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We conducted an anonymous self-administered questionnaire survey of 330 mothers with children required to undergo a health checkup for one-year and six-month old infants in City A to clarify related factors which caused the mothers to undergo cervical and breast cancer screenings or to perform self-examinations for these cancers. Subjects of the analysis were 193 mothers whose responses were deemed valid (response rate: 58.5%). Their average age was 34.5 years. Logistic regression analysis with whether a cancer screening test or self-examination was implemented or not chosen as a dependent variable revealed that age and disorder before receiving a screening test were related to cervical cancer, and that age, low awareness of the importance of screening, and subjective norm were related to breast cancer. Anxiety about breast cancer, burden of self-examination versus self-efficacy, and low awareness of the importance versus benefit of medical examination were related to self-examination. Because items found in the health behavior theory were related to both screening tests and self-examination, promoting screening tests by doctors and self-examination requires the creation of an environment where women with children can undergo screening tests more easily and support in learning how to perform self-examinations., 育児中の母親における子宮頸がん及び乳がん検診の受診と乳がん自己検診（以下、自己検診）の関連要因を健康行動理論を用いて明らかにするため、A 市の1歳6か月児健康診査の対象の児の母親330人を対象に無記名自記式質問紙調査を行った。 有効回答（率）の193人（58.5%）を分析対象とし、平均年齢は34.5歳であった。検診受診及び自己検診実施の有無を従属変数とするロジスティック回帰分析の結果、子宮頸がん検診受診には年齢、検診受診前の障害が、乳がん検診受診には年齢、検診の重要性の低さ、主観的規範が関連していた。自己検診実施には、乳がんへの懸念、自己検診の負担と自己効力、検診の重要性の低さと利益が関連していた。いずれの検診にも健康行動理論の項目が関連していたことより、検診の促進には育児中の女性が検診しやすい環境整備や自己検診の方法の習得への支援が必要である。

Breast cancer is the most commonly diagnosed female cancer and the leading cause of cancer death. Early detection and treatment are important to reduce the number of deaths. Japan recommends mammography every two years for women over 40 years of age. However, in recent years, an increasing number of younger women have been undergoing breast cancer screening (BCS). To reduce the harms of BCS among young adults, our study extracted data from an online survey conducted in 2018 and applied χ2 tests and logistic analysis to identify the influencing factors regarding interest in undergoing BCS. The results of our analysis support the need for a reduction in the BCS rate through awareness regarding the harms of health screening among young people. In particular, for those who receive BCS through occupational screening, we believe that improving education on breast awareness, the accuracy of occupational screening, and breast self-examination methods could reduce the harms from BCS in younger age groups.

