Undergo Breast Cancer Screening Research Articles

Abstract P5-14-03: Breast cancer screening and follow-up of abnormal mammogram results: A population-based study comparing results from an urban university cancer center to a national database.

Abstract Background: To improve access to screening, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) was developed through the Centers for Disease Control and Prevention (CDC) to provide low-income, and uninsured underserved women access to timely breast and cervical cancer screening and diagnostic services. This population-based study investigates the demographics and diagnostic outcomes of women who underwent breast cancer screening through this program established at an urban university cancer center compared to data obtained from the national program database. Methods: The Kimmel Cancer Center at Jefferson (KCC) launched its screening program with resources from the CDC, the State of Pennsylvania, and the Susan G. Komen Foundation in 2008. The core of the program is staff lead by a Social Worker/Navigator who connects patients to education and screening services, institutional information and guidance, and follow-up to minimize barriers to access, lessen dropout, and ensure follow-through for timely diagnosis and treatment. Working with our Community-Based partner organizations, uninsured and underinsured women in Philadelphia are able to seamlessly travel from education and screening through to treatment and support. All KCC patients evaluated through this program from 2008–2011 were included and records of the NBCCDP database 2006–2010 for this study and analyses. Results: KCC has a substantially larger African American (54.44% vs. 13.8%), smaller Hispanic (8.59% vs. 27.6%), larger percentage of abnormal mammograms (25.96% vs. 14%), higher breast cancer diagnosed per mammogram (2.13 vs 1.0) and a much younger population than the national cohort. Fewer than 1% of KCC patients have been lost to follow-up. Conclusions: The KCC Breast and Cervical Screening and Treatment Program Services reaches a highly vulnerable and at-risk population, has a higher abnormal mammogram and breast cancer detection rate, and a higher continued participation rate than the national cohort. The Social/Worker/Navigator has a distinct role in providing follow-up for abnormal findings to minimize no-shows by providing creative problem-solving, support, counseling, finding resources to minimize barriers, and contributes significantly to the ease of operation and the continued participation of patients in the program. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-14-03.

Diet quality and related factors among Spanish female participants in breast cancer screening programs

A healthy diet is particularly important during menopause, a period in which the risk of a number of health problems increases. This study analyzed diet quality as measured by two indices, namely, the Alternate Healthy Eating Index (AHEI) and the Alternate Mediterranean Diet (aMED) index, which measures adherence to a Mediterranean diet, and examined the factors associated with lower diet quality. This was a cross-sectional study covering 3,564 women aged 45 to 68 years who underwent breast cancer screening at 7 centers (Corunna, Barcelona, Burgos, Palma de Mallorca, Pamplona, Valencia, and Zaragoza). Data on diet were collected using a food frequency questionnaire validated for the Spanish population. We calculated the AHEI out of a total of 80 points and the aMED out of a total of 9 points. Ordinal logistic regression models were fitted, taking diet quality (tertiles of the AHEI and the aMED) as dependent variables. The following were included in the final multivariate models as explanatory variables: sociodemographic characteristics, chronic diseases, and lifestyles that were associated with diet quality, with a P value <0.100 in an initial simple model (adjusted solely for calorie intake and screening center). Interaction between menopause status and the other explanatory variables was checked. The median score for AHEI was 40 of a maximum of 80 points. Lower diet quality was registered by the youngest women (P for trend < 0.001), premenopausal and perimenopausal women (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.01-1.56; and OR, 1.48; CI, 1.20-1.83, respectively), obese women (OR, 1.18; CI, 0.99-1.41), those with a diagnosis of diabetes (OR, 1.35; CI, 1.01-1.79), smokers (OR, 1.41; CI, 1.21-1.66), and women reporting lower daily physical activity (OR, 1.31; CI, 1.12-1.53). Better diet quality was shown by women with higher education (OR, 0.74; CI, 0.62-0.88) and ex-smokers (OR, 0.82; CI, 0.69-0.98). Nulliparity was associated with higher AHEI scores, but only among premenopausal women (OR, 0.50; CI, 0.32-0.78). aMED index varied between 0 and 9 (median 5). Lower scores were associated with younger age (P for trend < 0.001), low socioeconomic level (OR, 1.13; CI, 0.96-1.33), lower educational level (P for trend = 0.008), and low level of daily physical activity (OR, 1.27, CI, 1.08-1.50). The youngest women, the most sedentary women, and those who had a lower educational level and socioeconomic status registered worse diet quality. Ex-smokers and postmenopausal women obtained better scores, probably reflecting a keener concern about leading a healthy life.

