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Abstract Background In Yemen, effective early detection and a comprehensive grasp of breast cancer symptoms and risk factors are vital in preventing its potentially deadly spread. However, challenges arise in combating breast cancer in Yemen due to the lack of patient registries, national strategies, and structured cancer treatment plans. Objective This research sought to evaluate the awareness levels of breast cancer and the perceived obstacles to breast cancer screening among adult Yemeni women. Methods A community-based cross-sectional questionnaire study was conducted from September 2023 to January 2024 from two teaching and largest hospitals in the capital municipality, Sana’a, Yemen, where 533 women (≥ 18 years old) were conveniently selected in this study. Data were analyzed using SPSS software (version 23).. The Chi-square test was used to test associations. The factors associated with breast cancer awareness and barriers to breast cancer screening were analyzed separately, using multivariable logistic regression. Results The study revealed that 88.6% of women were familiar with breast cancer, and 61.9% being knowledgeable about screening methods such as clinical breast examination (CBE) or mammography. The primary hindrance to screening (84.1%, n = 53) was the absence of symptoms or pain. The second most common reason for not undergoing screening was a lack of understanding about breast cancer and its treatment (61.9%, n = 39). Conclusion To enhance breast cancer screening rates among Yemeni women consistently, targeted educational programs emphasizing the benefits of early detection and dispelling misconceptions and barriers related to the disease are essential.

Abstract Background Breast Cancer remains among the top five cancers responsible for morbidity and mortality globally. For many years, infectious (communicable) diseases were a primary concern in low- and middle-income countries (LMICs) compared to higher-income countries, where non-communicable diseases (NCDs) were already a major concern. However, starting from the early 2000s, the LMICs including Tanzania has witnessed an epidemiological transition being equally affected by NCDs, and breast cancer, is among the prevalent NCDs. While the evidence is vast on the role of breast cancer screening messages in promoting screening, debunking myths, and addressing barriers to the uptake of breast cancer services, context-specific messages are limited. Amidst the changing technology, growth of social media and cultural dynamics, context-specific breast cancer screening messages are needed. We aimed to analyze the breast cancer screening messages from the experiences of women seeking care at Ocean Road Cancer Institute in Tanzania. Methods An exploratory qualitative case study adopting in-depth interviews (IDI) and focused group discussion (FGD) was carried out among purposefully selected women aged from 18 years to 65 years seeking care from Ocean Road Cancer Institute in Dar es Salaam, Tanzania. Eighteen women participated in the IDIs, and 16 women participated in FGD. Data analysis followed inductive qualitative content analysis. Findings Three main categories emerged: the existence of multiple sources of breast cancer screening messages, the strengths and weaknesses of breast cancer screening messages, and clients’ mixed perceptions of breast cancer screening messages. Conclusion The findings of this study depict that although breast cancer screening promotion messages are regarded as a source of information about cancers, they fall short of completeness and relevance to the otherwise at-risk population and trigger negative perceptions toward screening. Therefore, this study advocates revisiting the breast cancer screening messages, employing participatory approaches to tailor the screening messages and communication media to fit specific audiences. This calls for re-designing both the content of the messages and means of delivery; thus, collaborative efforts are needed.

Abstract Background Annual breast magnetic resonance imaging (MRI) is highly recommended to assist mammography for women at high risk of breast cancer (BC). This study explored the knowledge, attitude, and willingness toward breast MRI screening among women at high risk of BC. Methods This cross-sectional study enrolled women at high risk of BC between August 2022 and January 2023 in Beijing, China. A structural equation model (SEM) was used to analyze the relationships among knowledge, attitude, and willingness. Results A total of 596 questionnaires were collected, and 412 questionnaires (69.13%) were valid. The women’s knowledge and attitude scores were 7.75 ± 2.79 (possible range: 0–12) and 48.53 ± 6.31 (possible range: 13–65). Among the women, 297 (72.09%) were willing to undergo regular breast MRI screening. The SEM showed that knowledge had direct effect on attitude [β = 0.77, 95% CI: (0.57, 0.98), P

Abstract Background Breast cancer is a major health concern worldwide, especially in Vietnam. This study aimed to explore women’s motivation for and factors related to breast cancer screening. Methods A mixed-methods study was conducted in Danang, Vietnam, using a convergent parallel approach. This study utilized both quantitative and qualitative methods to gather the data. The quantitative approach involved surveys to assess motivation levels and related factors, including demographic information and experience with breast cancer screening. In-depth qualitative interviews were used to gain deeper insights into participants' perspectives and experiences related to breast cancer screening. Results The average motivation score for breast cancer screening was moderate (3.55 ± 0.55). Ethnicity, regular health check-ups, family history of breast cancer, receiving information about breast cancer, and women’s health issues have direct relationships with breast cancer screening motivation. According to the qualitative data, three categories emerged: intrinsic motivation, external motivation/internalization, and amotivation. The individual, and sociocultural environmental factors impacted screening motivation. Conclusions This study highlights the motivations behind breast cancer screening among women. Healthcare providers could use these findings to improve screening policies and guidelines and encourage more women to undergo regular screening, ultimately reducing the incidence of breast cancer in the community.

Abstract Background This study aimed to assess the recognition and understanding of breast awareness (BA) among hospital staff, a group considered influential in disseminating information about health. Compared to the traditional approach of breast self-examination (BSE), BA has gained prominence as a concept focused on early detection. The study also explored the effectiveness of an informational leaflet in conveying BA concepts. Methods We conducted an online, voluntary, and anonymous questionnaire survey at St. Luke’s International Hospital in Japan, where approximately 1,000 breast cancer surgeries are performed annually. The survey comprised three sections: pre-leaflet questions, the informational leaflet, and post-leaflet questions. Results From a pool of 500 completed questionnaires, 499 were deemed suitable for the analysis. Notably, 78% of respondents were unfamiliar with “BA” before the survey. However, 89.1% expressed interest in adopting daily practices for early breast cancer detection. Following the leaflet exposure, 98.4% of respondents claimed to have understood BA, either completely or partially. The leaflet aided 93.2% of these individuals in differentiating between BA and the traditional BSE method. These outcomes remained consistent across various demographic segments such as occupation, age, and experience with breast cancer care. Conclusions The study underscores a concerning lack of awareness regarding BA among hospital staff within the surveyed institution. This highlights the need to engage medical professionals in promoting BA within the community. The informational leaflet proved effective in enhancing comprehension of BA across diverse groups, indicating its potential as a widely applicable educational tool. The leaflet facilitated the comprehension of BA among respondents across all demographic groups, indicating its potential for widespread utility.

Abstract Background Although artificial intelligence (AI) has potential in the field of screening of breast cancer, there are still issues. It is vital to make sure AI does not overlook cancer or cause needless recalls. The aim of this work was to investigate the effectiveness of indulging AI in combination with one radiologist in the routine double reading of mammography for breast cancer screening. The study prospectively analyzed 32,822 screening mammograms. Reading was performed in a blind-paired style by (i) two radiologists and (ii) one radiologist paired with AI. A heatmap and abnormality scoring percentage were provided by AI for abnormalities detected on mammograms. Negative mammograms and benign-looking lesions that were not biopsied were confirmed by a 2-year follow-up. Results Double reading by the radiologist and AI detected 1324 cancers (6.4%); on the other side, reading by two radiologists revealed 1293 cancers (6.2%) and presented a relative proportion of 1·02 (p

Abstract Background Taiwan implemented the Cancer Screening Quality Improvement Program (CAQIP) in 2010. The program sought to enhance mass breast cancer screening accessibility. This study aimed to examine socioeconomic disparities in outreach screening utilization pre-CAQIP (2005–2009) and post-CAQIP (2010–2014). Method We conducted a nationwide population-based observational study in Taiwan, analyzing four population databases to evaluate socioeconomic disparities among women aged 50 to 69 years undergoing their first mammography screening pre-CAQIP. Multivariate logistic regression was used to examine changes in utilization of outreach screening pre- and post-CAQIP implementation, and to estimate the Slope Index of Inequity (SII) and Relative Index of Inequity (RII) values. Results Utilization of outreach screening through mobile mammography units (MMUs) increased from 6.12 to 32.87% between the two periods. Following CAQIP, a higher proportion of screened women were older, less educated, and from suburban or rural areas. The SII and RII for age, income, and urbanization levels decreased post-CAQIP. However, regarding education level, SII was − 0.592 and RII was 0.392 in the pre-CAQIP period, increasing to -0.173 and 0.804 post-CAQIP, respectively. Conclusions Our study observed that utilization of outreach screening through MMUs increased after CAQIP. The MMUs made outreach screening services more accessible in Taiwan. Expanding outreach screening services and educational programs to promote mammography uptake in local communities could help reduce the potential effect of socioeconomic disparities, and thus may enhance early detection of breast cancer. Further study could focus on the accessibility of outreach screening and breast cancer outcomes.