Mechanical ventilation (MV) occupies a critical position in the field of modern clinical medicine. MV is an effective mean to artificially replace, control, or change spontaneous breathing movement and ventilation function. Therefore, it has been widely used in respiratory failure caused by various reasons, breathing management of anesthesia during major surgery, supportive respiratory care and emergency resuscitation. However, most the traditional ventilators can only provide one-dimensional information such as pressure. Such comprehensive information cannot analyze the local lung injury. Electrical impedance tomography (EIT) is a very promising imaging technique. After the electric field is applied, the induced boundary voltages can be measured to image the spatial conductivity distribution of the sensing region bounded by electrodes. EIT has the advantages of high speed, high temporal resolution, low-cost, non-invasive, and radiation-free, etc., which makes it arouse wide attention and interest in the field of biomedical imaging. Well-studied biomedical clinical applications of EIT include breast and prostate cancer screening, functional brain imaging, thoracic imaging, and lung ventilation monitoring. Therefore, it shows excellent potential in organ characterization, where experimental samples have the same electrical properties as tissues of the human body. This PhD work mainly explores the possibility of more emerging biomedical applications of EIT in pulmonary ventilation monitoring. The combination of EIT and ventilator realized real-time pulmonary monitoring and control, expanded the dimension of useful information and clearly saw the volume change of the lung, which could help doctors better analyze the quality of lung function. This work aims to construct a novel and intelligent EIT-guided mechanical ventilation modality, to evaluate the possibility of this medical device qualitatively and quantitatively, and to improve its performance in real-time 3D monitoring. Around this topic, the contributions of this thesis can be summarized from the aspects of Towards Intelligent Mechanical Ventilation Guided by Electrical Impedance Tomography mechanical ventilation system combined with ultrasonic sensor design, realtime and effective EIT reconstruction algorithm for monitoring respiratory status, EIT-based automated ventilation system and deep learning-based EIT reconstruction algorithm. A control system study was first developed to complete a single-variablecontrolled mechanical ventilation device. Firstly, three-dimensional lung imaging was studied through single-layer electrodes. Compared to traditional algorithms, this 3D algorithm proposed in the work achieved a correlation coefficient of 0.8. In addition, the tidal volume information was extracted from the 2D and 3D reconstructed images as the feedback input of the control system to realize closed-loop control. The simulation has been implemented and the results show that the error is controlled to within 3%. In the work, an active disturbance rejection control method with excellent anti-interference ability was designed to improve the stability of the system. According to the simulation results, the rise time of the system can be improved by 12.8%. At the same time, the error of the experimental results can be reduced by 22.2%. The evaluation results show that the proposed EIT-guided MV system is a powerful tool for real-time 2D and 3D biomedical imaging. The quality of tomographic images is vital for qualitative or quantitative analysis in biomedical applications. Finally, in order to achieve high-quality conductivity imaging, two deep learning-based image reconstruction algorithms were proposed. The RP-UNet algorithm has a structural similarity of 96.99% and a correlation coefficient of 97.27%. The proposed algorithm exhibits excellent spatial resolution and better noise reduction performance in reconstructed images. In conclusion, the work presented in this thesis validates the feasibility of the proposed image reconstruction algorithm using the developed EIT-guided mechanical ventilation system. It also demonstrates the potential of EIT for biomedical research and medical devices.

Objectives To explore barriers to cervical and colorectal cancer screening and attitudes to promotion of self-sampling kits upon attendance for breast cancer screening. Methods Interview study with women who had not responded to one or more invitations to cervical or colorectal cancer screening. A semi-structured interview guide was used and interviews were audio recorded and transcribed verbatim. Concepts from Temporal Motivation Theory were used to structure and analyse the data. Results Twenty-two women were interviewed. Screening was highly valued but the women perceived screening for cervical cancer and colorectal cancer as more troublesome to participate in, compared with participation in breast cancer screening. The lack of a pre-booked appointment or a suggested deadline attenuated the perceived value of cervical and colorectal cancer screening and this further increased procrastination. Promotion of self-sampling kits for cervical and colorectal cancer screening upon attendance for breast cancer screening was considered a feasible way to increase salience of both types of screening. Conclusion A high number of micro steps and absence of a deadline in cervical and colorectal cancer screening diverted attention away from screening participation in cervical and colorectal cancer screening. The main facilitator could be reduction of micro actions, proposing a suggested deadline, and promotion of self-sampling kits when attending breast cancer screening to increase salience and a renewed attention to all three screening programmes.