Highlights of This Issue

Although changes in mitochondrial DNA (mtDNA) copy number have been implicated in different cancers, specific data on mtDNA copy number and colorectal cancer risk have been lacking. To address this lack of data, Thyagarajan and colleagues evaluated the association between mtDNA copy number and colorectal cancer risk among participants in the Singapore Chinese Health Study. The authors report that Individuals with low and high relative mtDNA copy numbers both showed increased risk of colorectal cancer, suggesting that mtDNA may play a critical role in colorectal cancer development.BRCA1/2 mutation carriers are recommended to undergo breast cancer screening with magnetic resonance imaging (MRI) because of the high sensitivity of MRI. To evaluate the impact of various screening protocols on cancer detection and mortality, Heijnsdijk and colleagues analyzed 3 studies of BRCA1/2 mutation carriers who were undergoing the recommended annual MRI and mammography screenings. The model from this analysis predicts breast cancer mortality reductions of 42% to 47% for mammography screening, 48% to 61% for MRI screening, and 50% to 62% for combined screening. These studies suggest substantial mortality benefits with the use of MRI to screen BRCA1/2 mutation carriers.To test cell-cycle proteins as predictive markers in urothelial carcinoma, Lenz and colleagues assembled tissue from 491 bladder cancer cases as tissue microarrays and examined them for aberrant expression of p53, p63, p16, cyclin D1, Rb, and Ki-67. The authors report that overexpression of p53 and Ki-67 was associated with high-grade tumors, whereas expression of p63 and p16 was decreased in high-grade tumors. These results reveal significant heterogeneity in the expression of key cell-cycle proteins in bladder cancer tissue.To identify novel gene variants for breast cancer risk, Higginbotham and colleagues conducted a multistage genetic association study in a series of breast cancer study populations. In their analysis, over 1,100 single-nucleotide polymorphisms were examined for evidence of association with breast cancer in independent study groups. The authors found that a series of validated breast cancer risk variants yielded the expected associations. In addition, 2 previously unreported loci were significantly associated with breast cancer risk in 3 of the 4 study populations. This important report adds to the compendium of known breast cancer genetic risk variants.

Differences in Natural History between Breast Cancers in BRCA1 and BRCA2 Mutation Carriers and Effects of MRI Screening-MRISC, MARIBS, and Canadian Studies Combined

It is recommended that BRCA1/2 mutation carriers undergo breast cancer screening using MRI because of their very high cancer risk and the high sensitivity of MRI in detecting invasive cancers. Clinical observations suggest important differences in the natural history between breast cancers due to mutations in BRCA1 and BRCA2, potentially requiring different screening guidelines. Three studies of mutation carriers using annual MRI and mammography were analyzed. Separate natural history models for BRCA1 and BRCA2 were calibrated to the results of these studies and used to predict the impact of various screening protocols on detection characteristics and mortality. BRCA1/2 mutation carriers (N = 1,275) participated in the studies and 124 cancers (99 invasive) were diagnosed. Cancers detected in BRCA2 mutation carriers were smaller [80% ductal carcinoma in situ (DCIS) or ≤10 mm vs. 49% for BRCA1, P < 0.001]. Below the age of 40, one (invasive) cancer of the 25 screen-detected cancers in BRCA1 mutation carriers was detected by mammography alone, compared with seven (three invasive) of 11 screen-detected cancers in BRCA2 (P < 0.0001). In the model, the preclinical period during which cancer is screen-detectable was 1 to 4 years for BRCA1 and 2 to 7 years for BRCA2. The model predicted breast cancer mortality reductions of 42% to 47% for mammography, 48% to 61% for MRI, and 50% to 62% for combined screening. Our studies suggest substantial mortality benefits in using MRI to screen BRCA1/2 mutation carriers aged 25 to 60 years but show important clinical differences in natural history. BRCA1 and BRCA2 mutation carriers may benefit from different screening protocols, for example, below the age of 40.

Diabetes, Metformin, and Breast Cancer: Lilac Time?

Diabetes, Metformin, and Breast Cancer: Lilac Time?

