Breast Cancer Screening Tests Research Articles

Natural Language Processing to Identify Abnormal Breast, Lung, and Cervical Cancer Screening Test Results from Unstructured Reports to Support Timely Follow-up.

Cancer screening and timely follow-up of abnormal results can reduce mortality. One barrier to follow-up is the failure to identify abnormal results. While EHRs have coded results for certain tests, cancer screening results are often stored in free-text reports, which limit capabilities for automated decision support. As part of the multilevel Follow-up of Cancer Screening (mFOCUS) trial, we developed and implemented a natural language processing (NLP) tool to assist with real-time detection of abnormal cancer screening test results (including mammograms, low-dose chest CT scans, and Pap smears) and identification of gynecological follow-up for higher risk abnormalities (i.e. colposcopy) from free-text reports. We demonstrate the integration and implementation of NLP, within the mFOCUS system, to improve the follow-up of abnormal cancer screening results in a large integrated healthcare system. The NLP pipelines have detected scenarios when guideline-recommended care was not delivered, in part because the provider mis-identified the text-based result reports.

Extent of Follow-Up on Abnormal Cancer Screening in Multiple California Public Hospital Systems: A Retrospective Review

BackgroundInequitable follow-up of abnormal cancer screening tests may contribute to racial/ethnic disparities in colon and breast cancer outcomes. However, few multi-site studies have examined follow-up of abnormal cancer screening tests and it is unknown if racial/ethnic disparities exist.ObjectiveThis report describes patterns of performance on follow-up of abnormal colon and breast cancer screening tests and explores the extent to which racial/ethnic disparities exist in public hospital systems.DesignWe conducted a retrospective cohort study using data from five California public hospital systems. We used multivariable robust Poisson regression analyses to examine whether patient-level factors or site predicted receipt of follow-up test.Main MeasuresUsing data from five public hospital systems between July 2015 and June 2017, we assessed follow-up of two screening results: (1) colonoscopy after positive fecal immunochemical tests (FIT) and (2) tissue biopsy within 21 days after a BIRADS 4/5 mammogram.Key ResultsOf 4132 abnormal FITs, 1736 (42%) received a follow-up colonoscopy. Older age, Medicaid insurance, lack of insurance, English language, and site were negatively associated with follow-up colonoscopy, while Hispanic ethnicity and Asian race were positively associated with follow-up colonoscopy. Of 1702 BIRADS 4/5 mammograms, 1082 (64%) received a timely biopsy; only site was associated with timely follow-up biopsy.ConclusionDespite the vulnerabilities of public-hospital-system patients, follow-up of abnormal cancer screening tests occurs at rates similar to that of patients in other healthcare settings, with colon cancer screening test follow-up occurring at lower rates than follow-up of breast cancer screening tests. Site-level factors have larger, more consistent impact on follow-up rates than patient sociodemographic traits. Resources are needed to identify health system–level factors, such as test follow-up processes or data infrastructure, that improve abnormal cancer screening test follow-up so that effective health system–level interventions can be evaluated and disseminated.

Cancer Screening Test Use―U.S., 2019

The U.S. Preventive Services Task Force recommends breast, cervical, and colorectal cancer screening to reduce mortality from these cancers, but screening use has been below national targets. The purpose of this study is to examine the proportion of screening-eligible adults who are up to date with these screenings and how screening use compares with Healthy People 2020 targets. Data from the 2019 National Health Interview Survey were used to examine the percentages of adults up to date with breast cancer screening among women aged 50‒74 years without previous breast cancer, cervical cancer screening among women aged 21‒65 years without previous cervical cancer or hysterectomy, and colorectal cancer screening among adults aged 50‒75 years without previous colorectal cancer. Estimates are presented by sociodemographic characteristics and healthcare access factors. Analyses were conducted in 2021. Percentages of adults up to date were 76.2% (95% CI= 75.0, 77.5) for breast cancer screening, 76.4% (95% CI= 75.2, 77.6) for cervical cancer screening, and 68.3% (95% CI= 67.3, 69.3) for colorectal cancer screening. Although some population subgroups met breast and colorectal cancer screening targets (81.1% and 70.5%, respectively), many did not, and cervical cancer screening was below the target for all examined subgroups. Lower education and income, nonmetropolitan county of residence (which included rural counties), no usual source of care or health insurance coverage, and Medicaid coverage were associated with lower screening test use. Estimated use of breast, cervical, and colorectal cancer screening tests based on the 2019 National Health Interview Survey were below national targets. Continued monitoring may allow for examination of screening trends, inform interventions, and track progress in eliminating disparities.