Abstract Background Organized breast cancer screening (BCS) programs are effective measures among women aged 50–69 for preventing the sixth cause of death in Germany. Although the implementation of the national screening program started in 2005, participation rates have not yet reached EU standards. It is unclear which and how sociodemographic factors are related to BCS attendance. This scoping review aims to identify sociodemographic inequalities in BCS attendance among 50-69-year-old women following the implementation of the Organized Screening Program in Germany. Methods Following PRISMA guidelines, we searched the Web of Science, Scopus, MEDLINE, PsycINFO, and CINAHL following the PCC (Population, Concept and Context) criteria. We included primary studies with a quantitative study design and reviews examining BCS attendance among women aged 50–69 with data from 2005 onwards in Germany. Harvest plots depicting effect size direction for the different identified sociodemographic inequalities and last two years or less BCS attendance and lifetime BCS attendance were developed. Results We screened 476 titles and abstracts and 33 full texts. In total, 27 records were analysed, 14 were national reports, and 13 peer-reviewed articles. Eight sociodemographic variables were identified and summarised in harvest plots: age, education, income, migration status, type of district, employment status, partnership cohabitation and health insurance. Older women with lower incomes and migration backgrounds who live in rural areas and lack private insurance respond more favourably to BCS invitations. However, from a lifetime perspective, these associations only hold for migration background, are reversed for income and urban residency, and are complemented by partner cohabitation. Finally, women living in the former East German states of Saxony, Mecklenburg-Western Pomerania, Saxony-Anhalt, and Thuringia, as well as in the former West German state of Lower Saxony, showed higher BCS attendance rates in the last two years. Conclusion High-quality research is needed to identify women at higher risk of not attending BCS in Germany to address the existing research’s high heterogeneity, particularly since the overall attendance rate still falls below European standards. Protocol registration https://osf.io/x79tq/ .

Introduction: In recent decades, attendance to organized breast cancer screening has been decreasing in European countries. This could be partly due to an increase in the use of opportunistic screening. The aim of this study was to assess the coverage of imaging in and outside the screening program in Finland during the period of 1999–2018. We also compared the usage of imaging services across sociodemographic groups in the more recent years (2017–2018). Methods: Our initial data consisted of 1,159,000 screening-target-aged women (50–69 years) in 1999–2018 and 1,849,000 women aged 30–89 years in 2017–2018. Data on organized breast cancer screening program was drawn from the Finnish Cancer Registry and supplemented with comprehensive individual data on mammograms and ultrasounds performed outside the program. Results: Among the screening-aged women (50–69), a clear decline in the overall imaging coverage was observed during the study period (from 89 to 85%). The use of outside imaging increased slightly but not enough to compensate for the overall decrease. There were large differences in coverages between sociodemographic groups. Compared to manual workers and the unemployed, upper-level employees were around two times more active in using outside imaging (8.2% vs. 3.6% and 4.3%, respectively). Interpretation: Overall breast imaging coverage has slowly decreased during the 2000s, while outside imaging has increased slightly. The coverage of imaging in and outside the program largely followed the same trends, with the highest usage concentrating on higher socioeconomical groups, native speakers and highly educated women.

Background: The breast cancer burden on the South African healthcare system is severe, with rural South African women often diagnosed at an advanced stage of the disease. South Africa’s rural areas are classified as low-resource settings with limited medical services and infrastructure. The impact of breast cancer on rural communities in South Africa requires ongoing research to better understand the severity of this disease among one of the most vulnerable populations. Objectives: This study aimed to explore the barriers and enablers of breast cancer screening among rural South African women. Method: An exploratory qualitative study was utilised. A semi-structured interview was conducted with 22 rural South African women. Data were analysed using thematic analysis. This study utilised the care-seeking behaviour theory as its theoretical framework. Results: Participants identified many barriers to breast cancer screening, including individual affordability, transportation, rural services, infrastructure, health professional behaviour, and the lack of educational materials. Several factors are suggested to enable the screening of breast cancer in rural South Africa, including breast cancer campaigns, health education, the involvement of key stakeholders, and promotional materials. Conclusion: Despite the many barriers to breast cancer screening among rural South African women, there is still hope in implementing the various promotional tools outlined in this study and ensuring that breast self-examination is an alternative, affordable screening method. Contribution: The purpose of this article is to contribute to the attainment of the Sustainable Development Goal (SDG) 3, which focusses reducing premature mortality from non-communicable diseases, including cancer.

Abstract Background Mammography (MG) has demonstrated its effectiveness in diminishing mortality and advanced-stage breast cancer incidences in breast screening initiatives. Notably, research has accentuated the superior diagnostic efficacy and cost-effectiveness of digital breast tomosynthesis (DBT). However, the scope of evidence validating the cost-effectiveness of DBT remains limited, prompting a requisite for more comprehensive investigation. The present study aimed to rigorously evaluate the cost-effectiveness of DBT plus MG (DBT-MG) compared to MG alone within the framework of Taiwan’s National Health Insurance program. Methods All parameters for the Markov decision tree model, encompassing event probabilities, costs, and utilities (quality-adjusted life years, QALYs), were sourced from reputable literature, expert opinions, and official records. With 10,000 iterations, a 2-year cycle length, a 30-year time horizon, and a 2% annual discount rate, the analysis determined the incremental cost-effectiveness ratio (ICER) to compare the cost-effectiveness of the two screening methods. Probabilistic and one-way sensitivity analyses were also conducted to demonstrate the robustness of findings. Results The ICER of DBT-MG compared to MG was US$5971.5764/QALYs. At a willingness-to-pay (WTP) threshold of US$33,004 (Gross Domestic Product of Taiwan in 2021) per QALY, more than 98% of the probabilistic simulations favored adopting DBT-MG versus MG. The one-way sensitivity analysis also shows that the ICER depended heavily on recall rates, biopsy rates, and positive predictive value (PPV2). Conclusion DBT-MG shows enhanced diagnostic efficacy, potentially diminishing recall costs. While exhibiting a higher biopsy rate, DBT-MG aids in the detection of early-stage breast cancers, reduces recall rates, and exhibits notably superior cost-effectiveness.

Abstract Breast cancer (BC) screening plays a major role in the prevention of BC through early detection and timely treatment. This study aims to determine the level of uptake of BC screening and associated factors. A community-based analytical cross-sectional study was conducted in Dodoma City, Tanzania from July to December 2020. The study included women aged 8 years and above without a known history of breast cancer. Multivariable logistic regression was used to determine the socio-demographic factors associated with BC screening. P value

Abstract Background Pregnancy-related cancers are mostly breast cancers, and their incidence is likely to increase as a result of the modern trend of delaying childbearing. In particular, advanced maternal age increases breast cancer risk, and younger breast cancer patients are more likely to die and metastasize. This study compared a population with a high incidence of delayed childbearing with another population with a lower mean age at childbirth in order to determine whether breast cancer diagnosis and childbearing age overlap. Methods We retrospectively analyzed multiple data sources. The Surveillance, Epidemiology, and End Results (SEER) program, the United States National Center for Health Statistics as part of the National Vital Statistics System, the United Nations Population Division, the GLOBOCAN Cancer Observatory, the CLIO-INFRA project database, the Human Fertility Database, and anonymized local data were used. Results As women’s age at delivery increased, the convergence between their age distribution at breast cancer diagnosis and childbearing increased. In addition, the overlap between the two age distributions increased by more than 200% as the average age at delivery increased from 27 to 35 years. Conclusions As women’s average childbearing age has progressively risen, pregnancy and breast cancer age distributions have significantly overlapped. This finding emphasizes the need for increased awareness and educational efforts to inform women about the potential consequences of delayed childbearing. By providing comprehensive information and support, women can make more informed decisions about their reproductive health and cancer prevention strategies.