Breast cancer screening in women aged 50–74 years

Regular mammography screening has been available in France, free of charge, for all women aged 50-74 years since 2005. Two nationwide surveys [EDIFICE 1 (507 women interviewed; age 50-74 years) and EDIFICE 2 (488 women)] recently collected data on individuals' access to cancer screening procedures. Two further surveys interviewed 600 general practitioners (GPs) each to determine their attitudes towards screening in general and screening for breast cancer in particular. The method of quotas ensured the populations surveyed were representative. In 2005, 93%, and in 2008, 94% of women reported having undergone a screening mammography. Anage-related effect was apparent in the 70-74 year subgroup in 2005, whereas in 2008, over 90% of women aged 50-74 years had had a mammography in their lifetime. In 2008, 66% of women had undergone a mammography as a part of an organized screening programme, versus 45% in 2005. In 2005, 15% of women reported having received no recommendation from their GP, whereas this figure fell to 4% in 2008. In both EDIFICE surveys, two thirds of GPs systematically recommended breast cancer screening to female patients aged 50-74 years; however, female GPs were more likely to systematically recommend this screening. In 2008, 77% of the GPs questioned were aware of the recommended frequency for breast cancer screening, compared with 71% in 2005. Results of studies such as EDIFICE may help increase the proportion of women who undergo breast cancer screening. Successful implementation of organized screening relies heavily on treating physicians. The impact of mammography in breast cancer screening may be further improved by systematic organized screening, by encouraging regular examination and by targeting women who give up screening.

Questionnaire Survey on Breast Diagnostic Imaging Techniques: Subjective Impression of Mammography, Conventional Ultrasonography, and Automated Breast Ultrasonography

In Japan, mammography (MMG) has become the common practice for breast cancer screening. However, the proportion of women who undergo breast cancer screening remains low. We hypothesized that psychological problems especially pain, are the most important factors. To investigate the effect of pain and other psychological factors on the willingness of women to undergo imaging examinations for breast cancer. Between November 2007 and November 2008, we performed a questionnaire survey for women who had all undergone MMG, conventional ultrasonography (US), and automated breast ultrasonography (ABUS). Women who felt the duration of the examination was “long” comprised 20.8% for MMG, 9.7% for US, and 11.1% for ABUS. Those who experienced pain during the examinations comprised 91.7% for MMG, 22.2% for US, and 27.7% for ABUS. Those who experienced discomfort other than pain during the examinations comprised 11.1% for MMG, 8.3% for US, and 5.6% for ABUS. The discomforts experienced were the following: direct touching of the breast by the examiner, male examiner performing the examination, maintaining the required position during MMG, and difficulty in wiping off the cream after US and ABUS. The preferred breast cancer screening methods were MMG in 25.0%, US in 69.4%, and ABUS in 75.0%. The pain experienced during an MMG examination may be related to the unwillingness to undergo future MMG examination. US is a method with less pain and also an alternative examination for women who do not accept MMG examination because of the pain.

The first national public breast cancer screening program in Saudi Arabia

BACKGROUND AND OBJECTIVES:Despite its relatively low incidence in Saudi Arabia, breast cancer has been the most common cancer among Saudi females for the past 12 consecutive years. The objective of this study was to report the results of the first national public breast cancer screening program in Saudi Arabia.METHODS:Women 40 years of age or older underwent breast cancer screening. Mammograms were scored using the Breast Imaging-Reporting and Data System (BI-RADS). Correlations between imaging findings, risk factors and pathological findings were analyzed.RESULTS:Between September 2007 and April 2008, 1215 women were enrolled. The median age was 45 years, and median body mass index was 31.6 kg/m2. Sixteen cases of cancer were diagnosed. No cancer was diagnosed in 942 women with R1/R2 scores, and only 1 case of cancer was diagnosed in 228 women with R0/R3 scores. However, among 26 women with R4/R5 scores, 50% had malignant disease and 35% had benign lesions. No correlation was found between known risk factors and imaging score or cancer diagnosis.CONCLUSIONS:Public acceptance of the breast cancer screening program was encouraging. Longitudinal follow-up will help in better determining the risk factors relevant to our patient population.

Mammographic Density and Lobular Involution in Older Women with Abnormal Breast Imaging.

