Undergoing Screening Mammography Research Articles

Overcoming obstacles to mammography screening: Examining the role of offline healthcare barriers and online patient-provider communication.

Barriers to accessing offline healthcare may discourage patients from undergoing mammography screening. Online patient-provider communication (OPPC) offers a supplementary health resource that can complement traditional medical encounters and facilitate mammography screening. This study examines how offline healthcare barriers influence mammography screening, taking into account OPPC as an independent variable and cancer fatalism and patient activation as two mediators. Data from the 2017, 2018, and 2020 iterations of the Health Information National Trends Survey were used for this study. Results showed that OPPC was positively linked to mammography screening. Offline healthcare barriers had a negative association with patient activation and subsequent mammography behaviors. Moreover, offline healthcare barriers and OPPC were associated with mammography screening through serial mediation of cancer fatalism and patient activation. This study has important implications for encouraging mammography screening.

Top 5 Research Studies of the month for Italian Primary Care Physicians: January 2024.

This monthly article provides a collection of summaries of the most relevant studies identified as POEMs (patient-oriented evidence that matters) for Italian primary care physicians. 1) A recent high-quality systematic review (SR) of 76 SRs found that, compared to all other lipid-lowering medications, for overall, primary, and secondary prevention the best balance of benefits, harms, and costs is provided by statins. 2) To our surprise, a network meta-analysis of 12 randomized controlled trials (RCTs) concluded that acetaminophen and ketorolac were more effective than morphine in alleviating pain from renal colic and were less likely than morphine to cause adverse effects and the need for rescue analgesia. 3) Proton pump inbibitors (PPI) use in children is associated with an increased risk of developing serious infections as compared with the use other acid-suppressing therapy. It seems prudent to use antacids and histamine 2 receptor antagonists first and reserve PPIs for nonresponders. 4) Overdiagnosis - the identification of, in this case, breast cancer, that would not have caused symptoms in a person's lifetime - seems to increase with age. In a study including more than 50.000 women aged above 70 who underwent mammography screening, the overdiagnosis rate was 31%, 47% and 51% for women aged 70 to 74 years, 75 to 84 years and over age 85, respectively. 5) An RCT among community-dwelling adults conducted in the US found that using a regular cuff on larger-than-average arms can falsely raise blood pressure readings by almost 5 mmHg, and a regular cuff on an especially thin arm can lower readings by 3.6 mmHg.

Predictors of Breast Cancer Outcome in a Cohort of Women Seeking Care at a Safety Net Hospital

ObjectiveThis study aimed to identify predictors associated with lower mortality in a population of women diagnosed and treated for breast cancer at a safety net hospital. MethodsFrom 2008-2014, 1,115 patients were treated for breast cancer at our academic safety net hospital. 208 were excluded due to diagnosis at an outside facility, and the remaining 907 (81%) formed the study cohort. Retrospective charts and imaging reviews looked at race, ethnicity, insurance status, social determinants of health, screening utilization, treatment regimen, and 7-13-year follow-up care, including the cause of death. Multivariable logistic regression modeling assessed mortality, and adjusted odds ratios (aOR) with 95% confidence intervals (CI) were computed. ResultsOf the 907 women, the mean age was 59 years (inter-quartile range 50-68 years), with 40% White, 46% Black, 4% Asian, and 10% Other. Increasing age (aOR=1.03, p=0.001) and more advanced stage at diagnosis (aOR=6.37, p<0.0001) were associated with increased mortality. There was no significant difference in mortality based on race or ethnicity (p>0.05). Of 494 with screening prior to diagnosis, longer screening time was observed for patients with advanced stage (median 521 days) vs. early stage (median 404 days), p=0.0004. Patients with Medicaid, insurance not specified, and no insurance were less likely to undergo screening before diagnosis than privately insured (all p<0.05). Shorter screening time was associated with lower all-cause mortality (aOR=0.57, 95% CI=0.36-0.89, p=0.013). DiscussionIn a safety net population, a more advanced stage at diagnosis was associated with higher mortality and lower odds of undergoing screening mammography in the two years prior to a breast cancer diagnosis. Early screening was associated with lower mortality. Finally, given no racial or ethnic differences in mortality, the safety net infrastructure at our institution effectively provides equitable cancer care once a cancer is confirmed.

