Undergo Breast Cancer Screening Research Articles

Clinical experience on the limited role of ultrasound for breast cancer screening in BRCA1 and BRCA2 mutations carriers aged 30–39 years

PurposeIn BRCA germline pathogenic sequence variants (PSV) carriers aged 30–39 years imaging is recommended at six-month intervals. The European society for medical oncology recommendation of the use of 6-monthly MRI six-monthly MRI screening is being considered at our institution, particularly for younger carriers under the age of 35, although it is not mandatory. If 6-monthly MRI is unavailable, annual MRI may be supplemented by ultrasound (with or without mammography). The aim of this study was to evaluate the utility of ultrasound screening added to mammography, as a 6-month supplement to annual MRI in BRCA PSV carriers aged 30–39 years. Materials and methodsThis IRB approved retrospective study included BRCA PSV carriers aged 30–39 years, who underwent breast cancer screening at our institution between January 2015 and March 2023. Participants were divided into two groups, those who had supplemental whole-breast US and mammography at six months and underwent screening before March 2019, and those who had only mammography without supplemental US and enrolled in screening after March 2019. Patient characteristics, cancer detection rates and cancer characteristics were compared between the two groups. ResultsOverall, 200 asymptomatic BRCA1/2 PSV carriers undergoing screening in our institution were included in the study. Mean age was 35.7 ± 3.5 years, and mean follow-up time was 37.4 ± 38.0 months. There were 118 (59 %) women screened with supplemental US, and 82 (41 %) women without. Eight cancers were diagnosed during the study period, four in women with supplemental US and four in women without. The sensitivity of whole-breast screening US was 25 % (1/4), specificity 85.7 % (222/259), PPV 2.6 % (1/38), and NPV 98.7 % (222/225). Of the four cancers detected in women screened with supplemental US, one was diagnosed by whole-breast US, two by MRI, and one by mammography. Of eight cancers included in this study, two were not detectable by targeted second-look US. All eight cancers were detectable by MRI. ConclusionThe addition of whole-breast ultrasound to mammography and MRI screening in BRCA PSV carriers aged 30–39 years offered limited incremental benefit. MRI with 6 months supplemental mammography without US detected all cancer cases.

Transforming Breast Cancer Care and Clinical Outcomes: Local Experience in Yanbu Industrial City, Saudi Arabia

ObjectiveThis study aimed to enhance outcomes for women undergoing breast cancer screening in a low utilization setting by implementing structured improvement cycles. MethodsImprovement cycles were conducted using the Plan-Do-Study-Act (PDSA) methodology. Three cycles were implemented: (1) dedicating a specific day for breast screening and increasing appointment slots; (2) establishing a breast screening clinic with same-day registration; and (3) introducing a breast surgery clinic to expedite biopsy procedures for BI-RADS-4 category cases. ResultsFollowing each improvement cycle, dramatic increases in patient attendance were observed. In 2021, there was a 67.5% rise compared to the previous year, and a 72% increase in 2022 compared to 2021 figures. Patient characteristics revealed that 60% of attendees were new patients, with 53% of cancer and precancerous cases observed in women below 50 years old. Before the third cycle, the estimated diagnosis turnaround time (TAT) showed that only 23% of patients had their biopsy completed within five working days. However, after the third cycle (n = 131), 63.5% of biopsies were done within five working days. ConclusionStructured improvement cycles guided by the PDSA methodology effectively enhanced breast cancer screening outcomes. These cycles led to increased patient attendance, expedited biopsy procedures, and improved access to timely diagnosis. The findings highlight the importance of systematic approaches in optimizing breast cancer screening and improving patient care. MicroAbstractThis study aimed to improve breast cancer screening outcomes using structured Plan-Do-Study-Act (PDSA) cycles. Implementing dedicated screening days, same-day registration, and expedited biopsy procedures. Turnaround improved from 23% to 63.5% within 5 days post-third cycle. PDSA-guided cycles dramatically improved patient attendance, expedited biopsy procedures, and timely diagnosis, optimizing breast cancer screening and patient care.

How does mammography in combination with breast ultrasonography (US) compare with mammography alone for women with dense breasts undergoing breast cancer screening?

How does mammography in combination with breast ultrasonography (US) compare with mammography alone for women with dense breasts undergoing breast cancer screening?

