Individual Woman's Risk Research Articles

Vaccine-associated axillary lymphadenopathy with a focus on COVID-19 vaccines.

Axillary lymphadenopathy (LA) after COVID-19 vaccination is now known to be a common side effect. In these cases, malignancy cannot always be excluded on the basis of morphological imaging criteria.Narrative review for decision-making regarding control and follow-up intervals for axillary LA according to currently published research. This article provides a practical overview of the management of vaccine-associated LA using image examples and a flowchart and provides recommendations for follow-up intervals. A particular focus is on patients presenting for diagnostic breast imaging. The diagnostic criteria for pathological lymph nodes (LN) are explained.Axillary LA is a common adverse effect after COVID-19 vaccination (0.3-53%). The average duration of LA is more than 100 days. LA is also known to occur after other vaccinations, such as the seasonal influenza vaccine. Systematic studies on this topic are missing. Other causes of LA after vaccination (infections, autoimmune diseases, malignancies) should be considered for the differential diagnosis. If the LA persists for more than 3 months after COVID-19 vaccination, a primarily sonographic follow-up examination is recommended after another 3 months. A minimally invasive biopsy of the LA is recommended if a clinically suspicious LN persists or progresses. In the case of histologically confirmed breast cancer, a core biopsy without a follow-up interval is recommended regardless of the vaccination, as treatment appropriate to the stage should not be influenced by follow-up intervals. For follow-up after breast cancer, the procedure depends on the duration of the LA and the woman's individual risk of recurrence.Vaccination history should be well documented and taken into account when evaluating suspicious LN. Biopsy of abnormal, persistent, or progressive LNs is recommended. Preoperative staging of breast cancer should not be delayed by follow-up. The risk of false-positive findings is accepted, and the suspicious LNs are histologically examined in a minimally invasive procedure. · The vaccination history must be documented (vaccine, date, place of application).. · If axillary LA persists for more than 3 months after vaccination, a sonographic follow-up examination is recommended after 3 months.. · Enlarged LNs that are persistent, progressive in size, or are suspicious on control sonography should be biopsied.. · Suspicious LNs should be clarified before starting oncological therapy, irrespective of the vaccination status, according to the guidelines and without delaying therapy.. · Wilpert C, Wenkel E, Baltzer PA et al. Vaccine-associated axillary lymphadenopathy with a focus on COVID-19 vaccines. Fortschr Röntgenstr 2024; DOI 10.1055/a-2328-7536.

Combining Molecular and Radiomic Features for Risk Assessment in Breast Cancer.

Breast cancer risk is highly variable within the population and current research is leading the shift toward personalized medicine. By accurately assessing an individual woman's risk, we can reduce the risk of over/undertreatment by preventing unnecessary procedures or by elevating screening procedures. Breast density measured from conventional mammography has been established as one of the most dominant risk factors for breast cancer; however, it is currently limited by its ability to characterize more complex breast parenchymal patterns that have been shown to provide additional information to strengthen cancer risk models. Molecular factors ranging from high penetrance, or high likelihood that a mutation will show signs and symptoms of the disease, to combinations of gene mutations with low penetrance have shown promise for augmenting risk assessment. Although imaging biomarkers and molecular biomarkers have both individually demonstrated improved performance in risk assessment, few studies have evaluated them together. This review aims to highlight the current state of the art in breast cancer risk assessment using imaging and genetic biomarkers. Expected final online publication date for the Annual Review of Biomedical Data Science, Volume 6 is August 2023. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Evaluating Risk-Stratified HPV Catch-up Vaccination Strategies: Should We Go beyond Age 26?

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. HPV can cause genital warts and multiple types of cancers in females. HPV vaccination is recommended to youth age 11 or 12 years before sexual initiation to prevent onset of HPV-related diseases. For females who have not been vaccinated previously, catch-up vaccines are recommended through age 26. The extent to which catch-up vaccines are beneficial in terms of disease prevention and cost-effectiveness is questionable given that some women may have been exposed to HPV before receiving the catch-up vaccination. This study aims to examine whether the cutoff age of catch-up vaccination should be determined based on an individual woman's risk characteristic instead of a one-size-fits-all age 26. We developed a microsimulation model to evaluate multiple clinical outcomes of HPV vaccination for different women based on a number of personal attributes. We modeled the impact of HPV vaccination at different ages on every woman and tracked her course of life to estimate the clinical outcomes that resulted from receiving vaccines. As the simulation model is risk stratified, we used extreme gradient boosting to build an HPV risk model estimating every woman's dynamic HPV risk over time for the lifetime simulation model. Our study shows that catch-up vaccines still benefit all women after age 26 from the perspective of clinical outcomes. Women facing high risk of HPV infection are expected to gain more health benefits compared with women with low HPV risk. From a cancer prevention perspective, this study suggests that the catch-up vaccine after age 26 should be deliberately considered.

