound for primary screening followed by mammography for triage, was significantly higher than mammography alone (p=0.008 and p=0.039). Additionally, ultrasound alone (48,323 RMB ($7,550)) and ultrasound for primary screening followed by mammography for triage (55,927 RMB ($8,739)) were the most cost-effective methods for breast cancer screening than other modalities.ConclusionsUltrasound alone and ultrasound for primary screening and mammography are superior to mammography for breast cancer screening in high-risk Chinese women.

A Single-Center Study of Adherence to Breast Cancer Screening Mammography Guidelines by Transgender and Non-Binary Patients.

Adherence to screening guidelines among transgender and non-binary (TGNB) populations is not well studied. This study examines breast cancer screening patterns among TGNB patients at an urban academic medical center. Demographic information, risk factors, and screening mammography were collected. Mammography rates were calculated in populations of interest according to national guidelines, and mammogram person-years were also calculated. Univariate and multivariate logistic regression was performed. Overall, 253 patients were analyzed: 193 transgender women and non-binary people designated male at birth (TGNB DMAB) and 60 transgender men and non-binary people designated female at birth (TGNB DFAB). The median (interquartile range) age was 53.2years (42.3-62.6). Most patients had no family history of breast cancer (n=163, 64.4%) and were on hormone therapy (n=191, 75.5%). Most patients where White (n=164, 64.8%), employed (n=113, 44.7%), and had public insurance (n=128, 50.6%). TGNB DFAB breast screening rates were low, ranging from 2.0 to 50.0%, as were TGNB DMAB screening rates, ranging from 7.1 to 47.6%. The screening rates among the TGNB DFAB and TGNB DMAB groups did not significantly differ from one another. Among TGNB DFAB patients, univariate analyses showed no significant predictors for mammography. Among TGNB DMAB patients, not being on hormone therapy resulted in fewer odds of undergoing mammography. There were no significant findings on multivariate analyses. Mammography rates in the TGNB population are lower than institutional and national rates for cisgender patients, which are 77.3% and 66.7-78.4%, respectively. Stage of transition, organs present, hormone therapy, and risk factors should be considered to guide screening.

Digital breast tomosynthesis (DBT) plus synthesised two-dimensional mammography (s2D) in breast cancer screening is associated with higher cancer detection and lower recalls compared to digital mammography (DM) alone: results of a systematic review and meta-analysis

ObjectivesDigital breast tomosynthesis (DBT) plus digital mammography (DM) in screening is problematic due to increased radiation by the double exposure. Synthesised two-dimensional mammography (s2D) calculated from DBT datasets at no additional dose appears a sensible alternative compared to adding DM. This systematic review and meta-analysis focuses on screening performance outcomes in women screened with DBT plus s2D compared to DM alone.MethodsPubMed was searched from January 1, 2010, to September 2, 2020. Studies comparing DBT plus s2D to DM alone in breast cancer screening were included. Pooled risk ratios (RR) were estimated for cancer detection rates (CDR), recall rates, interval cancer rates (ICR), biopsy rates, and positive predictive values for recalls (PPV-1), for biopsies recommended (PPV-2), and for biopsies performed (PPV-3). Sensitivity analyses were performed using the leave-one-out approach. Risk of bias (RoB) was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool.ResultsTwelve papers covering 414,281 women were included from 766 records identified. CDR is increased ([RR, 95% CI] 1.35, 1.20–1.52), recall rates are decreased (0.79, 0.64–0.98), and PPV-1 is increased (1.69, 1.45–1.96) when using DBT plus s2D compared to DM alone. ICR and biopsy rates did not differ, but PPV-2 respectively PPV-3 increased with DBT plus s2D (1.57, 1.08–2.28 respectively 1.36, 1.17–1.58). Overall RoB of studies was assessed to be low.ConclusionResults show improved diagnostic outcomes with DBT plus s2D compared to DM alone and underline the value of DBT in combination with s2D in breast cancer screening.Key Points• DBT plus s2D is associated with higher CDR, lower recall rates, and a higher PPV-1 compared to DM alone in breast cancer screening.• No differences in biopsy rates were found between screening modalities, but PPV-2 and PPV-3 were higher in women screened with DBT plus s2D compared to DM alone.• We identified inconsistent results of ICR in two studies comparing DBT plus s2D to DM alone—resulting in no differences when pooling ICR in meta-analysis.