Abstract C112: Improving breast cancer screening disparities through A3 problem solving: Design of a quality improvement initiative

Abstract Introduction: Extensive research studies on breast cancer disparities have had limited impact on reducing breast cancer disparities. Quality improvement initiatives use data-driven, rigorous approaches to plan, execute, and study the delivery of healthcare services. There have been limited studies using quality improvement methods to address health disparities. The purpose of our study was to describe the design of a quality improvement initiative to address breast cancer disparities using the A3 problem solving method. Methods: A3 problem solving method was used to reduce breast cancer screening disparities. The A3 method is a quality improvement tool used to identify problems, organize and synthesize data, and propose solutions to achieve goals (summarized on one side of a sheet of paper). A3 methods are outlined by the FOCUS-PDCA acronym: F - Find process to improve, O - Organize team of stakeholders, C - Clarify current state, U - Understand sources of variation that contribute to the problem, S - Select change ideas, P - Plan and do the improvement, C - Check the results, A - Act. Quantitative data was derived from the electronic medical record. Qualitative data was derived from divergent thinking exercises asking participants from diverse standing urban stakeholder groups about barriers to cancer screening. Results: Design of the A3 problem solving process was conducted between November 2022 until May 2023 yielding the following FOCUS-PDCA design and initial results. F - Increase the percentage of patients who have undergone mammography screening within the last two years. O - Team includes representative leaders from primary care, community health, ambulatory operations, diversity, equity, and inclusion, radiology, breast center, population health, information services, and federally qualified health centers. C and U - Quantitative data collection revealed that 74% of 37,509 eligible patients (women between 50-74 years old) received a mammogram within the last two years (75% White, 58% Black, 67% Asian, 60% American Indian, 64% Hispanic). Divergent thinking exercises revealed the following root causes for mammography screening disparities: patients don’t know they are due, transportation issues, barriers to scheduling, access to mammography facilities, financial concerns, and fears about returning to clinics during COVID-19. S - Process improvements included multilingual and modality reminders, marketing campaigns, transportation vouchers, co-location of screening centers with federally qualified health centers, expanded access to mammography screening facilities, educational activities for primary care physicians, participation in community events, equity-focused review of screening guidelines. PDCA - Based on selected improvements, changes in breast cancer screening percentages will be displayed using run charts until December 2024, stratified by race and ethnicity. Conclusion: A3 problem solving tools represent structured, scientifically rigorous approaches that cancer centers can use to reduce screening disparities. Citation Format: Nia Foster, Arissa J. Milton, Mai A. Elezaby, Roberta M. Strigel, Meeghan A. Lautner, Ryan W. Woods, Nicci O. Brackett, Noelle K. LoConte, Anand K. Narayan. Improving breast cancer screening disparities through A3 problem solving: Design of a quality improvement initiative [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C112.

Mammographic breast density and cardiovascular disease risk in women

AimsWe aimed to determine the predictive role of mammographic breast density in addition to the Framingham Risk Score (FRS) on subsequent CVD events in women. Methods and ResultsThis cohort study included 4,268,579 women aged ≥40 years who underwent mammography screening between 2009 and 2010 with follow-up until 2020. Breast density was reported following the Breast Imaging Reporting and Data System. Primary outcomes included coronary heart disease, cerebrovascular disease, peripheral arterial disease, and heart failure. The incremental predictive ability of breast density added to the FRS model was assessed using the ROC and net reclassification index (NRI) among all women and strata based on FRS risk categories (<5% as low-risk, 5%–10% as moderate-risk, and ≥10% as high-risk). In total, 135,475 CVD events were recorded after a median follow-up of 10.9 years. A lower category of breast density was associated with a higher risk of CVD. Compared to the extremely dense breast group, the hazard ratios (95% CI) for CVDs were 1.12 (1.09–1.14), 1.19 (1.17–1.22), and 1.29 (1.26–1.32) in women with heterogeneously dense, scattered fibroglandular densities, and almost entirely fat breast density, respectively. Adding breast density to the FRS showed a slight improvement in AUROC but a modest improvement in NRI; the C-statistic difference was 0.083% (95% CI 0.069–0.096) with a 7.15% (6.85–7.69) increase in NRI, with the strongest improvement observed in the low-risk group. ConclusionsMammographic breast density is an independent predictor of incident CVD among women. The addition of mammographic breast density to FRS improves the prediction of CVDs, especially in low-risk individuals.