Rationale and Objectives To quantitatively compare breast parenchymal texture between two Digital Breast Tomosynthesis (DBT) vendors using images from the same patients. Materials and Methods This retrospective study included consecutive patients who had normal screening DBT exams performed in January 2018 from GE and normal screening DBT exams in adjacent years from Hologic. Power spectrum analysis was performed within the breast tissue region. The slope of a linear function between log-frequency and log-power, β, was derived as a quantitative measure of breast texture and compared within and across vendors along with secondary parameters (laterality, view, year, image format, and breast density) with correlation tests and t-tests. Results A total of 24,339 DBT slices or synthetic 2D images from 85 exams in 25 women were analyzed. Strong power-law behavior was verified from all images. Values of β d did not differ significantly for laterality, view, or year. Significant differences of β were observed across vendors for DBT images (Hologic: 3.4±0.2 vs GE: 3.1±0.2, 95% CI on difference: 0.27 to 0.30) and synthetic 2D images (Hologic: 2.7±0.3 vs GE: 3.0±0.2, 95% CI on difference: -0.36 to -0.27), and density groups with each vendor: scattered (GE: 3.0±0.3, Hologic: 3.3±0.3) vs. heterogeneous (GE: 3.2±0.2, Hologic: 3.4±0.1), 95% CI (-0.27, -0.08) and (-0.21, -0.05), respectively. Conclusion There are quantitative differences in the presentation of breast imaging texture between DBT vendors and across breast density categories. Our findings have relevance and importance for development and optimization of AI algorithms related to breast density assessment and cancer detection.

The successful intervention of breast cancer relies on effective early detection and definitive diagnosis. While conventional screening mammography has substantially reduced breast cancer-related mortalities, substantial challenges persist in women with dense breasts. Additionally, complex interrelated risk factors and healthcare disparities contribute to breast cancer-related inequities, which restrict accessibility, impose cost constraints, and reduce inclusivity to high-quality healthcare. These limitations predominantly stem from the inadequate sensitivity and clinical utility of currently available approaches in increased-risk populations, including those with dense breasts, underserved and vulnerable populations. This PhD dissertation aims to describe the development and validation of alternative, cost-effective, robust, and high-resolution systems for point-of-care (POC) breast cancer screening and image-guided needle interventions. Specifically, 2D and 3D ultrasound (US) and positron emission mammography (PEM) were employed to improve detection, independent of breast density, in conjunction with mechatronic and automated approaches for accurate image acquisition and precise interventional workflow. First, a mechatronic guidance system for US-guided biopsy under high-resolution PEM localization was developed to improve spatial sampling of early-stage breast cancers. Validation and phantom studies showed accurate needle positioning and 3D spatial sampling under simulated PEM localization. Subsequently, a whole-breast spatially-tracked 3DUS system for point-of-care screening was developed, optimized, and validated within a clinically-relevant workspace and healthy volunteer studies. To improve robust image acquisition and adaptability to diverse patient populations, an alternative, cost-effective, portable, and patient-dedicated 3D automated breast (AB) US system for point-of-care screening was developed. Validation showed accurate geometric reconstruction, feasible clinical workflow, and proof-of-concept utility across healthy volunteers and acquisition conditions. Lastly, an orthogonal acquisition and 3D complementary breast (CB) US generation approach were described and experimentally validated to improve spatial resolution uniformity by recovering poor out-of-plane resolution. These systems developed and described throughout this dissertation show promise as alternative, cost-effective, robust, and high-resolution approaches for improving early detection and definitive diagnosis. Consequently, these contributions may advance breast cancer-related equities and improve outcomes in increased-risk populations and limited-resource settings.