Objective: Despite facing unique barriers, Catholic nuns in Tanzania require accessible breast health promotion. This study explores interventions to empower nuns through knowledge, improved attitudes, and positive practices, ultimately promoting well-being and early detection for better breast cancer outcomes. Materials and Methods: A quasi-experimental design study guided by the Health Belief Model was conducted to monitor the implementation of a breast health intervention program aimed at increasing breast cancer screening knowledge among 385 Catholic nuns aged 20 to over 60 years old within Lake Zone, Tanzania. Data were collected at two-time points: pre-intervention (baseline) and implementation phase intervention (after three months). The intervention consisted of a 2-hour educational session. Participants had opportunities to ask questions and provide feedback. Results: The breast health promotion intervention was well-received by Catholic nuns, with 339 (88%) expressing strong motivation to learn and promote awareness. The training effectively increased knowledge and positive attitudes towards breast cancer screening. Researcher assistants successfully delivered the program, and 354 (92%) of participants expressed interest in continued education and support. The intervention addressed cultural barriers and empowered nuns to take charge of their health, though some challenges remain meanwhile 158 (41%) had limited prior knowledge, 81 (21%) hesitated to discuss breast health due to religious beliefs, and some faced difficulty applying the learnings. Conclusion: Overall, the breast health promotion intervention had a positive outcome on the Catholic nuns’ awareness and knowledge of breast health. However, addressing the identified barriers and challenges is crucial to further enhance the intervention's effectiveness and sustainability.

Artificial Intelligence (AI) is defined as the simulation of human intelligence by a digital computer or robotic system and has become a hype in current conversations. A subcategory of AI is deep learning, which is based on complex artificial neural networks that mimic the principles of human synaptic plasticity and layered brain architectures, and uses large-scale data processing. AI-based image analysis in breast screening programmes has shown non-inferior sensitivity, reduces workload by up to 70% by pre-selecting normal cases, and reduces recall by 25% compared to human double reading. Natural language programs such as ChatGPT (OpenAI) achieve 80% and higher accuracy in advising and decision making compared to the gold standard: human judgement. This does not yet meet the necessary requirements for medical products in terms of patient safety. The main advantage of AI is that it can perform routine but complex tasks much faster and with fewer errors than humans. The main concerns in healthcare are the stability of AI systems, cybersecurity, liability and transparency. More widespread use of AI could affect human jobs in healthcare and increase technological dependency. AI in senology is just beginning to evolve towards better forms with improved properties. Responsible training of AI systems with meaningful raw data and scientific studies to analyse their performance in the real world are necessary to keep AI on track. To mitigate significant risks, it will be necessary to balance active promotion and development of quality-assured AI systems with careful regulation. AI regulation has only recently included in transnational legal frameworks, as the European Union’s AI Act was the first comprehensive legal framework to be published, in December 2023. Unacceptable AI systems will be banned if they are deemed to pose a clear threat to people’s fundamental rights. Using AI and combining it with human wisdom, empathy and affection will be the method of choice for further, fruitful development of tomorrow’s senology.

Carriers of germinal mutations are at high risk of developing malignant neoplasms, characterized by an early age of manifestation, an aggressive course, and a high risk of recurrence. The wide introduction of medical genetic testing in the target population of potential carriers of germinal mutations will optimize primary prevention, screening, and treatment approaches. Primary prevention (removal of target organs) with BRCA½ mutation carriers should be based on the benefit-risk ratio; the development of screening programs should take into account the early age of disease manifestation, high breast density in young women, and the predominance of aggressive biological subtypes of the disease, which requires more intensive screening programs in this population. Pathogenetic adjuvant therapy with olaparib significantly reduces the risk of recurrence and death in patients with early BRCA - associated breast cancer and can also help prevent the development of second malignant neoplasms.

Background: Breast cancer is the most frequent malignancy in women worldwide and one of the most curable cancers if diagnosed at an early stage. Female patients presenting solid breast lesions are greatly predisposed to breast cancer development, and as such, effective screening of high-risk patients is valuable in early-stage breast cancer detection. Objectives: The aim of our study was to identify the most relevant demographic, reproductive and lifestyle risk factors for breast cancer among women with solid breast lesions living in western Romania, namely the urban region consisting of Timisoara and the rural surrounding regions. Methods: From January 2017 to December 2021, 1161 patients with solid breast lesions, as detected by sonoelastography, were divided into two groups: patients with benign lesions (1019, 87.77%) and patients with malignant nodules (142, 12.23%). The malignancy group was confirmed by a histopathological result. Variables including age, BMI, menarche, menopause, years of exposure to estrogen, number of births, breastfeeding period, use of oral combined contraceptives, smoker status, family medical history and living area (rural-urban) were recorded. Results: It was evidenced by our study that the main risk factors for malignancy were elevated age (OR = 1.07, 95% CI 1.05–1.08), BMI (OR = 1.06, 95% CI 1.02–1.10), living area (rural) (OR = 1.86, 95% CI 1.13–2.85) and family medical history (negative) (OR 3.13, 95% CI 1.43–8.29). The other proposed risk factors were not found to be statistically significant. Conclusions: Age and BMI were observed to be the most significant factors for breast cancer risk increase, followed by living in a rural area. A family history of breast cancer was shown to be inversely correlated with cancer risk increase.

Abstract Background The decision to screen for breast cancer among older adults with dementia is complex and must often be individualized, as these individuals have an elevated risk of harm from over-screening. Medicare beneficiaries with dementia are increasingly enrolling in Medicare Advantage plans, which typically promote receipt of preventive cancer screening among their enrollees. This study examined the utilization of breast cancer screening among Medicare enrollees with dementia, in Medicare Advantage and in fee-for-service Medicare. Methods We conducted a pooled cross-sectional study of women with Alzheimer’s disease and related dementias or cognitive impairment who were eligible for mammogram screening. We used Medicare Current Beneficiary Survey data to identify utilization of biennial mammogram screening between 2012 and 2019. Poisson regression models were used to estimate prevalence ratios of mammogram utilization and to calculate adjusted mammogram rates for Medicare Advantage and fee-for-service Medicare enrollees with dementia, and further stratified by rurality and by dual eligibility for Medicare and Medicaid. Results Mammogram utilization was 16% higher (Prevalence Ratio [PR] 1.16; 95% CI: 1.05, 1.29) among Medicare Advantage enrollees with dementia, compared to their counterparts in fee-for-service Medicare. Rural enrollees experienced no significant difference (PR 0.99; 95% CI: 0.72, 1.37) in mammogram use between Medicare Advantage and fee-for-service Medicare enrollees. Among urban enrollees, Medicare Advantage enrollment was associated with a 21% higher mammogram rate (PR 1.21; 95% CI: 1.09, 1.35). Dual-eligible Medicare Advantage enrollees had a 34% higher mammogram rate (PR 1.34; 95% CI: 1.10, 1.63) than dual-eligible fee-for-service Medicare enrollees. Among non-dual-eligible enrollees, adjusted mammogram rates were not significantly different (PR 1.11; 95% CI: 0.99, 1.24) between Medicare Advantage and fee-for-service Medicare enrollees. Conclusions Medicare beneficiaries age 65–74 with Alzheimer’s disease and related dementias or cognitive impairment had a higher mammogram use rate when they were enrolled in Medicare Advantage plans compared to fee-for-service Medicare, especially when they were dual-eligible or lived in urban areas. However, some Medicare Advantage enrollees with Alzheimer’s disease and related dementias or cognitive impairment may have experienced over-screening for breast cancer.