Factors Influencing Patient Confidence in Screening Mammography.

We aimed to assess factors associated with patients' confidence in the ability of screening mammography to detect breast cancer. Data were analyzed from a cross-sectional, prospective survey conducted in 2017 of women without a breast cancer history who were undergoing screening mammography at our institution. In total, 390 women completed the survey questions relevant to this study. Most respondents were 46 years or older (89.7%), White (87.6%), and college-educated (66.1%). Approximately 80% of respondents reported having confidence in the ability of screening mammography to detect breast cancer. Factors significantly associated with lower confidence in screening mammography were higher education (P = .01) and dense breast tissue (P < .001). Age (P = .12), race (P = .64), family history of breast cancer (P = .17), prior abnormal mammogram (P = .07), and mammogram frequency (P = .42) were nonsignificant. Women with a college education or higher were less likely to report confidence in routine mammography than women with less education (odds ratio [OR]= 0.43; 95% CI, 0.20-0.84; P = .02). Compared with women who reported their breast tissue as not dense, women who were aware they had increased breast density (OR = 0.16; 95% CI, 0.04-0.49; P = .004) or were unaware whether they had increased breast density (OR = 0.17; 95% CI, 0.04-0.51; P = .005) reported less confidence in screening mammography. Most respondents were confident in the ability of screening mammography to detect breast cancer. Confidence was inversely associated with education level and self-reported increased breast density. These findings highlight the importance of continued patient education about the effectiveness of screening mammography for patients with dense breast tissue.

Trends in the pre-operative diagnosis and surgical management of axillary lymph node metastases in women with screen-detected breast cancer

AimThe aim of the current study was to investigate time-trends in pre-operative diagnosis and surgical treatment of axillary lymph node metastases in breast cancers detected at screening mammography. MethodsWe included all women who underwent screening mammography in the South of the Netherlands between 2005 and 2020. During a follow-up period of at least two years, data on clinical radiological examinations, biopsy procedures and surgical interventions were obtained. The 15 years of inclusion were divided into five cohorts of three years each. ResultsOf the 4049 women with invasive breast cancer, 22.1 % (896/4049) had axillary lymph node metastasis at pathology (ALN+). Percutaneous axillary biopsy was performed in 39.6 % (355/896) of these women, with the proportions of fine needle aspiration biopsy (FNAB) decreasing from 97.6 % (40/41) in 2005–2007 to 41.6 % (37/89) in 2017–2019 and core needle biopsy (CNB) rising from 2.4 % (1/41) in 2005–2007 to 58.4 % (52/89) in 2017–2019 (P < 0.001). Sensitivity of FNAB and CNB was comparable (77.4 % (188/243, 95%CI = 71%–82 %) versus 82.4 % (103/125), 95%CI = 74%–88 %) (P = 0.26). Pre-operative confirmation of ALN + by percutaneous biopsy ranged from 27.3 % (56/205) in 2011–2013 to 39.0 % (80/205) in 2017–2019, with no significant trend changes over time (P = 0.103). The proportion of ALN + women who underwent axillary lymph node dissection (ALND) decreased from 96.0 % (97/101) in 2005–2007 to 16.6 % (34/205) in 2017–2019 (P < 0.001). ConclusionPre-operative confirmation of axillary lymph node metastasis by ultrasound-guided biopsy did not rise despite the increased use of CNB at the expense of less invasive FNAB. A significant reduction in ALND was observed through the years.

Patient Notification About Breast Arterial Calcification on Mammography: Empowering Women With Information About Cardiovascular Risk.

To assess the impact of informing women about the presence of breast arterial calcification (BAC) on mammography by determining whether those notified about the presence of BAC would seek cardiovascular evaluation. This IRB-approved prospective study included 494 patients who underwent screening mammography between June 8, 2021, and April 22, 2022. Mammograms were reviewed by a radiologist, and patients were notified via e-mail about the presence or absence of BAC. Patients with BAC were advised to discuss the results with their physicians and were surveyed 3 months later. Frequencies and proportions were calculated for study participation, presence of BAC, survey participation, health actions, and perceptions. Confidence intervals were calculated for proportions of health actions and perceptions. Of 494 study participants, 68/494 (13.8%; 95% CI: 10.9%-17.1%) had BAC detected on mammography and 42/68 (61.8%; 95% CI: 61.1%-62.1%) with BAC completed the follow-up survey at 3 months. Of these 42 survey respondents, 24/42 (57.1%; 95% CI: 41.1%-72.3%) reported discussing results with their primary care physician (PCP) or a cardiologist. In addition, 34/42 (81.0%; 95% CI: 65.9%-91.4%) reported finding it helpful to receive information about BAC and 32/42 (76.2%; 95% CI: 60.6%-88.0%) believed all women should be informed about BAC after mammography. After notification about the presence of BAC on screening mammography, the majority (57.1%) of survey respondents reported discussing the results with a PCP or cardiologist. These results suggest that providing mammography patients with information about BAC may promote preventive cardiovascular health.