How does mammography in combination with breast ultrasonography (US) compare with mammography alone for women with non-dense breasts undergoing breast cancer screening?

How does mammography in combination with breast ultrasonography (US) compare with mammography alone for women with non-dense breasts undergoing breast cancer screening?

The predictive role of mammographic breast calcifications in cardiovascular disease among women undergoing breast cancer screening: Insights from a retrospective database analysis of breast cancer screening.

The predictive role of mammographic breast calcifications in cardiovascular disease among women undergoing breast cancer screening: Insights from a retrospective database analysis of breast cancer screening.

IJCM_156A: A Cross-sectional study on the Prevalence of Risk Factors of Breast Cancer and Awareness of Breast Cancer Screening in Women of age group 30 to 70 years in Karamadai Block of Coimbatore Health Unit District

Background: Breast cancer, the most common malignancy among women globally, recorded over 2.26 million new cases and almost 685,000 deaths in the same year. Evidence indicates breast cancer risk links to both modifiable and non-modifiable lifestyle factors. Promoting education and access to screening programs is crucial for early detection and intervention in breast cancer. This approach ultimately enhances the effectiveness of prevention efforts and reduces complications and mortality of breast cancer. Objective: To estimate the prevalence of risk factors of breast cancer and to assess the awareness of breast cancer screening in women of age group 30-70 years in Karamadai Block of Coimbatore Health Unit District. Methodology: A cross sectional study was conducted among 150 women in Coimbatore using a semi-structured questionnaire and statistical analysis was done using SPSS 21 version. Results: Out of 150 participants, the mean age of subjects was 50 ± 11 years, with 98% being married women. The prevalence of modifiable and non- modifiable risk factors of breast cancer were found to be 61% and 9% respectively. 54% were aware of government facility-based breast cancer screening. But only 25% had undergone screening for breast cancer. Individuals who underwent breast cancer screening in the last one year found to be aware of breast cancer screening compared to those who did not. (OR 2.5, 95% CI 2.02-3.18). Conclusion: Awareness and screening for breast cancer are low among the study participants. Women =30 years of age attending all outpatient departments in any health facility should be educated regarding the importance of screening of breast cancer.

Relationship between health checkups and cancer screenings of wives and health checkups of their husbands: A cross-sectional study in Japan

ObjectivesThis study investigated the relationship between health checkups, cervical cancer screenings, and breast cancer screenings (collectively referred to as wellness examinations) of wives and health checkups of their husbands. We aimed to develop strategies to encourage wellness examinations among married individuals in Japan. MethodsThis study used the 2019 Comprehensive Survey of Living Conditions, focusing on married couples aged 40–64. We analyzed the percentage of wives undergoing wellness examinations, grouped based on whether their husbands had undergone health checkups. Subsequently, multivariable modified Poisson regression analysis was performed considering sociodemographic and health-related factors. All analyses considered medical insurance of wives because wellness examination methods varied depending on medical insurance type. ResultsThe sample comprised 40,560 couples undergoing health checkups, 39,870 undergoing cervical cancer screening, and 39,895 undergoing breast cancer screening. Regardless of the medical insurance type of the wife, a significant positive association was observed between the wellness examination of wives and the health checkup of husbands across all age groups. After adjusting for covariates, prevalence ratios (95% confidence intervals) for wives whose husbands underwent health checkups were 2.24 (2.09–2.40) for national health insurance, 1.18 (1.16–1.21) for employee insurance (employee), and 1.53 (1.44–1.63) for employee insurance (family) for health checkups. Similar trends were observed in cervical and breast cancer screening. ConclusionsWellness examinations of wives were associated with those of their husbands, suggesting that couples often share similar health-seeking behaviors. Hence, targeted interventions are important for couples who do not undergo wellness examinations.

Factors Associated with Increased Knowledge about Breast Density in South Australian Women Undergoing Breast Cancer Screening.