Background: African American (AA) women historically present with more advanced breast cancer (BC) stages. The 2019 novel Coronavirus (COVID-19) stressed healthcare systems, leading to the reduction of resources for non-urgent care, including cancer screening. Limiting screening access may worsen existing delays in cancer screening and potentially widen racial disparities in BC diagnosis stages.Methods: We conducted a retrospective cohort study of 321 self-identified AA and 2841 White women aged 18 and over with invasive BC at The Ohio State University Comprehensive Breast Center between 2018 and 2021 to evaluate differences in the stage of BC at presentation. Variables of interest included time (pre-COVID [2018-2019] and COVID era [2020-2021]), sociodemographic factors, neighborhood socioeconomic composition (low [1-33], medium [34-66], and high [67-100] Yost tertiles), and tumor receptor status (ER, PR, HER2). Data were analyzed using chi-square, Fisher’s Exact tests, Wilcoxon Two Sample tests, and logistic regression.Result: Significant predictors of late-stage diagnosis included higher age at diagnosis, ER, PR, HER2 receptors, and medium vs. high Yost Index Score. Race and time were not significant predictors of late-stage diagnosis.Discussion: The clinical impact of COVID-19 on healthcare delivery will continue to be observed, and how the pandemic affects existing BC inequalities requires exploration.

Comprehensive evaluation of cancer screening activities based on individual experiences is urgently needed to address the burden of cancer among Métis people. In this co-designed and co-led study, a cancer screening questionnaire developed for Métis people to evaluate their cancer screening histories and to explore barriers and facilitators to cancer screening was used. Adult Métis Albertans were invited to participate in the anonymous survey through a multi-modal strategy used for community consultations. Descriptive analyses compared responses between regions, age groups and geographic locations. In total, 370 participants who identified as Métis consented and contributed responses between 12 September and 2 December 2022. Female respondents reported higher rates of cervical and breast cancer screening (>94%) and lower rates of colorectal cancer screening (67–78%). Most of the barriers and facilitators were rated as very important, especially access to reliable and accurate information on screening, risks and benefits of cancer screening, explanation of the test results or procedures, trust in their health care provider(s) and health care system and access to a primary health care provider. This study fills a crucial gap that can inform targeted interventions to increase cancer screening awareness and rates among Métis Albertans and reduce their cancer burden.

Abstract Background To inform the development of an online tool to be potentially used in shared decision-making about breast cancer screening, French women were questioned about participation in breast cancer screening, the health professional’s role, and their perceptions of the proposed tool. Methods We organised focus group discussions with 55 French women. Two different strategies were used to recruit women from high and low socioeconomic backgrounds. We applied both inductive and deductive approaches to conduct a thematic analysis of the discussions. We analysed the responses by using the main determinants from different health behaviour models and compared the two groups. Results Independently of socioeconomic status, the most important determinant for a woman’s participation in breast cancer screening was the perceived severity of breast cancer and the perceived benefits of its early detection by screening. Cues to action reported by both groups were invitation letters; recommendations by health professionals, or group/community activities and public events were reported by women from high and low socioeconomic backgrounds, respectively. Among other positive determinants, women from high socioeconomic backgrounds reported making informed decisions and receiving peer support whereas women from low socioeconomic backgrounds reported community empowerment through group/community events. Fear of cancer was reported as a barrier in both groups. Among other barriers, language issues were reported only by women from low socioeconomic backgrounds; women from high socioeconomic backgrounds reported breast cancer screening-related risks other than overdiagnosis and/or overtreatment. Barriers to accessing the online tool to be developed were mainly reported by women from high socioeconomic backgrounds. Conclusion Limitations in implementing shared decision-making for women from low socioeconomic backgrounds were highlighted. An online tool that is suitable for all women, regardless of socioeconomic status, would provide “on-demand” reliable and tailored information about breast cancer screening and improve access to health professionals and social exchanges.

Abstract Background Although mammography can significantly reduce breast cancer mortality, many women do not receive their annual breast cancer screening. Differences in screening adherence exist by race/ethnicity, socioeconomic status (SES), and insurance status. However, more detailed investigations into the impact of neighborhood disadvantage and access to resources on screening adherence are lacking. Methods We comprehensively examined the effect of individual social, economic, and demographic factors (n = 34 variables), as well as neighborhood level SES (nSES) indicators (n = 10 variables) on breast cancer screening adherence across a multi-ethnic population (n = 472). In this cross-sectional study, participants were surveyed from 2017 to 2018. The data was analyzed using univariate regression and LASSO for variable reduction. Significant predictors were carried forward into final multivariable mixed-effect logistic regression models where odds ratios (OR), 95% confidence intervals and p-values were reported. Results Nineteen percent of participants were non-adherent to breast screening guidelines. Race/ethnicity was not associated with adherence; however, increasing age (OR = 0.97, 95%CI = 0.95–0.99, p = 0.01), renting a home (OR = 0.53, 95%CI = 0.30–0.94, p = 0.04), food insecurity (OR 0.46, 95%CI = 0.22–0.94, p = 0.01), and overcrowding (OR = 0.58, 95% CI = 0.32–0.94, p = 0.01) were significantly associated with lower breast cancer screening adherence. Conclusion Socioeconomic indicators at the individual and neighborhood levels impact low breast cancer screening adherence and may help to inform future screening interventions.

Abstract Backgrounds Breast cancer screening plays an important role in the early detection, diagnosis and treatment of breast cancer. The aim of this study was to evaluate the screening results and explore the influencing factors of breast cancer detection rate in Guangdong. Methods This cross-sectional study was conducted among 2,024,960 women aged 35–64 in Guangdong Province during 2017–2021. The data about breast cancer screening information were collected from the Guangdong maternal and child health information system. Descriptive statistical analysis was used to explain demographic characteristics and results of breast cancer screening. The generalized linear regression model was applied to analyze the related influencing factors of breast cancer detection rate. Results The estimated detection rate of breast cancer in Guangdong Province is 70.32/105, with an early diagnosis rate of 82.06%. After adjusting covariates, those women with older age (45–55 [OR (95% CI) 2.174 (1.872, 2.526)], 55–65 [OR (95% CI) 2.162 (1.760, 2.657)]), education for high school ([OR (95% CI) 1.491 (1.254, 1.773)]) and older age at first birth ([OR (95% CI) 1.632 (1.445, 1.844)]) were more likely to have higher detection rate of breast cancer. No history of surgery or biopsy ([OR (95% CI) 0.527 (0.387, 0.718)]), no history of breast cancer check ([OR (95% CI) 0.873 (0.774, 0.985)]) and no family history of breast cancer ([OR (95% CI) 0.255 (0.151, 0.432)]) women were more likely to screen negative for breast cancer (P

Objective: An automated breast ultrasound system (ABUS) combined with screening mammography has increased cancer detection rates; however, supplemental ABUS use has increased recall rates. In this study, we aimed to identify an accurate and efficient method of ABUS interpretation and evaluate the potential usefulness of its coronal view versus the conventional transverse view. Materials and Methods: This retrospective observer study included comprised 114 ABUS cases (40 normal, 35 benign, 39 malignant). Ten physicians from multiple institutions interpreted the anonymized coronal and transverse views independently. The observers scored their confidence in the lesion detection for each case using a continuous scale and recorded reading times for each coronal and transverse view interpretation. Free-response receiver operating characteristic analysis was employed to compare detection accuracies between views; a paired t-test was used to compare the average reading times. Results: Detection accuracy did not differ significantly between the coronal and transverse views (figure of merit=0.740 and 0.745, respectively; p = 0.72). However, the average reading time for the coronal view was significantly shorter than that for the transverse view (149.7 vs. 200.3 seconds per case, p = 0.003). Conclusion: The coronal view obtained with the ABUS was useful for interpretation and associated with significantly shorter reading times compared with the conventional transverse view while maintaining breast lesion detection accuracy.