Cancer Progress and Priorities: Breast Cancer.

Breast cancer is the most commonly diagnosed invasive cancer among women both globally and within the United States and the number one cause of cancer-related deaths among women globally ([1, 2][1]). Less than 1% of diagnosed breast cancers occur in men ([2][2]) and, therefore, male breast cancer is

Key steps for effective breast cancer prevention.

Despite decades of laboratory, epidemiological and clinical research, breast cancer incidence continues to rise. Breast cancer remains the leading cancer-related cause of disease burden for women, affecting one in 20 globally and as many as one in eight in high-income countries. Reducing breast cancer incidence will likely require both a population-based approach of reducing exposure to modifiable risk factors and a precision-prevention approach of identifying women at increased risk and targeting them for specific interventions, such as risk-reducing medication. We already have the capacity to estimate an individual woman's breast cancer risk using validated risk assessment models, and the accuracy of these models is likely to continue to improve over time, particularly with inclusion of newer risk factors, such as polygenic risk and mammographic density. Evidence-based risk-reducing medications are cheap, widely available and recommended by professional health bodies; however, widespread implementation of these has proven challenging. The barriers to uptake of, and adherence to, current medications will need to be considered as we deepen our understanding of breast cancer initiation and begin developing and testing novel preventives.

Abstract B108: Using patient navigation to inform determinants of breast cancer disparities among under-resourced women in Chicago

Abstract Background: Under-resourced women are subject to many factors that increase their risk of morbidity and mortality from breast cancer, such as being uninsured or underinsured and not having a medical home or primary care provider. They may also lack additional resources to access care such as transportation. Due to variance in mammography recommendations among health organizations, lack of knowledge or confusion about when to receive screening also poses a challenge to both women and providers. Objective: A partnership between University of Illinois (UI) Cancer Center, UI Hospital & Health System, and Chicago Department of Public Health was developed to initiate an implementation science program that aims to mitigate these barriers by providing free breast cancer screening services and patient navigation to under-resourced women at our Mile Square Federally Qualified Health Centers (FQHCs). The program also aims to increase community partnerships to extend community outreach and identify factors that facilitate or challenge women's access to breast care services. Methods: Breast health screening and navigation services are offered at 5 Mile Square FQHC clinics and through “mammography party” events with community partners. Navigators facilitate women's care through screening and any follow-up services, link patients to additional resources, and provide breast health education. Data obtained through electronic medical records and direct correspondence with women and providers are managed securely in REDCap and analyzed with SPSS software. A program evaluation will be implemented in September 2018. Program activities are ongoing. Results: Four hundred ten women completed a screening mammogram from August 1, 2017 to June 30, 2018. Ninety-seven percent of women were racial minorities, most of whom were Latina (60.2%), African American (31.5%) and uninsured (67.8%). Among this cohort of women, the recall rate (24.6%) and cancer detection rate (17 per 1000) exceeded Breast Cancer Surveillance Consortium 2013 recall and cancer detection rate benchmarks (11.5% and 4.8 per 1000, respectively). Ages of women diagnosed (n=7) ranged from 40 to 68 years. The majority of diagnosed women were uninsured (n=6), 4 of whom were not eligible for health insurance. Conclusion: Patient navigation has proven to be effective in increasing breast cancer screening rates, access to care and resources, and disseminating breast health education; however, systematic barriers to care still persist. Although the Affordable Care Act has been instrumental in increasing the number of insured Americans, health care costs still pose a significant challenge for those who are underinsured or not eligible to be insured. Additionally, our data imply that some recommended guidelines for mammography may not address the screening needs for women who are at higher risk for breast cancer, and more personalized screening based on a woman's individual risk factors may be instrumental in ameliorating breast cancer disparities. Citation Format: Vida Henderson, Karriem Watson, Kathy Tossas-Milligan, Erica Martinez, Mariela Rodriguez, Barbara Williams, Paola Torres, Lisa Aponte-Soto, Robert Winn. Using patient navigation to inform determinants of breast cancer disparities among under-resourced women in Chicago [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B108.