Non–timely referral of women aged 40 to 69 to preventive medicine for breast cancer detection and its association with the BI-RADS classification

PurposeIn the first level of health care, the timely detection of breast cancer is essential to prevent the progression of the disease, obtain optimal treatment and improve the prognosis and survival of patients. The objective of this study was to analyze the opportunity in referral to the Preventive Medicine Modules offered to women aged 40 to 69 years of the Family Medicine Unit 1, of the Mexican Social Security Institute, Decentralized Administrative Operation Body, Aguascalientes, Mexico, by their family physician, and its impact in the findings of mammographic screening according to the BI-RADS classification. Methods This was a cross-sectional comparative study of 412 mammograms performed on women aged 40 to 69, who were treated in the preventive medicine modules from January 2019 to June 2021. Data collection was carried out by simple random sampling using a checklist. Multiple logistic regression models adjusted for age were applied. ResultsA total of 90.29% of the patients who underwent screening mammography were not referred in a timely manner to the preventive medicine modules by the family physician, this delay in diagnosis and treatment increased by 3.01 times the probability of having a classification BI-RADS suspected of malignancy compared to those women whose referral was timely (OR adj = 3.01, 95% CI 1.04–8.72, p = 0.041). ConclusionThe untimely referral of women aged 40–69 to preventive medicine modules for the detection of breast cancer increases the risk of finding a malignant lesión.

Comparing the performance of full-field digital mammography and digital breast tomosynthesis in the post-treatment surveillance of patients with a history of breast cancer: A retrospective study

IntroductionThe purpose of our study was to compare the performance of 2D (FFDM) against 3D (FFDM plus DBT) examinations in the post-treatment surveillance of asymptomatic breast cancer survivors. MethodsA list of women with a history of breast cancer who underwent screening mammography (2D or 3D) from 5/2017 to 5/2020 was retrieved. A total of 20,210 examinations were identified and performance metrics were compared. ResultsThere were no statistically significant difference in cancer detection rate (CDR) (p = 0.38), recall rate (RR) (p = 0.087), or positive predictive value (PPV) (p = 0.74) between 2D vs. 3D examinations. Stratification by breast tissue identified no statistically significant difference in CDR (p = 0.581 and p = 0.428), RR (p = 0.230 and p = 0.205), or PPV (p = 0.908 and p = 0.721) between fatty/scattered and heterogeneous/extremely dense breast tissue when comparing 2D vs 3D examinations. Stratification by age did not identify a significant difference in RR or PPV between the two groups. CDR was statistically increased with 2D vs. 3D examinations in the 60–69 years group (p = 0.021). Stratification by race did not identify a significant difference in RR or PPV between the two groups. CDR was statistically increased with 3D vs. 2D examinations in white women (p = 0.036). Stratification by laterality (bilateral vs. unilateral post mastectomy) did not identify a significant difference in RR or PPV between the two groups. CDR was statistically increased in 2D vs. 3D examinations in unilateral studies (p = 0.009). ConclusionFor asymptomatic women with a history of breast cancer, there is no evidence that the addition of DBT to FFDM improves CDR, RR, or PPV. Implications for practiceMore studies are needed concerning screening methodologies supplementing FFDM in the screening regimens of breast cancer survivors.