Background: There is growing awareness of breast density in women attending breast cancer screening; however, it is unclear whether this awareness is associated with increased knowledge. This study aims to evaluate breast density knowledge among Australian women attending breast cancer screening. Method: This cross-sectional study was conducted on women undergoing breast cancer screening at The Queen Elizabeth Hospital Breast/Endocrine outpatient department. Participants were provided with a questionnaire to assess knowledge, awareness, and desire to know their own breast density. Result: Of the 350 women who participated, 61% were familiar with 'breast density' and 57% had 'some knowledge'. Prior breast density notification (OR = 4.99, 95% CI = 2.76, 9.03; p = 0.004), awareness (OR = 4.05, 95% CI = 2.57, 6.39; p = 0.004), younger age (OR = 0.97, 95% CI = 0.96, 0.99; p = 0.02), and English as the language spoken at home (OR = 3.29, 95% CI = 1.23, 8.77; p = 0.02) were independent predictors of 'some knowledge' of breast density. A significant proportion of participants (82%) expressed desire to ascertain their individual breast density. Conclusions: While knowledge of breast density in this Australian cohort is generally quite low, we have identified factors associated with increased knowledge. Further research is required to determine optimal interventions to increase breast density knowledge.

Outcomes of Breast Cancer Screening Strategies Based on Cancer Intervention and Surveillance Modeling Network Estimates.

Background There is ongoing debate about recommendations for breast cancer screening strategies, specifically regarding the frequency of screening and the age at which to initiate screening. Purpose To compare estimates of breast cancer screening outcomes published by the Cancer Intervention and Surveillance Modeling Network (CISNET) to understand the benefits and risks of different screening scenarios. Materials and Methods Modeling estimates published by CISNET are based on hypothetical cohorts in the United States and compare women, starting at 40 years of age, who do and do not undergo breast cancer screening with mammography. The four scenarios assessed in this study, of multiple possible scenarios, were biennial screening ages 50-74 years (2009 and 2016 U.S. Preventive Services Task Force [USPSTF] recommendations), biennial screening ages 40-74 years (2023 USPSTF draft recommendation), annual screening ages 40-74 years, and annual screening ages 40-79 years. For each scenario, CISNET estimates of median lifetime benefits were compared. Risks that included false-positive screening results per examination and benign biopsies per examination were also calculated and compared. Results Estimates from CISNET 2023 showed that annual screening ages 40-79 years improved breast cancer mortality reduction compared with biennial screening ages 50-74 years and biennial screening ages 40-74 years (41.7%, 25.4%, and 30%, respectively). Annual screening ages 40-79 years averted the most breast cancer deaths (11.5 per 1000) and gained the most life-years (230 per 1000) compared with other screening scenarios (range, 6.7-11.5 per 1000 and 121-230 per 1000, respectively). False-positive screening results per examination were less than 10% for all screening scenarios (range, 6.5%-9.6%) and lowest for annual screening ages 40-79 years (6.5%). Benign biopsies per examination were less than 1.33% for all screening scenarios (range, 0.88%-1.32%) and lowest for annual screening ages 40-79 years (0.88%). Conclusion CISNET 2023 modeling estimates indicate that annual breast cancer screening starting at 40 years of age provides the greatest benefit to women and the least risk per examination. © RSNA, 2024 See also the editorial by Joe in this issue.

Intersectional analysis of inequalities in self-reported breast cancer screening attendance using supervised machine learning and PROGRESS-Plus framework.

Breast cancer is a critical public health concern in Spain, and organized screening programs have been in place since the 1990s to reduce its incidence. However, despite the bi-annual invitation for breast cancer screening (BCS) for women aged 45-69, significant attendance inequalities persist among different population groups. This study employs a quantitative intersectional perspective to identify intersectional positions at risk of not undergoing breast cancer screening in Spain. Women were selected from the 2020 European Health Interview Survey in Spain, which surveyed the adult population (> 15 years old) living in private households (N = 22,072; 59% response rate). Inequality indicators based on the PROGRESS-Plus framework were used to disentangle existing social intersections. To identify intersectional groups, decision tree models, including classification and regression trees (CARTs), chi-squared automatic interaction detector (CHAID), conditional inference rees (CITs), and C5.0, along with an ensemble algorithm, extreme gradient boosting (XGBoost), were applied. XGBoost (AUC 78.8%) identified regional differences (Autonomous Community) as the most important factor for classifying BCS attendance, followed by education, age, and marital status. The C5.0 model (balanced accuracy 81.1%) highlighted that the relative importance of individual characteristics, such as education, marital status, or age, for attendance differs based on women's place of residence and their degree of interaction. The highest risk of not attending BCS was observed among illiterate older women in lower social classes who were born in Spain, were residing in Asturias, Cantabria, Basque Country, Castile and León, Extremadura, Galicia, Madrid, Murcia, La Rioja, or Valencian Community, and were married, divorced, or widowed. Subsequently, the risk of not attending BCS extends to three other groups of women: women living in Ceuta and Melilla; single or legally separated women living in the rest of Spain; and women not born in Spain who were married, divorced, or widowed and not residing in Ceuta or Melilla. The combined use of decision trees and ensemble algorithms can be a valuable tool in identifying intersectional positions at a higher risk of not utilizing public resources and, thus, can aid substantially in developing targeted interventions to increase BCS attendance.