Mammographic Screening in Older Women: When Is It Time to Stop?

Mammographic screening guidelines in women aged 75 and older are inconsistent due to a lack of data from prospective randomized controlled trials, such as those that exist for women between 40-74 years of age. In addition, older women are perceived as less likely to benefit from early detection due to increased comorbidities and a greater proportion of biologically favorable cancers. With increasing life expectancy and quality of life in the elderly, the question of when to stop mammographic screening merits renewed discussion. Observational data support a survival benefit from regular screening in older women with no severe comorbidities. In addition, screening mammography in this age group has been shown to perform better than in younger age groups, tipping the balance toward greater benefits than harms. Early studies of digital breast tomosynthesis (DBT) in older women suggest that performance metrics are further improved with DBT screening. While a biennial schedule in older women preserves some of the benefit of screening, annual mammography achieves the greatest reductions in breast cancer mortality and morbidity. As the medical community strives to offer personalized care for all age groups, health care providers are well positioned to offer shared decision-making based on existing data and tailored to each woman's individual risk profile, comorbid conditions, and personal values.

Long-Term Health Related Risks and Benefits of Oral Contraceptive Use

Background: Oral contraceptive use can influence the risk of many cancers and other diseases. However, so far, the long-term effects of oral contraceptives has not been extensively evaluated in relation to a broad set of diseases and disorders. In this observational study, we aimed to clarify the long-term health related risks and benefits associated with oral contraceptive use. Methods: Women were classified as never or ever oral contraceptive users, and the ever users further subdivided depending on duration of oral contraceptive use. Bonferroni correction for 26 common disease analysed were applied. Findings: There was lower odds among ever, compared to never users, for osteoporosis: OR = 0·87 (95% CI: 0·83-0·91), ovarian cancer: OR = 0·66 (0·60-0·74), endometrial cancer: OR = 0·59 (0·54-0·65), type 1 diabetes OR = 0·65 (0·57-0·73), and type 2 diabetes OR =0·89 (0·85-0·94), but higher odds for cervical cancer: OR = 1·30 (1·16-1·47), hay fever: OR·1·26 (1·22-1·31), osteoarthritis: OR = 1·07 (1·04-1·10), and depression: OR = 1·18 (1·14 to 1·21). Shot-term users had a nominally (P 20 years), compared to never users, for both deep vein thrombosis: OR = 0·63 (0·56-0·71) and hypertension: OR = 0·83 (0·79-0·87). Interpretation: In our study we highlight novel risks and beneficial effects of long-term oral contraceptive use and also confirm effects shown in previous studies. These results are very important given the large number of current users and will enable many women and physicians to make more informed decisions, regarding the use of oral contraceptives, based on the woman's individual risk factors. Funding Statement: SSMF, the Swedish Medical Research Council, the Kjell and Marta Beijers, the Marcus Borgstrom, the Ake Wiberg, the Swedish Heart-Lung and the Borgstrom and Hedstrom Foundations. Declaration of Interests: The authors declare that there is no conflict of interest. Ethics Approval Statement: The UK Biobank was approved by the National Research Ethics Committee (REC reference no. 11/NW/0382). All participants provided signed consent to participate in UK Biobank.

Women's perceptions of personalized risk‐based breast cancer screening and prevention: An international focus group study

ObjectiveIncreased knowledge of breast cancer risk factors enables a shift from one‐size‐fits‐all breast cancer screening to a risk‐based approach, tailoring screening policy to a woman's individual risk. New opportunities for prevention will arise. However, before this novel screening and prevention program is introduced, its acceptability from a woman's perspective needs to be explored.MethodsWomen eligible for breast cancer screening in the Netherlands, United Kingdom, and Sweden were invited to take part in focus groups. A total of 143 women participated. Data were transcribed verbatim and analyzed using thematic analysis.ResultsAnalysis identified five themes across the three countries. The first theme “impact of knowledge” describes women's concern of not being able to unlearn their risk, perceiving it as either a motivator for change or a burden which may lead to stigma. The second theme “belief in science” explains women's need to trust the science behind the risk assessment and subsequent care pathways. Theme three “emotional impact” explores, eg, women's perceived anxiety and (false) reassurance, which may result from knowing their risk. Theme four “decision making” highlights cultural differences in shared versus individual decision making. Theme five “attitude to medication” explores the controversial topic of offering preventative medication for breast cancer risk reduction.ConclusionsAcceptability of risk‐based screening and prevention is mixed. Women's perceptions are informed by a lack of knowledge, cultural norms, and common emotional concerns, which highlights the importance of tailored educational materials and risk counselling to aid either shared or individual informed decision making.