Objectives:Breast cancer is the leading cause of female cancer mortality in Armenia. The government is considering covering breast cancer screening, but prevailing attitudes towards it are unknown. This cross-sectional study assessed Armenian women’s awareness and perceptions of breast cancer screening.Methods:We administered a validated telephone survey to women ages 35–65 registered in Yerevan’s polyclinic system between 2019–2021, assessing sociodemographic characteristics, breast cancer exposure and screening attitudes, using an adapted Champion’s Health Belief Model Scale (CHBMS). We analyzed the association, unadjusted and adjusted, between sociodemographic characteristics, screening exposure, and CHBMS scores.Results:170 women completed surveys. Most (82.9%) were aware of screening, 48.5% knew someone with breast cancer, but only 42.5% had undergone screening, predominantly without their physician’s recommendation (63.2%). Despite elevated awareness, 76.2% had never discussed screening with their provider. Barriers included cost and mistreatment concerns. Education consistently predicted prior screening and most CHBMS scores.Conclusion:Armenian women are highly exposed to breast cancer, but knowledge and prior screening primarily emanate from non-physician sources. Results highlighted the influence of education, patient-provider relationships, and healthcare costs, underscoring the importance of multi-level interventions.

Background: Breast cancer is the most prevalent cancer among women worldwide. Due to its unknown causes, secondary prevention is highly encouraged for case early detection. Unfortunately, some women face difficulties in accessing it, even though they are covered by social health insurance. Objective: This study aimed to identify previous studies that mapped the various aspects within the domain of breast cancer screening access among low-income women under social health insurance. Design: This study used a scoping review method, following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Data Sources: The electronic databases were searched in PubMed, Scopus, and EBSCO identified 115 articles. After the selection process involves two main stages, we found 7 studies included for the full review. Methods: Data charting is used for the data extraction. Thematic analysis is conducted to address the research question. Results: Social Health Insurance has a positive influence on access to breast cancer screening. Based on the Levesque framework, access is conceptualized in five dimensions, namely approachability, acceptability, availability, affordability, and appropriateness. Some aspects are found as variations of the original concept proposed as evidence from the field. Conclusion: The Levesque framework remains relevant to the experiences of low-income women. The variations observed emphasize the need for tailored approaches to healthcare delivery, providing opportunities for improving access.

Purpose: In many fields, including bioinformatics, ensemble methods have been often employed to perform prediction tasks such as classification and regression due to their ability to improve the accuracy and robustness of machine learning models. Given that the most prevalent cancer and the primary cause of death for women is breast cancer, researchers have started using ensemble approaches to advance their studies in this area. Effectively, ensemble methods can be used to develop clinical decision support systems that can help healthcare providers make more accurate judgements. Methods: In the present study, we construct and evaluate bagging and boosting ensemble methods for the binary classification of breast cancer screening images from the CBIS-DDSM dataset. To build the bagging ensembles, a hybrid architecture consisting of three feature extractors (Inception V3, MobileNet V2, DenseNet 201) and four classifiers (K-nearest neighbors, Multilayer perceptron, Support vector machine, Decision trees) was chosen. As for the boosting ensembles, the method consists of the same three feature extractors with a decision trees-based classifier and the four boosting methods (AdaBoost, GBM, XGboost, LightGBM). Results: The evaluation of both ensemble methods over the mammography dataset was made using four performance metrics (accuracy, sensitivity, F1-score, and recall), as well as the Skott–Knott statistical test and the Borda count voting system to rank all the possible model combinations. Results proved that bagging and boosting ensembles generally outperformed both their base learners and single models, and that the best performing ensemble overall was Gradient boosting with DenseNet 201 as feature extractor and 200 trees which scored an accuracy of 85.50 %. Conclusions: The purpose of this research was to use hybrid learning based ensembles to maximize the potent performance of numerous models. It effectively illustrated the prospective potential of using ML approaches for the binary classification of mammography data used for breast cancer screening.

Background and purpose: Artificial intelligence (AI) technology is increasingly being used in the medical field. This study aimed to assess the effectiveness of artificial intelligence ultrasound system for identifying breast lesions in Chinese women and its role in breast cancer early detection. Methods: A prospective study was conducted on healthy women aged 35-74 years who came to Fudan University Shanghai Cancer Center from August 2020 to December 2020 for breast ultrasonography. All the women were examined by AI-assisted ultrasound first, and then by conventional ultrasonography. We compared the differences between AI-assisted ultrasound and conventional ultrasonography in identifying breast lesions in Chinese women. One year later, we looked up the hospital medical history and Shanghai Cancer Registration Management System for the final diagnosis of breast cancer. Results: A total of 360 women were included in the study and received breast examinations using both AI-assisted ultrasound and conventional ultrasound. A total of 2 504 breast lesions were detected, of which, 2 217 were detected by AI-assisted ultrasound, with a lesion recognition rate of 88.5%. Conventional ultrasound identified 1 090 lesions, with a lesion recognition rate of 43.5%. Using conventional ultrasound as the standard, the sensitivity and specificity of AI-assisted ultrasound for Breast Imaging Reporting and Data System (BI-RADS) level 4 and above lesions were 93.3% (95% CI: 80.7-98.3) and 100.0% (95% CI: 99.5-100.0), respectively. During one-year follow-up, 10 patients were diagnosed with breast cancer, and 8 of whom were identified by both AI-assisted ultrasound and conventional B ultrasound. The sensitivity of AI-assisted ultrasound and conventional ultrasound for breast cancer was 80.0% (95% CI: 44.2-96.4), and the specificity was 88.6% (95% CI: 84.6-91.6). Conclusion: AI-assisted ultrasound has good identification ability for breast lesions in Chinese women. The recognition ability for high-risk breast lesions (BI-RADS 4A and above) and early breast cancer is equivalent to that of conventional ultrasound, which is suitable for breast cancer screening in large-scale community of women with general risk.

Understanding the barriers to and facilitators of cancer screening programs among Indigenous populations remains limited. In the spirit of mutual respect, this co-led, collaborative project was carried out between the Métis Nation of Alberta and Screening Programs from Alberta Health Services (AHS). This scoping review assessed the cancer screening literature for available questionnaires and then identified themes and suitable questions for a Métis-specific cancer screening questionnaire. Literature searches on cervical, breast, and colorectal cancer screening programs and related concepts were conducted in electronic databases, including the Native Health Database, MEDLINE (Ovid), PsycINFO, PubMed, PubMed Central, CINAHL, MEDLINE (Ebsco), Psychology & Behavioral Sciences Collection, and Web of Science. Grey literature was collected from AHS Insite, Open Archives Initiative repository, American Society of Clinical Oncology, European Society of Medical Oncology, Google, and Google Scholar. 135 articles were screened based on the eligibility criteria with 114 articles selected, including 14 Indigenous-specific ones. Knowledge, attitude, belief, behaviour, barrier, and facilitator themes emerged from the review, but no Métis-specific cancer screening instruments were found. Thus, one was developed using existing cancer screening instruments, with additional questions created by the project team. A survey of the Métis population in Alberta will use this questionnaire and provide data to address the burden of cancer among Métis people.

Abstract Objective To present the update of the recommendations of the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology and the Brazilian Federation of Associations of Gynecology and Obstetrics for breast cancer screening in Brazil. Methods Scientific evidence published in Medline, EMBASE, Cochrane Library, EBSCO, CINAHL and Lilacs databases between January 2012 and July 2022 was searched. Recommendations were based on this evidence by consensus of the expert committee of the three entities. Recommendations Annual mammography screening is recommended for women at usual risk aged 40–74 years. Above 75 years, it should be reserved for those with a life expectancy greater than seven years. Women at higher than usual risk, including those with dense breasts, with a personal history of atypical lobular hyperplasia, classic lobular carcinoma in situ, atypical ductal hyperplasia, treatment for breast cancer or chest irradiation before age 30, or even, carriers of a genetic mutation or with a strong family history, benefit from complementary screening, and should be considered individually. Tomosynthesis is a form of mammography and should be considered in screening whenever accessible and available.