Different Types of Ultrasound Probes Usage for Multi-Angle Conventional 3D Ultrasound Compound Imaging: A Breast Phantom Study

Three-dimensional automated breast ultrasound (ABUS) systems seem to offer excellent results in breast cancer screening tests and its early detection, comparable to handheld ultrasound B-mode scanning, with the benefit of saving physician time and reducing handheld ultrasound issues. Nevertheless, the ABUS systems are not very popular, due to the cost and very narrow application. The multi-angle conventional 3D ultrasound compound imaging method (MACUI) is intended for use with standard B-mode scanners in order to reduce cost but preserve the advantages of ABUS systems. The rotational probe movement is utilized in order to collect images for the three-dimensional reconstruction of the scanned tissue’s anatomy. The authors evaluate the capabilities to increase the scanned volume and quality of reconstructions, which are limited in current MACUI implementations, with a probe tilt and shift. The study shows and discusses the results of the imaging using different probes available for SmartUs Telemed B-Mode scanner at different scanning geometry in order to determine the capabilities of such an ultrasound imaging system. The results discussed in the paper highlight the benefits in quality improvement and scanning area obtained with tilted and shifted probes, as well as the advantages of using a relatively simple convex probe that does not incorporate software beam steering over more advanced devices.

Abstract PO-065: Increasing breast and cervical cancer knowledge during COVID-19 pandemic in collaboration with Cooperative Extension Program

Abstract Introduction: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) of the Centers for Disease Control and Prevention (CDC) reported that in April 2020, screening tests for breast cancer decreased by 87% and 84% for cervical cancer, compared to the averages of the previous 5-year for the same month. In response to this finding, the Puerto Rico Breast and Cervical Cancer Prevention and Early Detection Program (PR-BCCPEDP), in collaboration with the Cooperative Extension Program (CEP), implemented an educational intervention of breast and cervical cancer in the northeast region of the island. The intervention aimed to reinforce knowledge in the early detection of breast and cervical cancer, increase screening tests, and reach out to women without health insurance who may qualify for the Program. Methodology: Since 2017, the PR-BCCPEDP agreed with the CEP to implement educational interventions for breast and cervical cancer in 4 of CEP's regions throughout the island. From February to May 2021, seven CEP Family and Consumer Educators (EFC) carried out 8 educational activities with 182 participants in the island's northeast region. We collected age, town of residence, level of education, health insurance, breast and cervical cancer screening history, and the reasons for not having performed screening tests according to the recommended guidelines. The educational activities were performed virtually through an educational PowerPoint and face-to-face using flip charts. The topics included breast and cervical cancer statistics, risk factors, symptoms, early detection guidelines, myths and facts, and barriers to not having screening tests. Participants that didn't have the screening tests according to the recommended guidelines had follow-up calls. Results: A total of 182 women participated in the intervention, with an average age of 47 years; most participants had a high school degree (42%), and 59% had the government's health plan. Regarding screening tests, 35.1% reported that they had not had a mammogram in the last two years, 73.4% authorized to be contacted after the intervention. Similarly, Pap tests, 30.7% reported that they had not had a Pap test in the last three years, of which 87.5% authorized to be contacted. Of the participants who had not had a mammogram (35.1%) or Pap test (30.7%), the main reason was the COVID-19 Pandemic (22.9% and 21.8%, respectively). Regarding the participants referred to the PR-BCCPEDP, 3.6% of the women without health insurance were referred to the Program and of these, 50% were recruited. Conclusion: Despite security, restrictions from the Pandemic, collaborations with community-based programs helped to reach a greater number of women to provide education and awareness about breast and cervical cancer. In terms of breast and cervical cancer screening, more than a third of the participants had not had their mammogram or Pap done due to the Pandemic. Women were recruited for the Program; however, additional efforts are necessary in order to reach a higher number of uninsured women. Citation Format: Omayra Salgado, Ircha Martinez, Nelybeth Santiago, Mirza Rivera, Taina De La Torre, Guillermo Tortolero. Increasing breast and cervical cancer knowledge during COVID-19 pandemic in collaboration with Cooperative Extension Program [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-065.