Abstract Mammographic density has been established as an independent risk factor for breast cancer, and there is data to suggest that the degree of lobular involution in the breast tissue may also function as an independent risk factor for the disease. The present study was designed to investigate the relationship between mammographic density and lobular involution in a population of mature women undergoing open biopsy for non-palpable breast lesions.A total of 199 women over the age of 60 who underwent breast biopsy with image-guided localization in 2008 at NYU Langone Medical Center formed the study population. Variables of interest included age, breast density, degree of involution, use of hormone replacement therapy (HRT) and biopsy histology (invasive ductal and lobular carcinoma and intraductal carcinoma vs. benign). Breast density was categorized according to BI-RADS classification as less dense (predominantly fatty and scattered fibroglandular elements) vs more dense (heterogeneously dense and extrememely dense). Degree of involution was classified as none (0%), partial (1-74%) and complete (&amp;gt;75%). All specimens were reviewed by a single pathologist who used the criteria of Hartmann, et al in evaluating degree of involution. Statistical analysis was performed using Pearson's Chi-square test and logistic regression analyses.In agreement with our previously presented data, we found an inverse relationship between breast density and age (p=0.02). In our cohort of women over 60 with abnormal breast imaging, we found a trend toward an inverse relationship between age and degree of lobular involution, but this did not achieve statistical significance. 129 of our patients had biopsies yielding malignant histology. There was no significant relationship between degree of lobular involution and biopsy histology. Use of HRT did not correlate with breast density in our cohort. There was no discernable relationship between degree of involution and history of prior or current HRT use.Association of lobular involution with age, density, histology, and HRT INVOLUTION TOTALP-VALUE NONEPARTIALCOMPLETEN (%) AGE (YRS) 60-696337617 (9%)0.18270-797202959 (29%) 80-894618123 (62%) DENSITY Less Dense143477125 (63%)0.177More Dense3254674 (37%) HISTOLOGY Benign5194670 (35%)0.690Malignant124077129 (65%) HRT Never11246398 (70%)0.774Ever3112741 (30%) Our study reinforces the general observation that breast density decreases with age. Our data do not permit us to comment on the validity of lobular involution as a risk factor for breast cancer. However, the degree of lobular involution did not predict malignant histology in our cohort. There was a trend toward an inverse relationship between mammographic density and lobular involution. This observation suggests that other factors such as stromal features may be responsible for the increased mammographic density in these older patients. Further study is warranted to better understand the significance of lobular involution and its relationship with mammographic density in all age groups of women undergoing breast cancer screening. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6072.

Factors related to second cancer screening practice in disease-free cervical cancer survivors

Although cancer survivors are at increased risk for developing cancers at other sites, little is known about the current status of second cancer (cancers other than the index cancer) screening practices and related factors in cervical cancer survivors. We enrolled 809 cervical cancer survivors aged >or=40 years who had been treated at six hospitals from 1983 to 2004. Subjects filled out a questionnaire that included the practices of second cancer screening (breast, stomach, and colorectum) and other sociodemographic variables. Among subjects, 38.9% had been recommended to receive screening for other cancers from health care providers, and 27.4% reported that they thought they had lower risk of other cancer than general population. Older (age >or=65 years) and poor (family income <1,000$/month) subjects were less likely to have second cancer screening. Those to whom health care providers had recommended screening for other cancers (aOR = 2.14; 95% CI, 1.54-2.98), and those who had an appropriate perception of second cancer risk (aOR = 1.64; 95% CI, 1.11-2.43) were more likely to undergo breast cancer screening. Lack of a recommendation for second cancer screening from health care providers and the misperception of second cancer risk might have negative impacts on the breast cancer screening behaviors in cervical cancer survivors.

Results of the first national public breast cancer screening program in the Kingdom of Saudi Arabia