Abstract Background Breast cancer is among the most common cancers globally with a projected increase in incidence and mortality in low- and middle-income countries. The majority of the patients in East Africa present with advanced disease contributing to poor disease outcomes. Breast cancer screening enables earlier detection of the disease and therefore reduces the poor outcomes associated with the disease. This study aims to identify and synthesize the reported barriers and enablers of breast cancer screening among East African women. Methods Medline, Embase, SCOPUS, and Cochrane library were searched for articles published on the subject from start to March 2022 using PRISMA guidelines. Also, forward citation, manual search of references and searching of relevant journals were done. A thematic synthesis was carried out on the “results/findings” sections of the identified qualitative papers followed by a multi-source synthesis with quantitative findings. Results Of 4560 records identified, 51 were included in the review (5 qualitative and 46 quantitative), representing 33,523 women. Thematic synthesis identified two major themes – “Should I participate in breast cancer screening?” and “Is breast cancer screening worth it?”. Knowledge of breast cancer and breast cancer screening among women was identified as the most influencing factor. Conclusion This review provides a rich description of factors influencing uptake of breast cancer screening among East African women. Findings from this review suggest that improving knowledge and awareness among both the public and providers may be the most effective strategy to improve breast cancer screening in Eastern Africa.

Background: Global breast cancer incidence is increasing at an annual rate of 3·1%. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%). However, the data from different parts of India are still lacking and the study was conducted to assess the burden of disease at tertiary referral centers in central India. Material and Methods: Retrospective record analysis (June 2013–June 2017) of data from outdoor clinics and pathology reports. The patients aged 5 cm (72.6%). Immunohistochemistry and pathological analysis was done on core biopsy (n = 20) and surgical procedure (n = 60). Modified radical mastectomy was done in 52, breast conservative surgery with Sentinal Lymph node biopsy and axillary lymph node dissection in 6, and toilet mastectomy in two patients. The predominant tumors were solid (n = 79/80), with both solid and cystic types (1/80). The solid and cystic lesion on FNAC was of C3b type, and an excision biopsy revealed medullary carcinoma of the breast. Invasive ductal carcinoma-no special type (IDC-NST) was observed to be the most common histopathologic type (n = 70/80), followed by medullary carcinoma (n = 2), metaplastic carcinoma (n = 1), papillary carcinoma (n = 4), Paget disease with DCIS (n = 1), mucinous carcinoma (n = 1), invasive lobular carcinoma (n = 1). One male patient with breast cancer and two female patient having bilateral breast cancer also have IDC-NST.Scarff Bloom Richardson Grade was predominantly graded 2 in 46.25% (37/80) of breast cancer patients (Grade 1 = 9, Grade 2 = 37, Grade 3 = 34). Lymphovascular (LVI) and perineural invasion (PNI) were predominantly without LVI and PVI. (Lymphovascular present and perineural invasion present = 4, Lymphovascular present and perineural invasion absent = 32, Lymphovascular absent and perineural invasion absent = 42, Lymphovascular absent and perineural invasion present = 2). Histological examination of axillary lymph nodes showed the presence of malignant cells in all. Triple-negative breast carcinoma was 26.58% (21/79). Most breast cancer presented at stage II A = 37.5% (30/80) and II B = 28.7% (23/80) of the AJCC staging system. Conclusion: The clinico-epidemio and histological profile of breast cancer in Chhattisgarh is similar to other parts of India. Scarff Bloom Richardson Grade was predominantly grade 2 in 46.25% (37/80) contrary to Grade III (70%) in other series from India.

The evidence shows that risk-based strategy could be implemented to avoid unnecessary harm in mammography screening for breast cancer (BC) using age-only criterium. Our study aimed at identifying the uptake of Slovenian women to the BC risk assessment invitation and assessing the number of screening mammographies in case of risk-based screening.

Abstract Background Numerous studies over the past four decades have revealed that breast cancer screening (BCS) significantly reduces breast cancer (BC) mortality. However, in BRICS-plus countries, the association between BCS and BC case fatality and disability are unknown. This study examines the association of different BCS approaches with age-standardized mortality, case-fatality, and disability-adjusted life years (DALYs) rates, as well as with other biological and sociodemographic risk variables, across BRICS-plus from a national and economic perspective. Methods In this ecological study applying mixed-effect multilevel regression models, a country-specific dataset was analyzed by combining data from the Global Burden of Disease study 2019 on female age-standardized BC mortality, incidence, and DALYs rates with information on national/regional BCS availability (against no such program or only a pilot program) and BCS type (only self-breast examination (SBE) and/or clinical breast examination (CBE) [SBE/CBE] versus SBE/CBE with mammographic screening availability [MM and/or SBE/CBE] versus SBE/CBE/mammographic with digital mammography and/or ultrasound (US) [DMM/US and/or previous tests] in BRICS-plus countries. Results Compared to self/clinical breast examinations (SBE/CBE) across BRICS-plus, more complex BCS program availability was the most significant predictor of decreased mortality [MM and/or SBE/CBE: − 2.64, p

Abstract Aim The aim of this study was to summarize the latest research reports about immigrant women and attendance in breast cancer screening. Design Scoping review. Methods Literature searches were made in CINAHL, PubMed, Web of Science, Google Scholar, Oatd and Oalster. Twenty‐three articles were included in the study. Data were analysed with inductive content analysis. Results Out of data four main categories were formed: attendance rates, incidence, barriers and facilitators, and knowledge and perception. The results show that attendance rates, barriers and facilitators for attendance, knowledge and experience of breast cancer and breast cancer screening differ between several factors such as the woman's migrant background, country of origin, religion, length of stay in the new home country and sociodemographic factors.

Assessing a woman’s risk of breast cancer is important for personalized screening. Mammographic density is a strong risk factor for breast cancer, but parenchymal texture patterns offer additional information which cannot be captured by density. We aimed to combine BI-RADS density score 4th Edition and a deep-learning-based texture score to stratify women in screening and compare rates among the combinations. This retrospective study cohort study included 216,564 women from a Danish populations-based screening program. Baseline mammograms were evaluated using BI-RADS density scores (1–4) and a deep-learning texture risk model, with scores categorized into four quartiles (1–4). The incidence rate ratio (IRR) for screen-detected, interval, and long-term cancer were adjusted for age, year of screening and screening clinic. Compared with subgroup B1-T1, the highest IRR for screen-detected cancer were within the T4 category (3.44 (95% CI: 2.43–4.82)−4.57 (95% CI: 3.66–5.76)). IRR for interval cancer was highest in the BI-RADS 4 category (95% CI: 5.36 (1.77–13.45)−16.94 (95% CI: 9.93–30.15)). IRR for long-term cancer increased both with increasing BI-RADS and increasing texture reaching 5.15 (4.31–6.16) for the combination of B4-T4 compared with B1-T1. Deep-learning-based texture analysis combined with BI-RADS density categories can reveal subgroups with increased rates beyond what density alone can ascertain, suggesting the potential of combining texture and density to improve risk stratification in breast cancer screening.

Background and Objectives: Breast cancer is one of the most widespread cancers among the female population around the world and is curable if diagnosed in an early stage. Consequently, breast cancer screening imaging techniques have greatly evolved and adjusted over the last decades. Alongside mammography, sonoelastography became an important tool for breast cancer detection. However, sonoelastography still has its limitations, namely, there is still a high occurrence of false positive results in the BIRADS 4 category. The aim of our study is to identify potential false positive predictors and to ascertain the factors influencing the quality of strain ultrasound elastography for the evaluation of suspicious solid breast lesions categorized as BIRADS 4B, 4C, and 5. Materials and Methods: We conducted a retrospective study in a single private medical center in Timisoara between January 2017 and January 2022 analyzing 1625 solid breast lesions by the sonoelastography strain using a standardized BIRADS-US lexicon. Results: Our study showed that most sonoelastography factors linked to incorrect and overdiagnosis were due to a nodule dimension (OR = 1.02 per unit increase), posterior acoustic shadowing (OR = 12.26), reactive adenopathy (OR = 6.35), and an increased TES score (TES3 OR = 6.60; TES4 OR = 23.02; TES5 OR = 108.24). Regarding patient characteristics, age (OR = 1.09 per unit increase), BMI, (OR = 1.09 per unit increase), and breastfeeding history (OR = 3.00) were observed to increase the likelihood of false positive results. On the other hand, the nodules less likely to be part of the false positive group exhibited the following characteristics: a regular shape (OR = 0.27), homogenous consistency (OR = 0.42), and avascularity (OR = 0.22). Conclusions: Older age, high BMI, patients with a breastfeeding history, and those who exhibit the following specific nodule characteristics were most often linked to false positive results: large tumors with posterior acoustic shadowing and high elasticity scores, accompanied by reactive adenopathy. On the other hand, homogenous, avascular nodules with regular shapes were less likely to be misdiagnosed.