Rates and Risk Factors for Future Stress Urinary Incontinence Surgery after Pelvic Organ Prolapse Repair in a Large Population-based Cohort in California

ObjectivesTo determine the rate and risk factors for future stress urinary incontinence (SUI) surgery in a large population-based cohort of previously continent women following pelvic organ prolapse (POP) repair without concomitant SUI treatment. MethodsData from the Office of Statewide Health Planning and Development were used to identify all women who underwent anterior, apical, or combined anteroapical POP repair without concomitant SUI procedures in the state of California between 2005 and 2011 with at least 1-year follow-up. Patient and surgical characteristics were explored for associations with subsequent SUI procedures. ResultsOf 41,689 women undergoing anterior or apical POP surgery, 1,504 (3.6%) underwent subsequent SUI surgery with a mean follow-up time of 4.1 years. Age (odds ratio [OR] 1.01), obesity (OR 1.98), use of mesh at the time of POP repair (OR 2.04), diabetes mellitus (OR 1.19), white race, and combined anteroapical repair (OR 1.30) were associated with increased odds of future SUI surgery. ConclusionThe rate of subsequent surgery for de novo SUI following POP repair on a population level is low. Patient and surgical characteristics may alter a woman's individual risk and should be considered in surgical planning.

Women's decision-making regarding risk-stratified breast cancer screening and prevention from the perspective of international healthcare professionals.

IntroductionIncreased knowledge of breast cancer risk factors may enable a paradigm shift from one-size-fits-all breast cancer screening to screening and subsequent prevention guided by a woman’s individual risk of breast cancer. Professionals will play a key role in informing women about this new personalised screening and prevention programme. Therefore, it is essential to explore professionals’ views of the acceptability of this new programme, since this may affect shared decision-making.MethodsProfessionals from three European countries (the Netherlands, United Kingdom, and Sweden) participated in digital concept mapping, a systematic mixed methods approach used to explore complex multidimensional constructs.ResultsAcross the three countries, professionals prioritised the following five themes which may impact decision-making from the perspective of eligible women: (1) Anxiety/worry; (2) Proactive approach; (3) Reassurance; (4) Lack of knowledge; and (5) Organisation of risk assessment and feedback. Furthermore, Dutch and British professionals expressed concerns regarding the acceptability of a heterogeneous screening policy, suggesting women will question their risk feedback and assigned pathway of care. Swedish professionals emphasised the potential impact of the programme on family relations.ConclusionsThe perspectives of Dutch, British, and Swedish professionals of women’s decision-making regarding personalised breast cancer screening and prevention generally appear in line with women’s own views of acceptability as previously reported. This will facilitate shared decision-making. However, concerns regarding potential consequences of this new programme for screening outcomes and organisation need to be addressed, since this may affect how professionals communicate the programme to eligible women.

A stillbirth calculator: Development and internal validation of a clinical prediction model to quantify stillbirth risk.

ObjectiveTo generate a clinical prediction tool for stillbirth that combines maternal risk factors to provide an evidence based approach for the identification of women who will benefit most from antenatal testing for stillbirth prevention.DesignRetrospective cohort studySettingMidwestern United States quaternary referral centerPopulationSingleton pregnancies undergoing second trimester anatomic survey from 1999–2009. Pregnancies with incomplete follow-up were excluded.MethodsCandidate predictors were identified from the literature and univariate analysis. Backward stepwise logistic regression with statistical comparison of model discrimination, calibration and clinical performance was used to generate final models for the prediction of stillbirth. Internal validation was performed using bootstrapping with 1,000 repetitions. A stillbirth risk calculator and stillbirth risk score were developed for the prediction of stillbirth at or beyond 32 weeks excluding fetal anomalies and aneuploidy. Statistical and clinical cut-points were identified and the tools compared using the Integrated Discrimination Improvement.Main outcome measuresAntepartum stillbirthResults64,173 women met inclusion criteria. The final stillbirth risk calculator and score included maternal age, black race, nulliparity, body mass index, smoking, chronic hypertension and pre-gestational diabetes. The stillbirth calculator and simple risk score demonstrated modest discrimination but clinically significant performance with no difference in overall performance between the tools [(AUC 0.66 95% CI 0.60–0.72) and (AUC 0.64 95% CI 0.58–0.70), (p = 0.25)].ConclusionA stillbirth risk score was developed incorporating maternal risk factors easily ascertained during prenatal care to determine an individual woman’s risk for stillbirth and provide an evidenced based approach to the initiation of antenatal testing for the prediction and prevention of stillbirth.