Survey of knowledge and awareness of breast density amongst Maltese Women undergoing mammography screening

IntroductionThe ratio of breast glandular tissue to fatty tissue is known as breast density. This study assessed the knowledge and awareness of breast density of Maltese women undergoing mammography screening at the National Screening Unit. Increased breast density knowledge may lead to an increase in supplementary imaging attendance. In Europe, there are very limited studies assessing the knowledge and awareness of breast density, providing a solid rationale for this study to be done locally. MethodsWomen aged 50 to 69 who were eligible for breast cancer screening at the National Screening Unit were given a validated closed-ended questionnaire as part of a quantitative, prospective, cross-sectional, and descriptive study. The questionnaire was designed to achieve the aims of the study. Using IBM-SPSS (v28) software, the data was analysed using the Friedman and Kruskal Wallis tests. ResultsA total of 127 surveys were gathered, with a maximum margin of error of 8.66% based on a 95% confidence range. Breast density and the risks associated with it were not well known or understood (average scores ranging from 2.80 to 3.34 out of 5), but supplemental screening was more widely known (3.65). Participants' knowledge and awareness were correlated with their age, profession, and degree of education. Leaflets (40%) and medical experts (40%) were respondents' favourite sources of information. ConclusionThe population under study lacks knowledge and awareness of breast density and the risks it entails. It's important to provide women more details about breast density. With this information, women will be empowered to seek the finest care. Implications for practiceAlthough some socio-demographic parameters were linked to women's knowledge and awareness, it is advised that more research be done using a bigger sample size through interviews and other studies. Moreover, more information regarding breast density must be provided to women undergoing breast cancer screening in Malta to increase their knowledge and awareness.

Breast Self-examination and Mammography: Assessing Knowledge, Attitudes, and Behaviors among Female Primary Health-care Workers in Southern Saudi Arabia

Background: Insufficient knowledge about breast cancer risk factors and suboptimal practice of screening methods among female health-care professionals necessitated this study. We aimed to assess the knowledge, attitude, and behaviors of breast self-examination (BSE) and mammography among female primary health-care workers in the southern region of Saudi Arabia. Methodology: This descriptive, cross-sectional observation study was conducted in the southern region of Saudi Arabia, specifically focusing on female primary health-care workers. The study was executed between March 2023 and May 2023, utilizing online self-administered questionnaires for data collection. Results: The analysis included 252 participants, with the majority 144 (57.1%) falling within the 20–29 age range. In terms of personal history, 207 (82.1%) reported no previous breast problems, while the prevalence of breast problems in first- and second-degree relatives was 43 (17.1%) and 45 (17.9%), respectively. Regarding BSE, 126 (50.0%) reported never having performed it, and 201 (79.8%) reported never undergoing screening mammography. Knowledge levels varied, with 156 (61.9%) classified as having poor knowledge and 96 (38.1%) as having good knowledge. Conclusion: This research highlights the insufficient understanding and suboptimal implementation of BSE and mammography among female primary health-care professionals in the southern part of Saudi Arabia.

Breast cancer risk characteristics of women undergoing whole-breast ultrasound screening versus mammography alone.

There are no consensus guidelines for supplemental breast cancer screening with whole-breast ultrasound. However, criteria for women at high risk of mammography screening failures (interval invasive cancer or advanced cancer) have been identified. Mammography screening failure risk was evaluated among women undergoing supplemental ultrasound screening in clinical practice compared with women undergoing mammography alone. A total of 38,166 screening ultrasounds and 825,360 screening mammograms without supplemental screening were identified during 2014-2020 within three Breast Cancer Surveillance Consortium (BCSC) registries. Risk of interval invasive cancer and advanced cancer were determined using BCSC prediction models. High interval invasive breast cancer risk was defined as heterogeneously dense breasts and BCSC 5-year breast cancer risk ≥2.5% or extremely dense breasts and BCSC 5-year breast cancer risk ≥1.67%. Intermediate/high advanced cancer risk was defined as BCSC 6-year advanced breast cancer risk ≥0.38%. A total of 95.3% of 38,166 ultrasounds were among women with heterogeneously or extremely dense breasts, compared with 41.8% of 825,360 screening mammograms without supplemental screening (p<.0001). Among women with dense breasts, high interval invasive breast cancer risk was prevalent in 23.7% of screening ultrasounds compared with 18.5% of screening mammograms without supplemental imaging (adjusted odds ratio,1.35; 95% CI, 1.30-1.39); intermediate/high advanced cancer risk was prevalent in 32.0% of screening ultrasounds versus 30.5% of screening mammograms without supplemental screening (adjusted odds ratio,0.91; 95% CI, 0.89-0.94). Ultrasound screening was highly targeted to women with dense breasts, but only a modest proportion were at high mammography screening failure risk. A clinically significant proportion of women undergoing mammography screening alone were at high mammography screening failure risk.