965The estimated impact of improved breast screening tests targeted at women with dense breasts

Abstract Background There is increasing interest in risk-based breast cancer screening, including interventions to improve outcomes for women with mammographically dense breasts. Methods Policy1-Breast is a continuous-time, multiple-cohort micro-simulation whole-population model which incorporates breast cancer risk, life-course breast density, menopause, hormone therapy use and screening participation. Outcomes include cancer diagnoses and characteristics (invasive/DCIS, tumour size, grade), mode of detection (screen-detected/interval/other) and mortality (breast cancer and other cause). Policy1-Breast validates well against key observed clinical outcomes in Australia. We estimate changes in outcomes within and outside the BreastScreen program upon the introduction of a hypothetical screening test with improved sensitivity for women with dense breasts. Results We estimate that introducing in year 2020 a screening test for women in the highest quintile of breast density at age 50 that halves the masking effect of their breast density would, by 2026-2030, increase diagnosis rates of population-level invasive cancers ( 10%) and screen-detected cancers (20%) and decrease rates of interval cancers (17%) and community-detected cancers (6%). Conclusions Targeted screening tests with improved sensitivity for women with dense breasts are expected to markedly reduce interval cancers and other cancers diagnosed outside the BreastScreen program, while increasing all cancer diagnoses due to increased rates of screen-detected cancers. Key messages Specialised breast cancer screening tests directed at women with very high breast density are expected to reduce interval cancers and increase overall cancer diagnoses. Population simulation models such as Policy1-Breast can complement trial evidence by evaluating a range of scenarios and estimating short and long-term implications.

Multilevel Follow-up of Cancer Screening (mFOCUS): Protocol for a multilevel intervention to improve the follow-up of abnormal cancer screening test results

IntroductionWhile substantial attention is focused on the delivery of routine preventive cancer screening, less attention has been paid to systematically ensuring that there is timely follow-up of abnormal screening test results. Barriers to completion of timely follow-up occur at the patient, provider, care team and system levels. MethodsIn this pragmatic cluster randomized controlled trial, primary care sites in three networks are randomized to one of four arms: (1) standard care, (2) “visit-based” reminders that appear in a patient's electronic health record (EHR) when it is accessed by either patient or providers (3) visit based reminders with population health outreach, and (4) visit based reminders, population health outreach, and patient navigation with systematic screening and referral to address social barriers to care. Eligible patients in participating practices are those overdue for follow-up of an abnormal results on breast, cervical, colorectal and lung cancer screening tests. ResultsThe primary outcome is whether an individual receives follow-up, specific to the organ type and screening abnormality, within 120 days of becoming eligible for the trial. Secondary outcomes assess the effect of intervention components on the patient and provider experience of obtaining follow-up care and the delivery of the intervention components. ConclusionsThis trial will provide evidence for the role of a multilevel intervention on improving the follow-up of abnormal cancer screening test results. We will also specifically assess the relative impact of the components of the intervention, compared to standard care. Trial registrationClinicalTrials.gov NCT03979495

Development of Imaging and Liquid Biomarker Analysis for Breast Cancer Screening: A Review

Breast cancer screening tests could reduce the mortality rates for breast cancer patients. Screening and detection are the keystone of cancer prevention and may significantly minimize the death rates in breast cancer patients for long-term. In this review, we would like to present a comprehensive summary from recent publications of the current development for breast cancer screening, classification of breast cancer based on pathological diagnosis, as well as development of breast cancer detection. The sources of the articles were collected from research published in the PubMed, NCBI databases and manual searches without time restriction based on review of the title, abstract and full review of the articles, using the keywords "breast cancer", "diagnostic", "screening", "imaging", "biomarker" and the combination of these terms. The criteria excluded in selecting references were articles that are not written in English, newspapers, and posters. Of the 146 articles that were selected, there were 103 articles included. Breast cancer screening consists of imaging and pathological assessment such as invasive biopsies of tumor tissue and measurement of biomarkers. The recent development of breast cancer screening utilizing different models and methods like biomarkers were being reviewed. For imaging methods, there are mammography, digital breast tomosynthesis (3D mammography), magnetic resonance imaging (MRI), and ultrasonography. For pathological assessment, there are primary biomarker analysis for breast cancer (estrogen receptor, progesterone receptor, HER2, KI67 index) and liquid biomarker analysis from blood or saliva samples. Additionally, there are some diagnostic kit models for breast cancer screening that were in use such as NanoString nCounter®, MammaTyper®, CellSearch System™, and AdnaTest BreastCancer™. Each of these methods has its own limitations. Therefore, the development of breast cancer models should be more sensitive, reliable, approachable and less harmful.