Cotesting Detects Cervical Cancers Missed by Human Papillomavirus–Only Testing in Clinical Practice [144

INTRODUCTION: Current American College of Obstetricians and Gynecologists and American Society for Colposcopy and Cervical Pathology guidelines support the use of Pap and human papillomavirus (HPV) cotesting for cervical cancer screening in women 30 years of age and older. The U.S. Food and Drug Administration approval of an HPV test for primary cervical cancer screening in women 25 years of age and older differs from these guidelines. This Quest Diagnostics Health Trends report describes how often primary HPV screening might miss an actionable lesion. METHODS: We reviewed deidentified cotesting and cervical biopsy results from January 2005 to September 2011 in women 21 years and older who had undergone cervical biopsy within 1 year of cotesting. Pap test results of atypical squamous cells of undetermined significance or more severe were considered abnormal. RESULTS: Of the 455,945 women, 6,515 had cervical intraepithelial neoplasia (CIN) type 3 or more severe lesions, including 587 cancers. As expected, cotesting was positive (ie, HPV-positive or abnormal Pap test results) in most women with CIN 3+ lesions (6,469 of 6,515 [99.3%]), including those with cancer (558 of 587 [95.1%]). However, HPV was negative in 295 of 6,515 (4.5%) women with CIN 3+ and 109 of 587 (18.6%) women with cancer. In HPV-negative women, Pap testing showed abnormal results in 249 of 295 (84%) with CIN 3+ lesions, including 80 of 109 (73%) with cancer. CONCLUSION: This retrospective, longitudinal analysis suggests that primary HPV testing alone would have missed detection of 4.5% of CIN 3+ lesions identified by cotesting (including 18.6% of cancers). Pap test results would have prompted further evaluation in a significant proportion of women with HPV-negative CIN 3+ pathology. These findings, supporting cotesting, may have implications for an individual woman's choice, guideline development, and legal risk.

Œstrogènes, traitement hormonal, et vieillissement

Recent data suggests that a "window of opportunity" to decrease the risk of mortality and coronary heart disease (CHD) exists, when initiation hormone replacement therapy (HRT) in menopausal women aged of 50 to 59 years, or within the 10 years following the onset of menopause. The risks of HRT are rare, especially in young postmenopausal women with symptoms who use HRT for long periods of time, and have lower rates of mortality and CHD than comparable postmenopausal women who do not use HRT Newer evidence suggests that there are distinct differences between synthetic molecules and estradiol ; the physiological hormone may be preferable especially from a non-oral delivery system as thrombosis risk is the lowest with such therapy. In addition, natural progesterone does not reverse the benefits of estrogen, particularly in the nervous system and the vessels, and seems to be neutral on breast cancer risk. HRT must be individualized and tailored according to symptoms and each woman's individual risk profile, her preferences and expectations.

A randomized controlled trial of the effects of a brief intervention to increase chlamydia and gonorrhea testing uptake among young adult female emergency department patients.