A scalable approach to democratizing cancer risk stratification: One healthcare system’s approach using a patient-facing digital platform.

10622 Background: Access to genetic testing and risk stratification is primarily gated by referrals from non-genetics providers for patients who meet testing criteria. The majority of Americans seek care at community hospitals that are closer to home; community hospitals are faced with the challenge of how to democratize access to precision oncology and cancer prevention. Research has shown that the establishment of such protocols is challenging, requiring organizational buy-in, capital, resources, and the involvement of multiple levels of clinical and nonclinical stakeholders. Here we highlight Sarah Cannon, the Cancer Institute of HCA Healthcare, and their programmatic approach to risk stratification using a digital platform offered universally to all patients undergoing screening mammography. Methods: From February to November in 2022, fourteen sites were assessed to have appropriate provider and facility capabilities to support the implement the CARE program. The web-based risk-stratification tool is sent to individuals before standard ambulatory appointments to assess their lifetime risk for breast cancer based on the Tyrer-Cuzick (version 8.0) risk algorithm and National Comprehensive Cancer Network (NCCN) genetic testing criteria. Testing criteria included hereditary breast, ovarian, pancreatic, and prostate cancers, Lynch syndrome, and familial adenomatous polyposis (FAP). Retrospective data was pulled from patients seen between February 2022 through January 2023. The outcome measures included percentage of individuals who completed the risk-assessment, met genetic testing criteria, pursued germline genetic testing, received a positive germline result, and/or had a breast cancer risk ≥20%. Results: During the 10 months at the 14 community hospitals a total of 25,671 individuals were invited for risk assessment through the CARE program; 19,277 (75.1%) individuals completed assessment. Overall, 5,070 (26.3%) met genetic testing criteria and 1,536 individuals had a ≥20% lifetime risk of breast cancer, for a total of 34% of patients identified as elevated risk. 23.4% (1,187) of those meeting criteria opted to proceed with germline genetic testing. An additional 126 individuals who did not meet criteria pursued genetic testing. Of the 1,313 completed genetic tests, 96 (7%) had positive genetic test results. Fifty-four of 96 (56%) positive results had an impact on medical management and cancer prevention. Conclusions: Sarah Cannon and HCA Healthcare have successfully begun implementing a comprehensive, digital risk stratification program in the community hospital setting to provide standardized access to genomic testing and risk stratification. By identifying patients with an elevated risk for cancer, the potential for increased early cancer detection and precision oncology can be observed in a scalable and sustainable program.

Breast cancer risk prediction combining a convolutional neural network-based mammographic evaluation with clinical factors.

Deep learning techniques, including convolutional neural networks (CNN), have the potential to improve breast cancer risk prediction compared to traditional risk models. We assessed whether combining a CNN-based mammographic evaluation with clinical factors in the Breast Cancer Surveillance Consortium (BCSC) model improved risk prediction. We conducted a retrospective cohort study among 23,467 women, age 35-74, undergoing screening mammography (2014-2018). We extracted electronic health record (EHR) data on risk factors. We identified 121 women who subsequently developed invasive breast cancer at least 1year after the baseline mammogram. Mammograms were analyzed with a pixel-wise mammographic evaluation using CNN architecture. We used logistic regression models with breast cancer incidence as the outcome and predictors including clinical factors only (BCSC model) or combined with CNN risk score (hybrid model). We compared model prediction performance via area under the receiver operating characteristics curves (AUCs). Mean age was 55.9years (SD, 9.5) with 9.3% non-Hispanic Black and 36% Hispanic. Our hybrid model did not significantly improve risk prediction compared to the BCSC model (AUC of 0.654 vs 0.624, respectively, p = 0.063). In subgroup analyses, the hybrid model outperformed the BCSC model among non-Hispanic Blacks (AUC 0.845 vs. 0.589; p = 0.026) and Hispanics (AUC 0.650 vs 0.595; p = 0.049). We aimed to develop an efficient breast cancer risk assessment method using CNN risk score and clinical factors from the EHR. With future validation in a larger cohort, our CNN model combined with clinical factors may help predict breast cancer risk in a cohort of racially/ethnically diverse women undergoing screening.