Breast cancer screening awareness among transgender individuals in Bangkok, Thailand

Background: Transgender women have higher rates of mortality associated with cancer diagnosis owing to inadequate transgender-specific cancer screening, leading to delayed diagnosis. Gender-affirming hormone therapy, age, and genetics are risk factors for breast cancer in transgender women. For transgender men, the risks were similar to those for cisgender women. However, population-based data on breast cancer screening and awareness among these sex groups are limited. Aim: This study aimed to assess breast cancer screening awareness, screening utilization, and factors associated with screening awareness among transgender individuals in Bangkok, Thailand. Methods: This multi-centered study included participants aged 18–80 years without a history of breast cancer. Data were collected using a structured questionnaire from October 2021 to October 2022. Sociodemographic data, hormonal use, gender affirming surgery, breast cancer screening awareness, utilization, and reasons for not undergoing screening were recorded. Associations with breast screening awareness were analyzed using multiple logistic regression analysis. Results: In Bangkok, 402 transgender women and 333 transgender men were surveyed. Among them, 92.8% and 64.6% of the women and men groups, respectively, had received gender-affirming hormone therapy. The women group had a higher awareness of breast cancer screening (70.9%) than the men group (60.8%). However, only 4% and 17.1% of the women and men patients, respectively, underwent breast cancer screening. A history of gender-affirming hormone therapy use was associated with a higher likelihood of breast cancer screening awareness among women. Among the men, older participants who later underwent breast-reduction surgery had a family history of breast cancer, and other types of cancer were positively associated with higher breast cancer screening awareness. Conclusion: Although awareness of breast cancer screening among urban transgender individuals is high, multiple factors limit their access to breast cancer screening.

The effects of breast density on the benefits of mammograms with adjunctive ultrasonography in breast screening.

Various efforts have been made to improve the accuracy of breast cancer screening. This study aimed to report differences in the contribution of ultrasonography to cancer screening assessments of dense and non-dense breasts. The participants in this study were 29,640 Japanese women in their 40s who underwent breast cancer screening at the Iwate Cancer Society between 2018 and 2021. This included women who chose mammography alone or mammography with adjunctive ultrasonography (overall assessment). They were classified into two groups according to the breast density in mammography: dense breasts and non-dense breasts. Recall rate, breast cancer detection rate, and positive predictive value of the two screening-type groups were evaluated for each breast density group. Of the 29,640 women analyzed, 18,861 (63.6%) underwent mammography alone and 10,779 (36.3%) were by overall assessments. The number of women recalled was higher in the overall assessment group than in the mammography-alone group (2.9% vs. 1.9%, p < 0.01). The proportion of women in whom breast cancer was detected was higher in the overall assessment group than in the mammography-alone group (0.31% [n = 33] vs. 0.15% [n = 28], p < 0.01). For non-dense breasts, there were no significant differences in either the recall rate or the breast cancer detection rate between those who underwent mammography alone and those who underwent overall assessment. Conversely, for dense breasts, the recall rate after mammography alone was lower than that after overall assessment (1.8% vs. 3.8%, p < 0.01), and the breast cancer detection rate was higher after overall assessment than after mammography alone (0.40% vs. 0.18%, p < 0.01). We found the benefits of adjunctive ultrasonography with mammography to differ depending on breast density. This could be used to tailor the selection of screening modalities to individuals.

Temporal Evolution and Associated Factors of Adherence to Mammography Screening among Women in Spain: Results from Two National Health Surveys (2017-2020).