COVID-19 impact on screening test volume through the National Breast and Cervical Cancer early detection program, January–June 2020, in the United States

Women from racial and ethnic minority groups face a disproportionate burden of cervical and breast cancers in the United States. The Coronavirus Disease 2019 (COVID-19) pandemic might exacerbate these disparities as supply and demand for screening services are reduced. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides cancer screening services to women with low income and inadequate health insurance. We examined COVID-19's impact on NBCCEDP screening services during January-June 2020. We found the total number of NBCCEDP-funded breast and cervical cancer screening tests declined by 87% and 84%, respectively, during April 2020 compared with the previous 5-year averages for that month. The extent of declines varied by geography, race/ethnicity, and rurality. In April 2020, screening test volume declined most severely in Health and Human Services Region 2 - New York (96% for breast, 95% for cervical cancer screening) compared to the previous 5-year averages. The greatest declines were among American Indian/Alaskan Native women for breast cancer screening (98%) and Asian Pacific Islander women for cervical cancer screening (92%). Test volume began to recover in May and, by June 2020, NBCCEDP breast and cervical cancer screening test volume was 39% and 40% below the 5-year average for that month, respectively. However, breast cancer screening remained over 50% below the 5-year average among women in rural areas. NBCCEDP programs reported assisting health care providers resume screening.

Measuring the impact of the COVID-19 pandemic on organized cancer screening and diagnostic follow-up care in Ontario, Canada: A provincial, population-based study

It is essential to quantify the impacts of the COVID-19 pandemic on cancer screening, including for vulnerable sub-populations, to inform the development of evidence-based, targeted pandemic recovery strategies. We undertook a population-based retrospective observational study in Ontario, Canada to assess the impact of the pandemic on organized cancer screening and diagnostic services, and assess whether patterns of cancer screening service use and diagnostic delay differ across population sub-groups during the pandemic. Provincial health databases were used to identify age-eligible individuals who participated in one or more of Ontario's breast, cervical, colorectal, and lung cancer screening programs from January 1, 2019–December 31, 2020. Ontario's screening programs delivered 951,000 (−41%) fewer screening tests in 2020 than in 2019 and volumes for most programs remained more than 20% below historical levels by the end of 2020. A smaller percentage of cervical screening participants were older (50–59 and 60–69 years) during the pandemic when compared with 2019. Individuals in the oldest age groups and in lower-income neighborhoods were significantly more likely to experience diagnostic delay following an abnormal breast, cervical, or colorectal cancer screening test during the pandemic, and individuals with a high probability of living on a First Nation reserve were significantly more likely to experience diagnostic delay following an abnormal fecal test. Ongoing monitoring and management of backlogs must continue. Further evaluation is required to identify populations for whom access to cancer screening and diagnostic care has been disproportionately impacted and quantify impacts of these service disruptions on cancer incidence, stage, and mortality. This information is critical to pandemic recovery efforts that are aimed at achieving equitable and timely access to cancer screening-related care.

The Present View of the Correlation of Breast Vascular Calcifications with Coronary Artery Calcifications

Breast vascular calcifications are a manifestation of calcinosis of the medial layer of the artery walls. This type of calcifications is well visualized on mammograms. Mammography is a widespread and affordable screening test for breast cancer. The studies published in recent years demonstrate a relationship of breast vascular calcifications to cardiovascular risk factors, coronary heart disease. Identification of the correlation of breast vascular calcifications with coronary artery calcifications will be able to improve cardiovascular risk stratification in the group of women with an asymptomatic course.

Frecuencia de la mamografía, ecografía, examen clínico y autoexamen de mama en población general