Genome-Wide Association Study of Breast Density among Women of African Ancestry.

Breast density, the amount of fibroglandular versus fatty tissue in the breast, is a strong breast cancer risk factor. Understanding genetic factors associated with breast density may help in clarifying mechanisms by which breast density increases cancer risk. To date, 50 genetic loci have been associated with breast density, however, these studies were performed among predominantly European ancestry populations. We utilized a cohort of women aged 40-85 years who underwent screening mammography and had genetic information available from the Penn Medicine BioBank to conduct a Genome-Wide Association Study (GWAS) of breast density among 1323 women of African ancestry. For each mammogram, the publicly available "LIBRA" software was used to quantify dense area and area percent density. We identified 34 significant loci associated with dense area and area percent density, with the strongest signals in GACAT3, CTNNA3, HSD17B6, UGDH, TAAR8, ARHGAP10, BOD1L2, and NR3C2. There was significant overlap between previously identified breast cancer SNPs and SNPs identified as associated with breast density. Our results highlight the importance of breast density GWAS among diverse populations, including African ancestry populations. They may provide novel insights into genetic factors associated with breast density and help in elucidating mechanisms by which density increases breast cancer risk.

The Impact of Social Determinants of Health on the Time Between Diagnostic Breast Imaging and Biopsy at a Safety Net Hospital.

Although social determinants of health (SDH) are thought to be associated with health outcomes, there is limited literature on the direct impact of SDH on delays in breast cancer diagnosis via breast imaging. Identifying SDH associated with longer lapses (defined in this study as a time interval between two events) between imaging and biopsy is essential to early-stage detection of breast cancer, which has a significant impact on survival. Previous work demonstrated associations between both housing and food insecurity with longer lapses between diagnostic imaging and biopsy. We aim to expand upon this retrospective analysis with a longer study period, more participants, and improved data cleaning techniques to better understand how SDH may affect the lapse between imaging and biopsy. This retrospective study was institutional review board approved and HIPAA compliant. Informed consent was waived. Patients who underwent screening mammography between January 1, 2015, and January 1, 2020, were assessed for timing of recommended biopsy due to a BI-RADS category 4 or 5. SDH were assessed with the unique Tool for Health & Resilience in Vulnerable Environments screening questionnaire developed at Boston Medical Center. Associations between imaging and biopsy timing and eight explanatory SDH variables (food insecurity, housing insecurity, ability to pay for medications, transportation access, ability to pay for utilities, caretaking needs, employment, and desire for more education) were assessed with multivariate Cox proportional hazard modeling, as well as demographic data. There were 2,885 unique patients who underwent 3,142 unique diagnostic imaging studies and were included in the multivariate analysis. Of those 3,142 imaging studies, 196 (6.2%) had not yet been followed by the recommended biopsy by the end of the study period; 2,271 patients (78.7%) had SDH data in at least one domain; and the individual domains ranged from 962 patients (32.1%) with complete data for education to 2,175 patients (75.4%) with complete data for food insecurity. A positive screen for at least one SDH was associated with a longer lapse between diagnostic imaging and biopsy (P= .048). Furthermore, housing insecurity alone was nearly associated with longer lapses between diagnostic imaging and biopsy (P= .059). Those who desired more education were found to have shorter lapses between diagnostic imaging and biopsy (P= .037). Only a positive screen of the aggregate of all SDH (using a novel tool developed at our safety net hospital) was associated with a statistically significant lengthening of this lapse. Of the eight SDH screened, housing insecurity was the closest to association with longer lapses between diagnostic imaging and biopsy, whereas patients who desired more education were found to have statistically significant shorter lapses; however, this survey domain had the lowest completion rate. Identification of which SDH might affect the time from imaging to biopsy can potentially inform targeted programs to intervene. Government and health system interventions addressing SDH, notably housing insecurity, could allow for shorter time to breast cancer diagnosis and treatment.

Mammography in combination with breast ultrasonography versus mammography for breast cancer screening in women at average risk.

Mammography in combination with breast ultrasonography versus mammography for breast cancer screening in women at average risk.