Abstract Background In Germany, all women aged 50–69 have been invited to biennial mammography screening since 2009. We aimed to assess longitudinal adherence over ten years in women aged 50 in 2009 and characterize the different adherence groups. Methods Using the German Pharmacoepidemiological Research Database (GePaRD, ~ 20% of the German population), we included women aged 50 in 2009 (baseline) with continuous health insurance coverage and without breast cancer or in-situ-carcinoma. We followed them until age 59 and categorized them according to mammography screening participation into the following groups: never, 1–2, 3–4, 5–6 times. We characterized these groups, inter alia, regarding the use of other preventive measures, non-screening mammography (i.e., mammography outside the organized screening program) and menopausal hormone therapy. Results Overall, 82,666 women were included. Of these, 27.6% never participated in the screening program, 15.1% participated 1–2 times, 31.7% participated 3–4 times and 25.6% participated regularly (5–6 times). Among regular participants, 91% utilized other preventive measures (e.g., cervical cancer screening, general health checkup) before baseline as compared to 66% among non-participants. Menopausal hormone therapy was least common among non-participants (11% vs. 18% among regular participants). Among non-participants, the proportions using ≥ 1, ≥ 2, and ≥ 3 non-screening mammographies between age 50–59 were 25%, 18%, and 15%, respectively. Conclusions Using a large cohort based on claims data, this study provides novel insights into longitudinal adherence to the mammography screening program and the use of mammography outside of the program in Germany. Between age 50–59, 57% of eligible women participated at least three times in the German mammography screening program and 28% (~ 3 in 10 women) never participated. Among non-participants, 15% had at least three non-screening mammographies during this period, indicating potential gray screening. Participants more often utilized other preventive measures as compared to non-participants.

Abstract Background The Coronavirus disease 2019 (COVID-19) pandemic has placed a great burden on Taiwan’s health care system. It has also had a great impact on other public health issues, including cancer screening. Delayed cancer screening was also noticed in the U.S. during the pandemic, which may have led to both delayed diagnosis and poor prognosis. In Taiwan, population-based cancer screening for breast cancer, oral cancer, colon cancer and cervical cancer has been executed and ongoing for years. Method In this study we have analyzed the change in screening numbers for cancer during the period of the 2019 to 2021 COVID-19 outbreak in Taiwan. Results Through our results we found that total cancer screening numbers decreased from 307,547 to 103,289 (a 66% decrease) from the years 2020 to 2021. Specifically, a 63%, 79%, 65% and 71% decrease in screening cases was seen for colon cancer, oral cancer, cervical cancer and breast cancer, respectively, during that period. A similar condition was noticed when comparing 2019 to 2021 when the disclosed total cancer screening numbers decreased by 70% (2019–2021); 65%, 83%, 70% and 76% in colon cancer, oral cancer, cervical cancer and breast cancer, respectively. Among these various cancer screenings, oral cancer screening showed the greatest reduction rate (a drop of 83% compared to 2019 and 79% compared to 2020). We also compared the reduction rates taken from different regions in Taiwan. It was in Taipei, where most COVID-19 cases were noted, that the greatest reduction rate of cancer screening numbers occurred (a drop of76% compared to 2019 and 74% compared to 2020). A proportional decrease of screening cases was also noticed in all areas when confirmed COVID-19 cases rose. Conclusions Screening for cancers dropped significantly due to the pandemic and its effect on long-term health needs to be evaluated. Additionally, efforts should be taken to address these cancer screening number deficits which have taken place during the COVID-19 pandemic.

Abstract Background Many upper-middle-income countries (UMICs), including Malaysia, continue to face low breast cancer (BC) screening rates and patients with delayed presentation of BC. This study investigated the role of beliefs about BC and use of screening (e.g. beliefs about whether or not screening reduced the possibility of dying from BC). Methods A nationwide cross-sectional study was conducted in which a total of 813 women (aged ≥ 40 years old) were randomly selected and surveyed using the validated Awareness and Beliefs about Cancer (ABC) measure. The association between BC screening use, sociodemographic characteristics, and negative beliefs about BC screening were analysed using stepwise Poisson regressions. Results Seven out of ten Malaysian women believed that BC screening was necessary only when experiencing cancer symptoms. Women > 50 years and from households with more than one car or motorcycle were 1.6 times more likely to attend a mammogram or a clinical breast examination (mammogram: Prevalence Ratio (PR) = 1.60, 95% Confidence Interval (CI) = 1.19–2.14, Clinical Breast Examination (CBE): PR = 1.61, 95% CI = 1.29–1.99). About 23% of women expected to feel anxious about attending BC screening, leading them to avoid the procedure. Women who held negative beliefs about BC screening were 37% less likely to attend a mammogram (PR = 0.63, 95% CI = 0.42–0.94) and 24% less likely to seek a CBE (PR = 0.75, 95% CI = 0.60–0.95). Conclusions Public health strategies or behaviour interventions targeting negative beliefs about BC screening among Malaysian women may increase uptake and reduce late presentation and advanced-stage cancer. Insights from the study suggest that women under 50 years, in the lower income group without a car or motorcycle ownership, and of Malay or Indian ethnicity (compared to Chinese-Malay) are more likely to hold beliefs inhibiting BC screening.

IntroductionThis scoping review aims to highlight key social determinants of health associated with breast cancer screening behavior in United States women aged ≥40 years old, identify public and private databases with SDOH data at city, state, and national levels, and share lessons learned from United States based observational studies in addressing SDOH in underserved women influencing breast cancer screening behaviors.MethodsThe Arksey and O’Malley York methodology was used as guidance for this review: (1) identifying research questions; (2) searching for relevant studies; (3) selecting studies relevant to the research questions; (4) charting the data; and (5) collating, summarizing, and reporting results.ResultsThe 72 included studies were published between 2013 and 2023. Among the various SDOH identified, those related to socioeconomic status (n = 96) exhibited the highest frequency. The Health Care Access and Quality category was reported in the highest number of studies (n = 44; 61%), showing its statistical significance in relation to access to mammography. Insurance status was the most reported sub-categorical factor of Health Care Access and Quality.DiscussionResults may inform future evidence-based interventions aiming to address the underlying factors contributing to low screening rates for breast cancer in the United States.

Background: and purpose:In France, women lack information to make a shared decision to start breast cancer screening. Decision aids are useful to facilitate this discussion, yet few meet international standards. The objective of this project was to build, validate and measure the quality of a decision aid for organized breast screening in France, in line with international standards, intended for both women and healthcare professionals. Materials and methods: This mixed-methods study was conducted between January 2017 and June 2022. The prototype was developed from a qualitative study, systematic review and targeted literature review and alpha tested during two Delphi rounds. Readability was evaluated with the Flesch score and content with International Patient Decision Aid Standards Instrument (IPSASi). Results: An online decision aid, accessible at www.Discutons-mammo.fr, written in French was developed. The content included eligibility, information about breast screening the advantages and disadvantages of screening, patient preferences and a patient-based discussion guide using text, infographics, and videos. The Flesch readability test score was 65.4 and the IPDASi construct quality score was 176 out of 188. Conclusions: This decision aid complies with IPDASi standards and could help women eligible for breast screening in France make a shared decision with a specialized healthcare professional about whether or not to participate in organized breast screening.

BackgroundBreast 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.MethodsWomen 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.ResultsXGBoost (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.ConclusionThe 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.