The objective of this study was to test the effect of a brief educational and counseling intervention on increasing the uptake of free testing for Chlamydia trachomatis (chlamydia) and Neisseria gonorrhea (gonorrhea) among young female emergency department (ED) patients. Women are particularly vulnerable to more serious consequences of these infections due to asymptomatic presentation. Increased testing is important to detect, treat, and halt the spread of these infections among asymptomatic women. This was a randomized controlled trial. Research assistants (RAs) approached female patients in two EDs. Eligible patients were between 18 and 35 years of age, who reported having sex with males, but were not attending the ED for either treatment of sexually transmitted infection (STI) or testing for possible STI exposure. Participants responded to survey questions about their lifetime and past 3-month substance use, number of recent sexual partners, condom use, and perception of risks for chlamydia and gonorrhea infections. Following the survey, the RAs randomized participants into study control or treatment arms. Each treatment arm participant received a brief educational/counseling intervention from the RA. The brief intervention focused on the woman's personal risks for chlamydia and gonorrhea and condoms attitudes and usage. As the primary outcome of this study, participants were offered free urine tests for chlamydia and gonorrhea infection postintervention or post-survey completion, depending on group assignment. A total of 171 women completed the baseline assessment and were offered chlamydia and gonorrhea testing. The mean (±SD) age was 26 (±4.76) years, 18% were Hispanic, and 12% were Spanish-speaking only. The brief intervention that was offered to increase these women's awareness of their STI risk did not result in increased acceptance of testing; 48% in the brief intervention group accepted testing (95% confidence interval [CI] = 32% to 64%) versus 36% in the control group (95% CI = 19% to 53%). In a multivariable logistic regression, only self-identifying as being Hispanic was associated with greater willingness to be tested. Of the asymptomatic women tested (n = 71), five tested positive for chlamydia. This represents a positivity rate of 7%. There were no positive test results for gonorrhea. Women who reported high-risk factors for STI, such as younger age (≤25 years), having sex in the past 90 days without using condoms, identified substance use, or previous STI, were not more likely to accept the offer of chlamydia and gonorrhea testing. The brief intervention used in this study did not increase the uptake of testing for chlamydia and gonorrhea infections in this sample, in comparison to receiving no intervention. Although Hispanic women were more likely to accept chlamydia and gonorrhea testing, it is concerning that those women who report STI risk factors were not more likely to accept the offer of chlamydia and gonorrhea testing. Future research should focus on the refinement of an intervention protocol to focus on prior STI and lack of condom use to increase the uptake of testing among this high-risk group.

Levator ani muscle avulsion during childbirth: a risk prediction model

To establish the incidence of levator ani muscle (LAM) avulsion in primiparous women and to develop a clinically applicable risk prediction model. Observational longitudinal cohort study. District General University Hospital, United Kingdom. Nulliparous women at 36weeks of gestation and 3months postpartum. Four-dimensional transperineal ultrasound was performed during both visits. Tomographic ultrasound imaging at maximum contraction was used to diagnose no, minor or major LAM avulsion. A risk model was developed using multivariable ordinal logistic regression. Incidence of LAM avulsion and its risk factors. Of 269 women with no antenatal LAM avulsion 71% (n=191) returned postpartum. No LAM avulsion was found after caesarean section (n=48). Following vaginal delivery the overall incidence of LAM avulsion was 21.0% (n=30, 95% confidence interval [95% CI] 15.1-28.4). Minor and major LAM avulsion were diagnosed in 4.9% (n=7, 95% CI 2.2-9.9) and 16.1% (n=23, 95% CI 10.9-23.0), respectively. Risk factors were obstetric anal sphincter injuries (odds ratio [OR] 4.4, 95% CI 1.6-12.1), prolonged active second stage of labour per hour (OR 2.2, 95% CI 1.4-3.3) and forceps delivery (OR 6.6, 95% CI 2.5-17.2). A risk model and nomogram were developed to estimate a woman's individual risk: three risk factors combined revealed a 75% chance of LAM avulsion. Twenty-one percent of women sustain LAM avulsion during their first vaginal delivery. Our risk model and nomogram are novel tools to estimate individual chances of LAM avulsion. We can now target postnatal women at risk of sustaining a LAM avulsion.

Screening Mammography: Revisiting Assumptions About Early Detection

Recommendations for the frequency of mammography screening vary across several professional advisory groups. In 2009, the United States Preventive Services Task Force Guidelines reduced screening to biennially for women 50-74 years old. Drivers of this change were false-positive results and unnecessary biopsies, exposure to radiation, and treatment of cancers that would never develop. Despite the recommendation, surveys show that screening has actually increased since the change. A review of the individual woman's risk and a more balanced approach addressing both the benefits and harms of screening is required so that patients can make an informed choice.