Introducción. El cáncer de mama es el cáncer que más afecta a las mujeres. Se estima que 1 en 8 mujeres desarrollarán cáncer de mama eventualmente. Una de las herramientas contra el cáncer de mama es crear estrategias de detección temprana de la enfermedad, y la mamografía ha demostrado ser de mucha utilidad. El objetivo del estudio fue determinar la frecuencia de la mamografía, ecografía, examen clínico y autoexamen mamario, y evaluar su uso como pruebas de tamización para cáncer de mama en una cohorte de pacientes atendidas en la Clínica del Prado en Medellín, Colombia. Metodología. Estudio descriptivo, transversal, efectuado a través de encuesta en 318 usuarias atendidas entre junio y diciembre de 2018. Se estimó la frecuencia de los diferentes métodos de tamización y se evaluaron las características sociodemográficas, antecedentes personales y antecedentes familiares. Adicionalmente, se buscó si había asociación significativa entre la práctica de la mamografía como prueba de tamización y las variables de estudio. Resultados. La media de la edad fue de 44,2 años. El método de tamización más usado fue el autoexamen (70,1%), en su mayoría mensual (76,7%), seguido por la mamografía (56%), en su mayoría ocasional (46%). El examen clínico de mama (ECM) se utilizó en el 45,9% de las pacientes, con una frecuencia anual en el 50% de ellas. Por último, la ecografía de mama se practicó en el 43,1% de las encuestadas, con una frecuencia en su mayoría ocasional (39,4%). Se realizó un análisis independiente para mujeres entre los 50 y 69 años, y aunque el 93,8% se habían realizado la mamografía, solo el 9,3% lo hizo bienal, como lo recomienda el Ministerio de Salud y Protección Social. No se hallaron diferencias estadísticamente significativas entre las variables de estudio y la realización de la mamografía como método de tamización. Conclusión. En la población estudiada, el autoexamen de mama es realizado por la mayoría de las mujeres con una frecuencia mensual. La frecuencia de la mamografía, el ECM y la ecografía de mama fue muy similar, y se esperaba encontrar un mayor porcentaje de mamografías realizadas como prueba de tamización. Se requiere fortalecer esta estrategia efectiva para la detección temprana de cáncer de mama, teniendo en consideración la situación particular de cada paciente, la efectividad y beneficio de la técnica, así como los costos asociados.

Automated breast US as the primary screening test for breast cancer among East Asian women aged 40–49 years: a multicenter prospective study

To prospectively evaluate the diagnostic performance of screening ABUS as the primary screening test for breast cancer among Korean women aged 40-49 years. This prospective, multicenter study included asymptomatic Korean women aged 40-49 years from three academic centers between February 2017 and October 2019. Each participant underwent ABUS without mammography, and the ABUS images were interpreted at each hospital with double-reading by two breast radiologists. Biopsy and at least 1 year of follow-up was considered the reference standard. Diagnostic performance of ABUS screening and subgroup analyses according to patient and tumor characteristics were evaluated. Reference standard data were available for 959 women. The recall rate was 9.8% (95% confidence interval [CI]: 7.9%, 11.7%; 94 of 959 women) and the cancer detection yield was 5.2 per 1000 women (95% CI: -0.6, 11.1; 5 of 959 women). There was only one interval cancer. The sensitivity was 83.3% (95% CI: 53.5%, 100%; 5 of 6 cancers) and the specificity was 90.7% (95% CI: 88.8%, 92.5%; 864 of 95. women). The positive predictive values of biopsies performed (PPV3) was 20.0% (95% CI: 4.3%, 35.7%; 5 of 25 women). Women with heterogeneous background echotexture had a higher recall rate (p = .009) and lower specificity (p = .036). Women with body mass index values < 25 kg/m2 had a higher mean recall rate (p = .046). In East Asia, screening automated breast US may be an alternative to screening mammography for detecting breast cancers in women aged 40-49 years. • Automated breast US screening for breast cancer in asymptomatic women aged 40-49 is effective with 5.2 per 1000 cancer detection yield. • Women with heterogeneous background echotexture had a higher recall rate and lower specificity. • Women with body mass index < 25 kg/m2 had a higher recall rate.

Application of chemoresistive gas sensors and chemometric analysis to differentiate the fingerprints of global volatile organic compounds from diseases. Preliminary results of COPD, lung cancer and breast cancer