1524 Background: Despite the relatively low incidence in the Kingdom of Saudi Arabia (KSA) compared to Western countries, breast cancer (BC) is the most common cancer among Saudi females for the past 11 consecutive years (National Cancer Registry 1994–2004). The objective of this study is to report the results of the first public national BC screening program in KSA and to evaluate the relationship between imaging and pathological findings and known BC risk factors. Methods: Asymptomatic women 40 years of age or older underwent BC screening at Abdulatif Charitable Cancer Screening Center, Riyadh, KSA. Mammograms were scored using American College of Radiology Breast Imaging Reports and Data System (BIRADS). Correlations between imaging findings and risk factors, as well as pathological findings, were analyzed. Results: A total of 1,215 women were enrolled between September 2007 and April 2008. Median age was 45 years (19–91) and median body mass index (BMI) was 31.6 kg/m2 (16.7–58). A total of 16 cases of cancer were diagnosed (80% are less than stage IIB). No cancer was diagnosed in 942 women with R1/R2 scores and only one case of cancer was diagnosed in 228 women with R0/R3 scores. However, among 26 women with R4/R5 scores, 50% had malignant disease and 35% had benign lesions (odds ratio = 1.96; 95% confidence interval = 1.5, 2.6) (p &lt; 0.0001). No correlation between known risk factors and imaging score or cancer diagnosis. Conclusions: The public acceptance of BC screening program was encouraging. Longitudinal follow-up and inclusion of more participants will help in better determining the risk factors relevant to our patient population. No significant financial relationships to disclose.

The Factors Associated with Changes in the Stage of Breast Cancer Screening Behavior among the Woman who are Eligible for the Korean National Cancer Screening Program

This study was performed to evaluate the relationships between psychosocial characteristics and changes in the stage of breast cancer screening behavior. The 474 study subjects were randomly sampled from 21,459 women (age range, 40-70 years) who were eligible for the Korean National Cancer Screening Program in 2006 in Jinju, Gyeongsangnam-do. The information, including behaviors and sociodemographic characteristics, attitudes, subjective norms and self-efficacy, was collected by trained interviewers via home visits. The breast cancer screening stages were grouped as precontemplation, contemplation, action, maintenance and relapse, according to Rakowski. Of the 474 women, 18.8% were in the precontemplation stage, 23.3% were in the contemplation stage, 13.1% were in the action stage, 36.6% were in the maintenance stage, and 8.2% were in the relapse stage. The distribution of stages was associated with attitude, subjective norms and self-efficacy (p for trend<0.01). To investigate the overall relationship between the variables, we conducted a linear structural equation model analysis based on the theory of planned behavior. The subjective norms and self-efficacy influenced the stage of the women's screening behavior. We should target on self-efficacy about the screening behavior of women by performing timely, thoughtful interventions. The support from family members, friends and other people is crucial for women to undergo breast cancer screening and to improve the breast cancer screening rate.

Scientific Impact Recognition Award: Molecular breast imaging: A review of the Mayo Clinic experience

Background Molecular breast imaging (MBI) depicts functional uptake of targeted radiotracers in the breast using dedicated gamma cameras. Methods MBI studies were performed under several institutional protocols evaluating the use of MBI in screening and diagnosis. Results By using a single-head system, sensitivity for breast cancer detection was 85% (57 of 67) overall and 29% for tumors 5 mm or less in diameter. Sensitivity improved to 91% (117 of 128) overall and 69% for tumors 5 mm or less using a dual-head system. In 650 high-risk patients undergoing breast cancer screening, MBI detected 7 cancers, 5 of which were missed on mammography. In 24 of 149 (16%) breast cancer patients MBI detected additional disease not seen on mammography. The sensitivity of MBI was 88% (83 of 94) for invasive ductal carcinoma, 79% (23 of 29) for invasive lobular carcinoma, and 89% (25 of 28) for ductal carcinoma in situ. Conclusions MBI can detect invasive ductal carcinoma, ductal carcinoma in situ, and invasive lobular carcinoma. It has a promising role in evaluating the extent of disease and multifocal disease in the breast for surgical treatment planning.

Breast Cancer Screening: A Medical Audit of the Screening Mammography Performed at One Institution for 10 Years