Strategies to ramp up breast cancer screening after COVID-19 require data on the influence of the pandemic on groups of women with historically low screening uptake. Using data from Ontario, Canada, our objectives were to 1) quantify the overall pandemic impact on weekly bilateral screening mammography rates (per 100,000) of average-risk women aged 50–74 and 2) examine if COVID-19 has shifted any mammography inequalities according to age, immigration status, rurality, and access to material resources. Using a segmented negative binomial regression model, we estimated the mean change in rate at the start of the pandemic (the week of March 15, 2020) and changes in weekly trend of rates during the pandemic period (March 15—December 26, 2020) compared to the pre-pandemic period (January 3, 2016—March 14, 2020) for all women and for each subgroup. A 3-way interaction term (COVID-19*week*subgroup variable) was added to the model to detect any pandemic impact on screening disparities. Of the 3,481,283 mammograms, 8.6 % (n = 300,064) occurred during the pandemic period. Overall, the mean weekly rate dropped by 93.4 % (95 % CI 91.7 % – 94.8 %) at the beginning of COVID-19, followed by a weekly increase of 8.4 % (95 % CI 7.4 % – 9.4 %) until December 26, 2020. The pandemic did not shift any disparities (all interactions p > 0.05) and that women who were under 60 or over 70, immigrants, or with a limited access to material resources had persistently low screening rate in both periods. Interventions should proactively target these underserved populations with the goals of reducing advanced-stage breast cancer presentations and mortality.

BackgroundEconomic evaluations have become an accepted methodology for decision makers to allocate resources in healthcare systems. Particularly in screening, where short-term costs are associated with long-term benefits, and adverse effects of screening intermingle, cost-effectiveness analyses provide a means to estimate the economic value of screening.PurposeTo introduce the methodology of economic evaluations and to review the existing evidence on cost-effectiveness of MR-based breast cancer screening.Materials and methodsThe various concepts and techniques of economic evaluations critical to the interpretation of cost-effectiveness analyses are briefly introduced. In a systematic review of the literature, economic evaluations from the years 2000-2022 are reviewed.ResultsDespite a considerable heterogeneity in the reported input variables, outcome categories and methodological approaches, cost-effectiveness analyses report favorably on the economic value of breast MRI screening for different risk groups, including both short- and long-term costs and outcomes.ConclusionEconomic evaluations indicate a strongly favorable economic value of breast MRI screening for women at high risk and for women with dense breast tissue.

Objective: To investigate the joint impact of sexual orientation, gender identity, and race/ethnicity on colorectal and breast cancer screening disparities in the United States. Methods: Utilizing sampling weighted data from the 2016 and 2018 Behavioral Risk Factor Surveillance System, we assessed differences in two metrics via chi-square statistics: 1) lifetime uptake, and 2) up-to-date colorectal and breast cancer screening by sexual orientation and gender identity, within and across racial/ethnic classifications. Results: Within specific races/ethnicities, lifetime CRC screening was higher among gay/lesbian (within NH-White, Hispanic, and Asian/Pacific Islander) and bisexual individuals (Hispanic) compared to straight individuals, and lowest overall among transgender women and transgender nonconforming populations (p

The level of participation in cancer screening is low in the Polish population. The aim of this study was to assess the opinions of centers providing cancer screening as to the reasons for the low frequency of cancer screening in Poland and possible methods to increase participation. In July 2020 433 centers in Poland carried out breast and/or cervical cancer screening. Of these, 136 centers decided to participate in the study. The study was conducted using an original questionnaire. The questions were addressed to opinion of centers about: reasons for the low frequency of cancer screening in Poland, methods to increase the frequency of cancer screening, pricing and motivating factors for providing cancer screening. Among opinions as to possible reasons for the low frequency of cancer screening in Poland related to the care-system, lack of encouragement from general practitioners, lack of invitations for cancer screening and lack of proper social advertising were most prevalent; whereas among reasons related to patients, a low awareness of cancer screening and fear of cancer diagnosis. The main methods that could potentially increase screening participation are considered to be the inclusion of cancer screening in mandatory periodic employee examinations, more activity by general practitioners, better promotion of screening by central institutions, and sending personal invitations. In conclude some interventions should be carried out to motivate people to break down barriers.

Purpose: To evaluate the stand-alone diagnostic performances of AI-CAD and outcomes of AI-CAD detected abnormalities when applied to the mammographic interpretation workflow. Methods: From January 2016 to December 2017, 6499 screening mammograms of 5228 women were collected from a single screening facility. Historic reads of three radiologists were used as radiologist interpretation. A commercially-available AI-CAD was used for analysis. One radiologist not involved in interpretation had retrospectively reviewed the abnormality features and assessed the significance (negligible vs. need recall) of the AI-CAD marks. Ground truth in terms of cancer, benign or absence of abnormality was confirmed according to histopathologic diagnosis or negative results on the next-round screen. Results: Of the 6499 mammograms, 6282 (96.7%) were in the negative, 189 (2.9%) were in the benign, and 28 (0.4%) were in the cancer group. AI-CAD detected 5 (17.9%, 5 of 28) of the 9 cancers that were intially interpreted as negative. Of the 648 AI-CAD recalls, 89.0% (577 of 648) were marks seen on examinations in the negative group, and 267 (41.2%) of the AI-CAD marks were considered to be negligible. Stand-alone AI-CAD has significantly higher recall rates (10.0% vs. 3.4%, P

Objective: Supporting patient-clinician communication is key to implementing tailored, risk-based screening for older adults. Objectives of this multiphase mixed methods study were to identify factors that primary care clinicians consider influential when making screening mammography recommendations for women ≥75 years, develop a patient decision aid that incorporates these factors, and gather feasibility and acceptability from the patients’ perspective. Methods: Clinicians from a Mid-Atlantic practice network completed online surveys. Women in the same network completed surveys before and after receiving a tailored booklet that included information about the benefits and harms of screening for women ≥ 75 years, a breast cancer risk-estimate, and a question prompt list to support patient-clinician communication Results: Clinicians (N=21) were primarily women [57.1%] and practiced family medicine [81.0%]. They cited patients’ age ≥75 years [95.4%], comorbidity [86.4%], functional status [77.3%], cancer family history [63.6%], U.S. Preventive Services Task Force guidelines [81.8%] and new research [77.3%] as factors influencing their recommendations. Fourteen women completed baseline surveys and received personalized decision aids (Mean age=79.1 years). Eleven completed the post-intervention survey. All were satisfied with the booklet length, 81.8% found the booklet easy to understand and 72.7% helpful in decision-making Perceived lifetime breast cancer risk decreased significantly from pre- to post-intervention (p = 0.02). Conclusions: Results suggest this decision aid, which incorporates key decisional factors from the clinician's perspective, is feasible and acceptable to patients. Innovation: A tailored decision aid booklet is innovative as it provides information on personalized risk and potential benefits and harms to older women considering screening.

Abstract Background Double reading (DR) in screening mammography increases cancer detection and lowers recall rates, but has sustainability challenges due to workforce shortages. Artificial intelligence (AI) as an independent reader (IR) in DR may provide a cost-effective solution with the potential to improve screening performance. Evidence for AI to generalise across different patient populations, screening programmes and equipment vendors, however, is still lacking. Methods This retrospective study simulated DR with AI as an IR, using data representative of real-world deployments (275,900 cases, 177,882 participants) from four mammography equipment vendors, seven screening sites, and two countries. Non-inferiority and superiority were assessed for relevant screening metrics. Results DR with AI, compared with human DR, showed at least non-inferior recall rate, cancer detection rate, sensitivity, specificity and positive predictive value (PPV) for each mammography vendor and site, and superior recall rate, specificity, and PPV for some. The simulation indicates that using AI would have increased arbitration rate (3.3% to 12.3%), but could have reduced human workload by 30.0% to 44.8%. Conclusions AI has potential as an IR in the DR workflow across different screening programmes, mammography equipment and geographies, substantially reducing human reader workload while maintaining or improving standard of care. Trial registration ISRCTN18056078 (20/03/2019; retrospectively registered).