BackgroundAnalysis of volatile organic compounds (VOCs) in exhaled breath has been proposed as a screening method that discriminates between disease and healthy subjects, few studies evaluate whether these chemical fingerprints are specific when compared between diseases. We evaluated global VOCs and their discrimination capacity in chronic obstructive pulmonary disease (COPD), lung cancer, breast cancer and healthy subjects by chemoresistive sensors and chemometric analysis. MethodsA cross-sectional study was conducted with the participation of 30 patients with lung cancer, 50 with breast cancer, 50 with COPD and 50 control subjects. Each participant's exhaled breath was analyzed with the electronic nose. A multivariate analysis was carried: principal component analysis (PCA) and, canonical analysis of principal coordinates (CAP). Twenty single-blind samples from the 4 study groups were evaluated by CAP. ResultsA separation between the groups of patients to the controls was achieved through PCA with explanations of >90% of the data and with a correct classification of 100%. In the CAP of the 4 study groups, discrimination between the diseases was obtained with 2 canonical axes with a correct general classification of 91.35%. This model was used for the prediction of the single-blind samples resulting in correct classification of 100%. ConclusionsThe application of chemoresistive gas sensors and chemometric analysis can be used as a useful tool for a screening test for lung cancer, breast cancer and COPD since this equipment detects the set of VOCs present in the exhaled breath to generate a characteristic chemical fingerprint of each disease.

Abstract PS3-31: Training multi-professional mammogram readers to interpret abbreviated breast MRI (FAST MRI): A UK multi-centre study

Abstract Background: As a breast cancer screening test, FAST MRI has the potential to combine the sensitivity of dynamic contrast enhanced breast MRI (DCE-MRI) with costs nearer to those of mammography. In the UK the NHS Breast Screening Programme (NHSBSP) screens women aged 50-70 with a mammogram every 3 years and has a workforce of radiologists, breast clinicians and advanced practitioner radiographers who interpret over 2 million screening mammograms annually. For FAST MRI to be used as a UK population screening tool it will need to be interpreted by the existing multi-professional workforce of mammogram readers. Our research team developed a single study day of standardised training in FAST MRI interpretation. In our single centre pilot study, a group of readers with no previous experience of DCE-MRI interpretation achieved an accuracy just 5% less than expert DCE-MRI readers (Br J Radiol 2019:92 DOI:10.1259/bjr.20190663). Our current study aimed to validate the feasibility of training the NHSBSP workforce in FAST MRI interpretation. We developed display software (MedXViewer) containing ground truth information for each FAST MRI case to train and assess mammogram readers, who represented multiple NHSBSP sites in the South West Region of England. Methods: The study was funded by the National Institute for Health Research (Research for Patient Benefit funding stream; ISRCTN 16624917). A per breast analysis of the frequency of results against the true outcome was obtained overall and for each reader. Differences in accuracy, sensitivity and specificity across reader groups (group 1 = mammogram readers experienced in DCE-MRI interpretation; group 2 = mammogram readers with no previous experience in DCE-MRI interpretation) were analysed using a multilevel generalised mixed model to account for multiple readers per case. Results: 37 NHSBSP mammogram readers at 6 NHSBSP sites attended the training day and completed interpretation of the summative assessment dataset (17 in group 1 and 20 in group 2). All 37 readers completed the reading task of 125 cases (250 breasts), for a total of 9250 reads. Median interpretation time was 99.08 seconds (interquartile range 66.83-150.54). The table below shows per breast analysis comparing the readers’ classification with the true outcome (cancer or normal): The concordance with the ground truth (accuracy) of 83% achieved by Group 2 (4129/5000 (95% CI 82-84%)) was significantly lower than that achieved by Group 1 (3814/4250 (90%; 89-91%); p&amp;lt;0.0001) but differed by only 7%. The concordance with the true outcome improved for the group 2 readers from the first 55 cases to the remaining 70 cases (p=0.02), whereas there was no significant improvement for the expert readers of group 1 (p=0.81). Conclusions: This study validates the feasibility of training the workforce of mammogram readers to interpret FAST MRI with only one day of standardised training. Improvement in performance with experience by the group 2 readers indicates a learning curve and suggests the performance gap between the two groups might be narrowed by further training for group 2. TotalGroup 1Group 2MeasureConcordance (Accuracy)7943/9250 (86%)3814/4250 (90%)4129/5000 (83%)True positive rate (Sensitivity)1806/2109 (86%)858/969 (89%)948/1140 (83%)True negative rate (Specificity)6137/7141 (86%)2956/3281 (90%)3181/3860 (82%)False positive rate1004/7141 (14%)325/3281 (10%)679/3860 (18%)False negative rate303/2109 (14%)111/969 (11%)192/1140 (17%) Citation Format: Lyn IL Jones, Rebecca Geach, Sam A Harding, Andrea Marshall, Sadie McKeown-Keegan, Sian Taylor-Phillips, Premkumar Elangovan, Mark Halling-Brown, Sarah Vinnicombe, Elizabeth O'Flynn, Hesam Ghiasvand, Claire T Hulme, Janet A Dunn. Training multi-professional mammogram readers to interpret abbreviated breast MRI (FAST MRI): A UK multi-centre study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS3-31.