Estimation of Abnormal Findings in Screening Mammography: A Crosssectional Descriptive Study

Introduction: Breast cancer is the second leading cause of death in women of Nepal. Breast cancer awareness and clinical breast examination are the key steps for early detection of breast cancer in countries with limited resources like Nepal. Meanwhile, screening mammography can be used as a major tool to detect breast cancer at an early stage before development of signs such as lump. Screening mammography is very effective in detection of breast cancer. The aim of this study was to estimate the abnormal findings in screening mammography. Methods: Quantitative, cross-sectional, descriptive study was performed in the Department of Radiology and Imaging of Civil Service Hospital. Data was collected over a period of 6 months (April to September 2018) of female patients who visited for screening mammography were included in this study. Results: Out of total 90 female patients, in screening mammography, 42.22% were benign lesions like macro calcifications and cysts, while 57.78% were normal findings. There was no evidence of breast malignancy in the study group. Among the age group of 35-44 years 15.38 % had abnormal findings. Women undergoing screening mammography were mostly in the age group of 45-54 where 53.47 % of 43 women had abnormalities. Similarly only 10 out of 18 and 1 out of 3 had abnormalities in the age group of 55-64 and 65 and above respectively. Conclusion: The study concluded that the abnormal findings in females who visited for screening mammography were benign lesions i.e. calcifications and cysts

Abstract PD16-02: Factors Associated with Receipt of Digital Breast Tomosynthesis Among Racially/Ethnically Diverse Women Undergoing Screening Mammography

Abstract Introduction: Digital breast tomosynthesis (DBT) is increasingly utilized in breast cancer screening, including among women at high risk for breast cancer. While there is a lack of rigorous data from randomized controlled trials demonstrating superior efficacy compared to two-dimensional (2D) digital mammography, observational studies suggest that DBT might have lower rates of false-positive results and increased detection of invasive cancer than 2D mammography. However, uptake of DBT might be lower among racial/ethnic minorities, which could contribute to breast cancer disparities. We evaluated whether sociodemographic and breast cancer risk factors were associated with receipt of DBT vs. 2D mammography among a racially/ethnically diverse population of women undergoing screening mammography. Methods: We conducted a respective cohort study among women, age 40-74 years, who underwent screening mammography at Columbia University Irving Medical Center (CUIMC) in New York, NY, from February 2020 to January 2022. We extracted data from the electronic health record (EHR) on age, race/ethnicity, first-degree family history of breast cancer (yes/no), prior breast biopsies (yes/no), and mammographic breast density (high vs. low), and calculated individual 5-year risks of invasive breast cancer according to the Breast Cancer Surveillance Consortium (BCSC) model. High risk was defined as a 5-year invasive breast cancer risk 1.67%. Our primary outcome was receipt of at least one DBT screening examination from 2020-2022 (yes/no). We conducted multivariable logistic regression analyses to assess the association between demographic/clinical factors and receipt of DBT. Results: Among 5617 evaluable women, mean age was 55.4 years (SD, 9.5 years) and 56% identified as non-Hispanic White, 10% as non-Hispanic Black, 17% as Hispanic, 8% as Asian, and 9% other/unknown. Over 60% of women had high breast density, and 34% met high-risk criteria. Seventy percent of women had at least one DBT from 2020-2022. In multivariable analyses (Table 1), women with high vs. low breast density were 2.5 times more likely to receive DBT (odds ratio [OR]=2.51, 95% confidence interval [CI]=2.19-2.88), while first-degree family history of breast cancer, prior breast biopsy, and age were inversely associated with DBT. Racial/ethnic minorities were less than half as likely to undergo DBT compared to non-Hispanic Whites; for example, Hispanic women were over 85% less likely to receive DBT (OR=0.14, 95% CI=0.11-0.16). Overall, there was no association between breast cancer risk status (high vs. low/average) and receipt of DBT (OR=1.00, 95% CI 0.92-1.08). Conclusion: We observed that the majority of women undergoing screening mammography at CUIMC from 2020-2022 received DBT for breast cancer screening. However, racial/ethnic minorities, including non-Hispanic Blacks and Hispanics, were significantly less likely than non-Hispanic Whites to have received DBT. Breast cancer risk according the BCSC model was also not associated with receipt of DBT. Future studies should determine which subsets of women are more likely to benefit from DBT. Citation Format: Julia E. McGuinness, Gargi Patel, Jacquelyn N. Amenta, Rita Kukafka, Katherine D. Crew. Factors Associated with Receipt of Digital Breast Tomosynthesis Among Racially/Ethnically Diverse Women Undergoing Screening Mammography [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD16-02.