Reader Variability in Breast Density Estimation from Full-Field Digital Mammograms: The Effect of Image Postprocessing on Relative and Absolute Measures

Mammographic breast density, a strong risk factor for breast cancer, may be measured as either a relative percentage of dense (ie, radiopaque) breast tissue or as an absolute area from either raw (ie, "for processing") or vendor postprocessed (ie, "for presentation") digital mammograms. Given the increasing interest in the incorporation of mammographic density in breast cancer risk assessment, the purpose of this study is to determine the inherent reader variability in breast density assessment from raw and vendor-processed digital mammograms, because inconsistent estimates could to lead to misclassification of an individual woman's risk for breast cancer. Bilateral, mediolateral-oblique view, raw, and processed digital mammograms of 81 women were retrospectively collected for this study (N = 324 images). Mammographic percent density and absolute dense tissue area estimates for each image were obtained from two radiologists using a validated, interactive software tool. The variability of interreader agreement was not found to be affected by the image presentation style (ie, raw or processed, F-test: P > .5). Interreader estimates of relative and absolute breast density are strongly correlated (Pearson r > 0.84, P < .001) but systematically different (t-test, P < .001) between the two readers. Our results show that mammographic density may be assessed with equal reliability from either raw or vendor postprocessed images. Furthermore, our results suggest that the primary source of density variability comes from the subjectivity of the individual reader in assessing the absolute amount of dense tissue present in the breast, indicating the need to use standardized tools to mitigate this effect.

Abstract P4-13-05: The gap between perceptions of risk and actual risk for breast cancer.

Abstract Background: Estimating a woman's individual risk for breast cancer is essential for tailoring appropriate screening and risk reduction strategies. Prior research suggests that women often misperceive their risk as either higher or lower than it actually is. As a result, average risk women who perceive their risk to be high may experience unnecessary anxiety. In contrast, high risk women who perceive their risk to be average/low may not utilize needed screening or available risk reduction options. The overall aim of this study is to compare perception of breast cancer risk to actual risk among a sample of multi-ethnic women with a range of breast cancer risk. Methods: As part of BREASTCARE, a randomized controlled trial designed to evaluate a PC-tablet based intervention providing multi-ethnic women and their primary care physicians with tailored information about breast cancer risk, we collected baseline information regarding perception of risk. Women visiting general internal medicine primary care clinics at two sites (one academic practice and one safety net practice) during the study period, between the ages of 40 and 74, who spoke English, Spanish or Chinese, and had no personal history of breast cancer were eligible to participate. Participants were asked how concerned they were about getting breast cancer: very concerned, somewhat concerned, a little concerned, or not at all concerned. They were also asked what they believed their chances of getting breast cancer were compared to other women their age: higher, the same, or lower. We classified women as high risk if they had a positive family history based on the Referral Screening Tool (Bellcross, et al. 2009), or were in the top 5% estimated 5-year risk for their age group based on either the Gail Model (Gail et al. 1999) or the Breast Cancer Surveillance Consortium Model when breast density data was available (Tice et al. 2008). We then compared women's perception of breast cancer risk with their actual risk. Results: To date, data has been obtained for 913 participants. One third of the women were white, 23% Black, 23% Latina and 17% Asian. Twenty percent (N = 182) of the women were classified as high risk. Among average risk women (N = 727) 48% were very or somewhat concerned about getting breast cancer. In contrast, 35% of high risk women were a little or not at all concerned. When asked how their chances of getting breast cancer compared to other women their age, 20% of average risk women thought their risk was higher than other women their age, while 71% of those at high risk indicated that they had the same or lower risk than other women their age. Conclusions: Our results suggest that both average and high risk women have an incorrect perception of their personal breast cancer risk compared to their actual risk. Interventions that address this misunderstanding can help those at high risk to initiate appropriate risk reduction practices and those at average risk to reduce unnecessary anxiety. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-13-05.

Risk of Developing Breast Cancer by Utilizing Gail Model

The Gail model has been widely used to quantify an individual woman's risk of developing breast cancer by using important clinical parameters, usually for clinical counselling purposes or to determine eligibility for mammography and genetic tests. The aim of the present study was to estimate the five-year and lifetime breast cancer risk among women in Rasht, Iran. In this cross-sectional study, 314 women were evaluated at Alzahra Women Hospital in 2007. Participants were ≥35 years of age without a history of breast cancer. Risk estimation was performed using the computerized Gail model. A five-year risk >1.66% was considered high-risk; 5.1% of women were high-risk. The mean five-year breast cancer risk was 0.8% (SD±1). Mean breast cancer risk up to the age of 90 years (lifetime risk) was 9.0% (SD±3.9%); 16.2% of the participants had a five-year risk higher than the average woman of the same age, and 18.2% had the same risk. Also for the lifetime risk, 11.1% of the women had higher risk and 1.6% had the same risk as the average woman. Routine use of the Gail model is recommended for identifying women at high average risk for increasing the survival of women from breast cancer.