Design and rationale of an intervention to improve cancer prevention using clinical decision support and shared decision making: A clinic-randomized trial

BackgroundDespite decades of research the gap in primary and secondary cancer prevention services in the U. S. remains unacceptably wide. Innovative interventions are needed to address this persistent challenge. Electronic health records linked with Web-based clinical decision support may close this gap, especially if delivered to both patients and their providers. ObjectivesThe Cancer Prevention Wizard (CPW) study is an implementation, clinic-randomized trial designed to achieve these aims: 1) assess impact of the Cancer Prevention Wizard-Clinical Decision Support (CPW-CDS) alone and CPW-CDS plus Shared Decision Making Tools (CPW + SDMTs) compared to usual care (UC) on tobacco cessation counseling and drugs, HPV vaccinations, and screening tests for breast, cervical, colorectal, or lung cancer; 2) assess cost of the CPW-CDS intervention; and 3) describe critical facilitators and barriers for CPW-CDS implementation, use, and clinical impact using a mixed-methods approach supported by the CFIR and RE-AIM frameworks. Methods34 predominantly rural, primary care clinics were randomized to CPW-CDS, CPW + SMDTs, or UC. Between August 2018 and October 2020, primary care providers and their patients who met inclusion criteria in intervention clinics were exposed to the CPW-CDS with or without SDMTs. Study outcomes at 12 months post index visit include patients up to date on screening tests and HPV vaccinations, overall healthcare costs, and diagnostic codes and billing levels for cancer prevention services. ConclusionsWe will test in rural primary care settings whether CPW-CDS with or without SDMTs can improve delivery of primary and secondary cancer prevention services. The trial and analyses are ongoing with results expected in 2021.

Patterns and Trends of Cancer Screening in Canada: Results From a Contemporary National Survey.

The aim of this study was to assess the patterns and trends of colorectal, breast, and cervical cancer screening within a contemporary cohort of Canadian adults. Canadian Community Health Survey datasets (2007-2016) were accessed and 3 cohorts were defined: (1) a colorectal cancer (CRC) screening cohort, defined as men and women aged 50 to 74 years with complete information about CRC screening tests and their timing; (2) a breast cancer screening cohort, defined as women aged 40 to 74 years with complete information about mammography and its timing; and (3) a cervical cancer screening cohort, defined as women aged 25 to 69 years with complete information about the Papanicolaou (Pap) test and its timing. Multivariable logistic regression analysis was then performed to evaluate factors associated with not having timely screening tests at the time of survey completion. A total of 99,820 participants were considered eligible for the CRC screening cohort, 59,724 for the breast cancer screening cohort, and 46,767 for the cervical cancer screening cohort. Among eligible participants, 43% did not have timely recommended screening tests for CRC, 35% did not have timely mammography (this number decreased to 26% when limiting the eligible group to ages 50-74 years), and 25% did not have a timely Pap test. Lower income was associated with not having a timely recommended screening tests for all 3 cohorts (odds ratios [95% CI]: 1.86 [1.76-1.97], 1.89 [1.76-2.04], and 1.96 [1.79-2.14], respectively). Likewise, persons self-identifying as a visible minority were less likely to have timely recommended screening tests in all 3 cohorts (odds ratios for White race vs visible minority [95% CI]: 0.87 [0.83-0.92], 0.85 [0.80-0.91], and 0.66 [0.61-0.70], respectively). More than one-third of eligible individuals are missing timely screening tests for CRC. Moreover, at least one-quarter of eligible women are missing their recommended breast and cervical cancer screening tests. More efforts from federal and provincial health authorities are needed to deal with socioeconomic disparities in access to cancer screening.

Disparities between Uptake of Germline BRCA1/2 Gene Tests and Implementation of Post-test Management Strategies in Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancer Patients.