Background Breast Cancer (BC) is the most common malignancy among female population. Its promotion and its early detection constitute very challenging for the treatment and the survivorship. It is well known that family caregivers (FMCs) have lack of knowledge in breast cancer screening and low rates of preventing behaviors. Aim The purpose of the study was to investigate the perceptions and beliefs of FMCs and HCPs regarding the early detection and breast cancer screening. Method A Qualitative focus group design was implemented and purposive sampling with predefined inclusion and exclusion criteria was used. A total of 3 focus groups were held in which 9 FMCs and 5 HCPs took part. Results A thematic analysis of the data was done using NVivo 12 in which 4 thematic groups emerged. The knowledge and perceptions about BC, the preventive behaviors and attitudes about BC, the barriers breast cancer screening, and the awareness of the prevention of BC were the 4 themes. Conclusion Knowledge, beliefs, family history and social support were motivating factors. While burden of care, cancer experience and lack of knowledge in BSE were the barriers. Campaigns and educational programs are recommended to promote breast health among FMCs. O καρκίνος του μαστού (ΚΜ) αποτελεί την μεγαλύτερη πρόκληση στον γυναικείο πληθυσμό ως η πιο συχνή κακοήθεια και καθιστά σημαντική την πρόληψη και την έγκαιρη διάγνωση του. Οι οικογενειακοί φροντιστές (ΟΦ) έχει διαπιστωθεί ότι έχουν μειωμένο επίπεδο γνώσης για τους προληπτικούς ελέγχους του ΚΜ και χαμηλά ποσοστά προληπτικών συμπεριφορών. Σκοπός Σκοπός της έρευνας ήταν η διερεύνηση των αντιλήψεων και πεποιθήσεων των οικογενειακών φροντιστών (ΟΦ) και των επαγγελματιών υγείας (ΕΥ) ως προς την έγκαιρη ανίχνευση και τον προληπτικό έλεγχο του ΚΜ. Μέθοδος Εφαρμόστηκε ο ποιοτικός σχεδιασμός με ομάδες εστίασης και χρησιμοποιήθηκε σκόπιμη δειγματοληψία με προκαθορισμένα κριτήρια ένταξης και αποκλεισμού. Συνολικά πραγματοποιήθηκαν 3 ομάδες εστίασης στις οποίες έλαβαν μέρος 9 ΟΦ και 5 ΕΥ. Αποτελέσματα Έγινε θεματική ανάλυση των δεδομένων με την χρήση του NVivo 12 κατά την οποία προέκυψαν 4 θεματικές ομάδες, οι γνώσεις και αντιλήψεις για τον ΚΜ, οι προληπτικές συμπεριφορές και στάσεις για τον ΚΜ, τα εμπόδια για τον Προ – συμπτωματικό έλεγχο για τον ΚΜ και οι ευαισθητοποίηση – προτροπή για την πρόληψη του ΚΜ. Συμπεράσματα Οι γνώσεις, τα πιστεύω, το οικογενειακό ιστορικό και οι κοινωνική στήριξη αποτελούσαν προτρεπτικούς παράγοντες για την διενέργεια προ-συμπτωματικού ελέγχου, ενώ ο φόρτος της φροντίδας, τα βιώματα του καρκίνου και η έλλειψη γνώσης για την ΑΕΜ ήταν αποτρεπτικοί παράγοντες. Συνίσταται η διοργάνωση εκστρατειών και εκπαιδευτικών προγραμμάτων που θα προάγουν την υγεία του μαστού των οικογενειακών φροντιστών. Completed

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 if and when they started 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: PR = 1.60, 95% CI = 1.19–2.14, CBE: PR = 1.61, 95%CI 1.29–1.99). Approximately one quarter of women (23%) reported anticipated anxiety about attending BC screening to the extent that they would avoid undergoing 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 There is a need for public health strategies designed to change beliefs about BC screening among Malaysian women as a way of increasing uptake and impacting on late presentation and advanced cancer. The results provide insights about targeting of public health strategies – women with BC screening uptake-inhibiting beliefs tend to be under 50 years, in the lower income group (that do not own a car or a motorcycle) and more likely to be ethnic Malay or Indian (compared to Chinese-Malay).

Breast cancer is the second most common cancer in Peruvian women. Due to limitations in national breast cancer screening programs, especially in rural areas, more than 50% of cases of breast cancer in Peru are diagnosed in advanced stages. In collaboration with a local clinic registered as a nongovernmental organization (CerviCusco), RAD-AID International aims to create a sustainable diagnostic structure to improve breast cancer screening in Cuzco. With the support of local, national, and international partners that have collaborated in analyzing radiological resources, raising awareness in the population, acquiring equipment, training clinical staff, and building referral networks, our teams of radiologists, included in the RAD-AID team, have participated in training CerviCusco staff in breast ultrasound, thus enabling additional training for radiology residents through a regulated international collaboration.