Ensuring equity in cancer screening is recommended by the European Commission. Despite the fact that breast cancer screening is a free population-based program in Spain, there remains considerable variation in the adherence to screening rate among population groups. This study was designed to describe the adherence of breast cancer screening in women in Spain, to evaluate the evolution in the period from 2017 to 2020, and to determine the variables that influence choosing to undergo breast cancer screening. A nationwide cross-sectional study with 7220 females aged 50-69 years from the 2017 Spanish National Health Survey and the 2020 European Health Survey for Spain was performed. We investigated mammography uptake rates, with socio-demographic factors, lifestyle habits, and health-related characteristics as independent variables. Multivariable logistic regression was used to identify the associated factors of mammography adherence. Of the women, 78% had undergone mammography in the previous two years, and there was a significant decrease in the uptake rate for breast cancer screening from 2017 (81.23%) to 2020 (74.68%) (p < 0.001). Educational level, marital status, residential location, nationality, smoking status, alcohol consumption, and leisure-time physical activity were all associated factors of mammography uptake.

Empowering women’s health: Opportunity to bridge breast cancer screening to lung cancer screening.

121 Background: Lung cancer (LC) is the leading cause of cancer-related death for women in the United States (US). It surpasses the combined mortality rate of breast, cervical and ovarian cancers. Early detection of LC at stage I increases the 5-year survival rate to 80%. Lung Cancer Screening (LCS) is an effective tool for early detection. However, while 78% of women over 50 in the US undergo Breast Cancer Screening (BCS), only 6% of eligible women receive LCS. Methods: This is a retrospective study of all women diagnosed with primary LC presenting to Indiana University Simon Comprehensive Cancer Center from January 2019 to December 2020. We collected sociodemographic characteristics and information related to smoking history, LCS and BCS. We excluded patients with a prior history of lung or breast cancer who were under surveillance, and those with unknown smoking history. We assessed the BCS and LCS eligibility and utilization according to the U.S. Preventive Services Task Force latest recommendations. We also determined the utilization of LCS in women who have received BCS. Results: Among the 307 women who met the eligibility criteria, 87.6% were white, 51.8% had a Medicare insurance, 41.7% were ever-smoker, and 64.5% had advanced stages of LC (Stage II-Stage IV). Approximately half of our cohort was eligible for LCS, but only 20% received LCS. On the other hand, 72% were eligible for BCS and 58% of them underwent BCS. Among women who received BCS and were eligible for LCS, only25% underwent LCS. The median time from BCS to LC diagnosis was approximately 2.2 years. Among the 178 women who received BCS within one year prior to LC diagnosis, 27% underwent LCS. Among the remaining women who did not have LCS,66.7% of women were already in a later stage (Stage II-IV) at the time of LC diagnosis. Conclusions: Our study demonstrates that majority of women, who met the eligibility criteria for BCS and LCS, received BCS but not LCS prior to their LC diagnosis. This shows that despite the potential mortality benefit, LCS is still underutilized. Receiving LCS at the time of BCS can provide a valuable opportunity to increase LCS participation among eligible women and the potential of diagnosing LC at earlier stages.

Deep Learning Mammography Classification with a Small Set of Data.

Breast cancer is one of the leading causes of mortality among women. In addition, 1 in 8 women and 1 in 833 men will be diagnosed with breast cancer in 2022. The detection of breast cancer can not only lower treatment costs but also increase survival rates. Due to increased cancer awareness, more women are undergoing breast cancer screening, leading to more cases being diagnosed worldwide, but doctors' ability to analyze these images is limited. As a result, they get overloaded leading to misinterpretations. The advent of computer-aided diagnosis (CAD) minimized man's involvement and achieved good results. CAD helps medical doctors automatically detect and analyze abnormalities found in the breast. Such abnormalities may be benign or malignant tumors. The goal of this study is to evaluate the effectiveness of using seven layers to classify breast cancer as either benign or malignant using mammograms. The open-source MIAS dataset of 322 images was used for our study, of which 207 were normal images and 115 were abnormal images. The proposed CNN model convolves an image into seven layers that extract features from the input images, and these features are used to classify breast cancer as malignant or benign. The proposed CNN used a limited data set and achieved the best result compared to previous work. The method achieved results with a 0.39% loss, 99.89% accuracy, 99.85% precision, 99.89% recall, 99.87% F1-score, and an area under the curve noted to be 100.0%. CNN uses a small amount of data to determine abnormalities; the method will assist a medical doctor in determining whether or not a specific patient has cancer.

Disparities in Breast Cancer Screening Rates Among Adults With and Without Intellectual and Developmental Disabilities.