BackgroundTo assess the rate of germline BRCA gene tests in epithelial ovarian cancer (EOC) patients and uptake of post-test risk management strategies in BRCA1/2-mutated patients.MethodsInstitutional databases were searched to identify patients who were diagnosed with epithelial ovarian, fallopian tube, or primary peritoneal cancer (EOC) between 2009 and 2019 in two academic hospitals. Retrospective review on medical records was performed to collect clinico-pathologic variables, including performance of germline BRCA gene test and its results, as well as conduct of breast cancer screening tests and cascade testing. If annual mammography +/− breast ultrasonography was performed, it was considered that regular breast cancer surveillance was done.ResultsA total of 840 women with EOC were identified during the study period. Of these, 454 patients (54.0%) received BRCA gene testing and 106 patients (106/454, 23.3%) were positive for BRCA1/2 mutations. The rate of BRCA tests has markedly increased from 25.8% in 2009-2012 to 62.7% in 2017-2019. Among the 93 patients with BRCA1/2 mutation without previous personal breast cancer history, 20 patients (21.5%) received annual mammography with or without breast ultrasonography for regular surveillance. Among the 106 BRCA1/2-mutated EOC patients, cascade testing on family members was performed only in 13 patients (12.3%).ConclusionAlthough BRCA1/2 gene tests have been substantially expanded, the uptake of post-test risk management strategies, including breast cancer screening for BRCA1/2-mutated patients and cascade testing for family members, has remained low. Strategies to increase its uptake and education about the importance of post-test risk managements are needed.

The Association of Socio-demographic Determinants and Mammography Screening in women in Serbia

Abstract Introduction Serbian screening mammography programs target women 50-69 years with biennial screening. Methods Research was conducted as a cross-sectional study on a sample of 2784 women aged 50-69 years in Serbia, as a part of the Health Survey in Serbia, 2013. The association between the socio-demographic determinants as independent variables, and mammography screening (within the past 2 years) as dependent variable were examined using univariate and binary logistic regression. Multivariate model were adjusted for marital status, education, employment status, DHS Wealth Index, type of settlement and self-perceived health. The minimum level of significance was p &amp;lt; 0.05. Results Only 22.2% of women aged 50-69 have done mammograms within the past 2 years in Serbia. In binary logistic regression model as predictors for a mammogram were singled out level of education, wealth index and self-perceived health. Women with medium level of education have 1.4 times higher chance to perform a mammogram in relation to those with low education (OR = 1.4; 95%CI 1.12-1-80), while women with high level of education have 1.8 times higher chance to do a mammogram in relation to those with low education (OR = 1.8; 95%CI 1.33-2.58). Women with good financial situation were 1.4 times more likely to perform a mammogram in relation to those with poor financial situation (OR = 1.4; 95%CI 1.05-1.80). Women who perceived their health as well have 26% less chance to do a mammogram compared to those who perceived their health as a poor (OR = 0.74; 95%CI 0.56-0.97). Conclusions This study showed the disparity in the prevalence of mammography utilization. The predictors for mammogram performance among women were: high level of education, high wealth index and self-perceived health as poor. Key messages The only breast cancer screening test that has been proven effective in organized, population-based programs is mammography screening. Screening mammography reduces the risk of death due to breast cancer. It is useful for detecting all types of breast cancer, including invasive ductal and invasive lobular cancer.

Automated Analysis of Ultrasound Videos for Detection of Breast Lesions

Background: Breast cancer is the second cause of death among women. Ultrasound (US) imaging is the most common technique for diagnosing breast cancer; however, detecting breast lesions in US images is a difficult task, mainly, because it provides low-quality images. Consequently, identifying lesions in US images is still a challenging task and an open problem in US image processing. This study aims to develop an automated system for the identification of lesions in US images Method: We proposed an automatic method to assist radiologists in inspecting and analyzing US images in breast screening and diagnosing breast cancer. In contrast to previous research, this work focuses on fusing information extracted from different frames. The developed method consists of template matching, morphological features extraction, local binary patterns, fuzzy C-means clustering, region growing, and information fusion-based image segmentation technique. The performance of the system was evaluated using a database composed of 22 US videos where 10 breast US films were obtained from patients with breast lesions and 12 videos belonged to normal cases. Results: The sensitivity, specificity, and accuracy of the system in detecting frames with breast lesions were 95.7%, 97.1%, and 97.1%, respectively. The algorithm reduced the vibration of the physician’s hands’ while probing by assessing every 10 frames regardless of the results of the prior frame; hence, lowering the possibility of missing a lesion during an examination. Conclusion: The presented system outperforms several existing methods in correctly detecting breast lesions in a breast cancer screening test. Fusing information that exists in frames of a breast US film can help improve the identification of lesions (suspect regions) in a screening test.