시행하고있고국가에서도선별유방촬영술을지원하고는있으나, Purpose: Screening for breast cancer has constantly been increasing since the benefit of screening for breast cancers was established. The purpose of this study was to investigate the efficacy of annual breast cancer screening at one institution for 10 years by conducting a medical audit. Methods: From March 1995 to July 2004, we performed 110,588 annual clinical examinations and mammographies on 58,024 women, who wanted to undergo breast cancer screening. Two hundred fourteen breast cancers were detected during screening, and one hundred sixty one of these patients were operated on. We then compared these results with the ideal rates for medical audits. Results: Of the 110,588 cases that were screened, the recall rate for further examination was 12.1% (n=13,423). The biopsy rate was 1.01% (n=1,116). Two hundred fourteen breast cancers were detected for a detection rate of 0.19%. The percent of stage 0 cancer among all the cancer was 23.6%, stage I was 40.4%, stage IIa was 19.9%, stage IIb and IIIa were a combined 6.2%, stage IIIc was 3.1%, and stage IV was 0.6%. The positive predictive value (PPV) based on the abnormal findings on the screening examinations was 1.6% (PPV1). The PPV when a biopsy or surgical consultation was recommended was 15.1% (PPV2). The percent of tumor found as stage 0 or I was 64% (103/161). The tumor found as minimal cancer (stage 0 or tumor lesser than 1 cm) was 38.5% (62/161). There were 38 cases of axillary lymph node metastasis (23.6%). The number of cases of cancers found per 1,000 cases was 1.7. The prevalence of cancer found per 1,000 first examinations was 2.3. The incidental cancer found per 1,000 follow-up examinations was 1.2. The recall rate for further evaluation was 12.1%. These results were compatible with the ideal rates for medical audits, except for the recall rate, the PPV1, the PPV2, and the cancers found per 1,000 cases. Conclusion: On the base of these results, breast cancer screening was properly performed in this institution. Breast cancer screening using a clinical examination and a mammography is effective for the early detection of breast cancer.

Cigarette Smoking and Risk of Breast Carcinoma In Situ

Although the associations with cigarette smoking have been explored extensively for invasive breast cancer, the relation to in situ cancer has not previously been examined in depth. We analyzed data from a population-based case-control study of women living in Wisconsin, Massachusetts, and New Hampshire. Eligible cases of incident breast carcinoma in situ were reported to statewide registries in 1997-2001 (n = 1878); similarly aged controls (n = 8041) were randomly selected from population lists. Smoking history and other risk factor information were collected through structured telephone interviews. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated from logistic regression models adjusting for potential confounders. In multivariate models, the OR for breast carcinoma in situ among current smokers was 0.8, compared with never-smokers (95% CI = 0.7-1.0). Risk estimates increased towards the null with greater time since smoking cessation. Odds ratios were also less than 1.0 among women who initiated smoking in adolescence (OR = 0.8) or after a full-term birth (OR = 0.7), relative to women who never smoked. The reduced odds ratios associated with current smoking were strongest among women with annual screening mammograms (OR = 0.7; 95% CI = 0.6-0.9). Odds ratios were not less than 1.0 among current smokers without a recent screening mammogram (1.3; 0.9-2.0). Our findings suggest an inverse association between current smoking and risk of breast carcinoma in situ among women undergoing breast cancer screening.

A decade of breast cancer screening in The Netherlands: trends in the preoperative diagnosis of breast cancer

In a prospective, multi-institutional follow-up study we describe the trends in the preoperative pathologic confirmation of breast cancer of women who underwent breast cancer screening between 1995 and 2005. We included all women aged 50-75 years who underwent biennial screening mammography in the southern breast cancer screening region of the Netherlands between February 13, 1995 and December 22, 2004. Clinical data, breast imaging reports, biopsy results and breast surgery reports were collected of all women with a positive screening result. Follow-up lasted through the next biennial screening examination and was approximately two years for all referred women. Of 258,900 mammographic screening examinations, 3,064 (1.2%) were positive screens. The majority of women (92%) were analyzed in four regional hospitals and workup yielded breast cancer in 1,332 women. From 1995 to 2005, the percentage of breast cancer cases that underwent percutaneous biopsy prior to surgery, increased from 42.4 to 100%. The proportion of cancers with a preoperative diagnosis of malignancy by percutaneous biopsy, increased from 27.1% in 1995 to 92.7% in 2004. Preoperative breast cancer confirmation by fine needle aspiration cytology (FNAC) gradually decreased from 91.3% to 14.5%, whereas preoperative confirmation by ultrasound guided core biopsy (USCB) or stereotactic core needle biopsy (SCNB) increased from 8.7% to 69.1% and from 0 to 17.4% respectively. A preoperative diagnosis of breast cancer is currently obtained in more than 90% of breast cancer patients. The increase in preoperative breast cancer diagnosis through 1995-2004 is correlated with the introduction of SNCB and increased use of USCB at the expense of FNAC.