Individuals with intellectual and developmental disabilities may face barriers in accessing healthcare, including cancer screening and detection services. We sought to assess the association of intellectual and developmental disabilities (IDD) with breast cancer screening rates. Data from 2018 to 2020 was used to identify screening-eligible individuals from Medicare Standard Analytic Files. Adults aged 65-79 years who did not have a previous diagnosis of breast cancer were included. Multivariable regression was used to analyze the differences in breast cancer screening rates among individuals with and without IDD. Among 9,383,349 Medicare beneficiaries, 11,265 (0.1%) individuals met the criteria for IDD. Of note, individuals with IDD were more likely to be non-Hispanic White (90.5% vs. 87.3%), have a Charlson Comorbidity Index score ≤ 2 (66.2% vs. 85.5%), and reside in a low social vulnerability index neighborhood (35.7% vs. 34.4%). IDD was associated with reduced odds of undergoing breast cancer screening (odds ratio (OR) 0.77, 95% confidence interval (CI) 0.74-0.80; p < 0.001). Breast cancer screening rates in individuals with IDD were further influenced by social vulnerability and belonging to a racial/ethnicminority. Individuals with IDD may face additional barriers to breast cancer screening. The combination of IDD and social vulnerability placed patients at particularly high risk of not being screened for breast cancer.

Comparison of the Diagnostic Accuracy of Mammogram-based Deep Learning and Traditional Breast Cancer Risk Models in Patients Who Underwent Supplemental Screening with MRI.

Background Access to supplemental screening breast MRI is determined using traditional risk models, which are limited by modest predictive accuracy. Purpose To compare the diagnostic accuracy of a mammogram-based deep learning (DL) risk assessment model to that of traditional breast cancer risk models in patients who underwent supplemental screening with MRI. Materials and Methods This retrospective study included consecutive patients undergoing breast cancer screening MRI from September 2017 to September 2020 at four facilities. Risk was assessed using the Tyrer-Cuzick (TC) and National Cancer Institute Breast Cancer Risk Assessment Tool (BCRAT) 5-year and lifetime models as well as a DL 5-year model that generated a risk score based on the most recent screening mammogram. A risk score of 1.67% or higher defined increased risk for traditional 5-year models, a risk score of 20% or higher defined high risk for traditional lifetime models, and absolute scores of 2.3 or higher and 6.6 or higher defined increased and high risk, respectively, for the DL model. Model accuracy metrics including cancer detection rate (CDR) and positive predictive values (PPVs) (PPV of abnormal findings at screening [PPV1], PPV of biopsies recommended [PPV2], and PPV of biopsies performed [PPV3]) were compared using logistic regression models. Results This study included 2168 women who underwent 4247 high-risk screening MRI examinations (median age, 54 years [IQR, 48-60 years]). CDR (per 1000 examinations) was higher in patients at high risk according to the DL model (20.6 [95% CI: 11.8, 35.6]) than according to the TC (6.0 [95% CI: 2.9, 12.3]; P < .01) and BCRAT (6.8 [95% CI: 2.9, 15.8]; P = .04) lifetime models. PPV1, PPV2, and PPV3 were higher in patients identified as high risk by the DL model (PPV1, 14.6%; PPV2, 32.4%; PPV3, 36.4%) than those identified as high risk with the TC (PPV1, 5.0%; PPV2, 12.7%; PPV3, 13.5%; P value range, .02-.03) and BCRAT (PPV1, 5.5%; PPV2, 11.1%; PPV3, 12.5%; P value range, .02-.05) lifetime models. Conclusion Patients identified as high risk by a mammogram-based DL risk assessment model showed higher CDR at breast screening MRI than patients identified as high risk with traditional risk models. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Bae in this issue.

Why Start Now? Retrospective Study Evaluating Baseline Screening Mammography in Patients Age 60 and Older

PurposeExtensive data exist regarding the importance of baseline mammography and screening recommendations in the age range of 40-50 years old, however, less is known about women who start screening at age 60. The purpose of this retrospective study is to assess the characteristics and outcomes of women aged 60 years and older presenting for baseline mammographic screening. MethodsThis is an IRB-approved single institution retrospective review of data from patients aged 60+ receiving baseline screening mammograms between 2010 and 2022 was obtained. Information regarding patient demographics, breast density, and BI-RADS assessment was acquired from Cerner EHR. Of patients with a BI-RADS 0 assessment, imaging, and chart review was performed. Family history, gynecologic history, prior breast biopsy or surgery, and hormone use was reviewed. For those with a category 4 or 5 assessment after diagnostic work-up, biopsy outcomes were reported. Cancer detection rate (CDR), recall rate (RR), positive predictive value 1 (PPV1), PPV2, and PPV3 were calculated. ResultsData was analyzed from 1409 women over age 60 who underwent breast cancer screening. The recall rate was 29.3% (413/1409). The CDR, PPV1, PPV2, and PPV3 were calculated as 15/1000, 5.2% (21/405), 29.2% (21/72), and 31.8% (21/66), respectively. After work-up, 224 diagnostic patients had a 1-year follow-up and none were diagnosed with breast cancer. One (1.4%, 1/71) of the BI-RADS 3 lesions was malignant at 2-year follow-up. Of the patients recalled from screening, 29.6% had a family history of breast cancer, and the majority of both recalled and nonrecalled patients had Category B breast density. There was no statistically significant difference in breast density or race of patients recalled vs not recalled. 93.2% of recalled cases were given BI-RADS descriptors, with mass and focal asymmetry being the most common lesions, and 22.1% of recalled cases included more than one lesion. ConclusionInitiating screening mammography for patients over 60 years old may result in higher recall rates, but also leads to a high CDR of potentially clinically relevant invasive cancers. After a diagnostic work-up, BI-RADS 3 assessments are within standard guidelines. This study provides guidance for radiologists reading baseline mammograms and clinicians making screening recommendations in patients over age 60.

Effect of Instructional Module on Knowledge, Attitudes and Practices of Women Undergoing Breast Cancer Screening Mammography

Effect of Instructional Module on Knowledge, Attitudes and Practices of Women Undergoing Breast Cancer Screening Mammography

Mobile Web App Intervention to Promote Breast Cancer Screening Among American Indian Women in the Northern Plains: Feasibility and Efficacy Study.

Breast cancer is the most common cancer in the United States and the second leading cause of death for American Indian women. American Indian women have lower rates of breast cancer screening than other racial groups, and disparities in breast cancer mortality and survival rates persist among them. To address this critical need, a culturally appropriate, accessible, and personalized intervention is necessary to promote breast cancer screening among American Indian women. This study used mobile health principles to develop a mobile web app-based mammogram intervention (wMammogram) for American Indian women in a remote, rural community in the Northern Plains. This study aimed to assess the feasibility and efficacy of the wMammogram intervention, which was designed to motivate American Indian women to undergo breast cancer screening, as compared with the control group, who received an educational brochure. Using community-based participatory research (CBPR) principles and a multipronged recruitment strategy in a randomized controlled trial design, we developed the wMammogram intervention. This study involved 122 American Indian women aged between 40 and 70 years, who were randomly assigned to either the intervention group (n=62) or the control group (n=60). Those in the intervention group received personalized and culturally appropriate messages through a mobile web app, while those in the control group received an educational brochure. We measured outcomes such as mammogram receipt, intention to receive breast cancer screening after the intervention, and participants' satisfaction with and acceptance of the intervention. A significantly higher proportion of women who received the wMammogram intervention (26/62, 42%; P=.009) completed mammograms by the 6-month follow-up than the control group (12/60, 20%). The wMammogram intervention group, compared with the control group, reported significantly higher ratings on perceived effectiveness of the intervention (t120=-5.22; P<.001), increase in knowledge (t120=-4.75; P<.001), and satisfaction with the intervention (t120=-3.61; P<.001). Moreover, compared with the brochure group, the intervention group expressed greater intention to receive a mammogram in the future when it is due (62/62, 100% vs 51/60, 85%) and were more willing to recommend the intervention they received to their friends (61/62, 98.4% vs 54/60, 90%) with statistically significant differences. This study shows the feasibility and efficacy of the wMammogram intervention to promote breast cancer screening for American Indian women in a remote, rural community-based setting. Findings suggest that, with advancements in technology and the ubiquity of mobile devices, mobile web apps could serve as a valuable health intervention tool that builds upon low-cost technology and enhances accessibility and sustainability of preventive care to help reduce breast health disparities experienced in hard-to-reach American Indian populations. ClinicalTrials.gov NCT05530603; https://clinicaltrials.gov/ct2/show/NCT05530603.