Use of hormone therapy and risk of breast cancer detected at screening and between mammographic screens

Postmenopausal hormone therapy (HT) is associated with increased risk of breast cancer, but in women undergoing breast cancer screening it is not clear whether use of HT is associated with increased risk of breast cancer detected at screening or between screens (interval cancer). Further, it is unclear whether the use of the HTs that have been common in Scandinavia is associated with higher risk of breast cancer than the HTs used in other countries. Our study was based on data from 296,651 women aged 50-69 years, who participated in the Norwegian Breast Cancer Screening Program during 1995-2004. After a mean enrollment time of 3.8 years, 1,512 women were diagnosed with invasive screen detected breast cancer, and 814 with invasive interval breast cancer. Cox regression models were used to estimate hazard ratios (HRs) of breast cancer associated with HT use, after adjusting for confounders. Ever users of HT had a 58% increased risk of breast cancer, compared to never users. The HRs associated with HT use were 1.45 (95% confidence interval (CI) = 1.29-1.63) for screen detected and 1.89 (95% CI = 1.61-2.23) for interval cancer. The difference between screen detected and interval cancer was statistically significant (p = 0.011). The HR of breast cancer increased with duration of HT use, but significantly more so for interval than for screen detected cancer (use of HT for 5 or more years compared to never use; HR = 2.91, 95% CI = 2.10-4.04 and HR = 1.94, 95% CI = 1.51-2.50, respectively; p = 0.002). The population attributable fraction of breast cancer due to HT use was 19.8% overall. Ever users of HT tended to develop a cancer of lower grade. No other differences in histological tumor characteristics were observed between ever and never users of HT among screen detected or interval cancers. The estimated risks of either breast cancer overall with HT use are higher in Norway than reported in similar studies from the U.S. HT-use is a stronger risk factor for interval cancer than for screen detected cancer. The increased risk of interval cancer, which may partly be due to decreased sensitivity of mammograms in HT users, remains a challenge in breast cancer screening programs.

Women with disabilities: General practitioners and breast cancer screening

Because they undergo breast cancer screening (BCS) relatively infrequently, women with physical or mental impairments may be at higher risk of late-stage breast cancer than women without impairments. A panel of 600 general practitioners (GPs) in Provence (southeastern France) provided information from which barriers potentially associated with BCS practices for women with disabilities were evaluated. In 2002, a telephone questionnaire collected data about GPs' personal and professional characteristics and their attitudes and practices regarding patients with disabilities. Analysis in 2003 used simple and multiple logistic regressions. More than a quarter of the GPs reported apparently inadequate BCS practices for people with disabilities. Feelings of discomfort when treating people with disabilities, lack of assistance, and communication difficulties were inversely associated with BCS for women with mental and physical impairments. General practitioners' information-seeking strategies were associated with BCS for women with mental impairments, and nursing home work experience was inversely associated with BCS for women with physical impairments. Appropriate training sessions should be made available to improve primary health care quality and prevention practices and to reduce GPs' misperceptions of people with disabilities.

Rational choice(s)? Rethinking decision-making on breast cancer risk and screening mammography.

Women who refrain from undergoing breast cancer screening are believed to be uninformed about risks and usually labeled as irrational. Our purpose in writing this paper is to challenge the traditional notion of rational behaviour, illustrating with qualitative data that people's rationality is influenced by their socio-cultural and political identities. We explore three major themes: (1) cultural explanations regarding intention to use screening mammography (2) (dis)trust in science and expert opinion, and (3) self-responsibility and self-surveillance in caring for one's body. Understanding that women rely on different risk discourses to make decisions about their health should aide researchers, health professionals, and the community in better understanding alternative ways of conceptualizing people's health-related behaviours when they do not coincide with health authorities recommendations.

Feeling healthy: so why should Mexican-descent women screen for breast cancer?

Mexican-descent women are at particular risk of late-stage breast cancer diagnosis by being the least likely of the major U.S. Hispanic subgroups to undergo breast cancer screening. This grounded theory study investigated how cultural health beliefs regarding the causes and nature of breast cancer influence women's decision to participate in screening. Thirty-four women (age 49 to 81) were interviewed in five focus groups using theoretical sampling across levels of acculturation and socioeconomic status. Analysis of the most prevalent cultural health beliefs led to a discovery that the core problem Mexican-descent women face is that they perceive there is no reason to participate in breast cancer screening when they are "feeling healthy." In addition, women who subjectively and cognitively feel healthy and otherwise have no evidence of illness according to their cultural health beliefs are unlikely to risk feeling ill rather than healthy by seeking to discover breast cancer through screening.