BACKGROUND: Ultrasound is commonly used in breast cancer screening but lacks quantification ability and diagnostic power due to its low specificity, which can lead to overdiagnosis and unnecessary biopsies. This study evaluated the diagnostic efficacy and clinical utility of adding shear-wave elastography (SWE) to the screening of the Breast Imaging Reporting and Data System (BI-RADS) category 4 breast cancer. METHODS: A machine learning–based diagnostic model was constructed using data retrospectively collected from 3 independent cohorts with features selected using lasso regression and support vector machine-recursive feature elimination algorithms. Propensity score matching (PSM) was used to preclude confounding baseline characteristics between malignant and benign lesions. A decision curve analysis (DCA) was used to evaluate the clinical benefit of the diagnostic model in identifying high-risk tumor patients for intervention while simultaneously avoiding overtreatment of low-risk patients with integrative evaluation using a net benefit value and treatment reduction rate. RESULTS: In our training center, a total of 122 patients were enrolled, and 577 breast tumors were collected. The comparison between malignant and benign lesions revealed significant differences in patient age, tumor size, resistance index (RI), and elasticity values. The maximum elasticity value (Emax) was identified as an independent diagnostic feature and was included in the diagnostic model. The combination of Emax with BI-RADS category 4 demonstrated a significantly better diagnostic efficacy than the BI-RADS category alone [BI-RADS+Emax: AUC =0.908, 95% confidence interval (CI): 0.842−0.974; BI-RADS: AUC =0.862, 95% CI: 0.784−0.94; P=0.024] and significantly increased the clinical benefit for patients and policy makers by effectively reducing overdiagnosis and biopsy rates. In the BI-RADS category 4A subgroup, adding Emax to breast cancer screening benefited patients and showed a greater absolute benefit than did the BI-RADS category alone when used for patients with a higher probability of cancer (>0.403), demonstrating a 50% overtreatment reduction. CONCLUSIONS: Adding Emax to BI-RADS category 4 breast cancer screening using SWE significantly reduced overdiagnosis and biopsy rates compared with the BI-RADS category alone, especially for BI-RADS 4A patients.

The postponing of screening and the health care system reorganization, due to the Covid-19 pandemic and lockdown, could led to a concerning decline in breast and colorectal cancer diagnoses. This monocentric retrospective analysis has compared the pre-Covid period (March 2019 to March 2020) to the Covid period (April 2020 to April 2021) in terms of screening programs, clinical, surgical and pathological. A total of 799 patients diagnosed with Breast Cancer (BC) and Colorectal Cancer (CRC) underwent surgery during the two periods. In FVG in 2020 a decrease in mammography screening of 17.1% has been registered compared to 2019; this reduction has been higher for CRC screening, which summed up to 24.5%. As far as BC is concerned, screening-detected tumours rose significantly from 18 to 28%, mastectomies decreased from 40 to 31% and advanced tumours treated surgically decreased from 12 to 6%. Concerning CRC, a significant increase in admissions through the Emergency Department has been registered in spite of a stable percentage of urgent surgery performed, proving that severely symptomatic patients have been treated adequately. Open surgery has significantly decreased, whereas the tumoral stage and complications have remained constant in the two periods. This study has proved that maintaining standards of care and validated protocols during emergency is the most adequate and winning strategy: impact on BC and CRC has been less important than expected. These results support the recommendations for immediate and rapid screening program resumption at operating speed, using prioritization strategies to make up for the diagnostic delays.

Screening programs must balance the benefits of early detection against the costs of over screening. Achieving this goal relies on two complementary technologies: (1) the ability to assess patient risk, (2) the ability to develop personalized screening programs given that risk. While methodologies for assessing patient risk have significantly improved with new advances in deep learning applied to imaging and genetics, our ability to personalize screening policies still lags behind. Here, we introduce a novel reinforcement learning-based framework for personalized screening, Tempo, and demonstrate its efficacy in the context of breast cancer. We trained our risk-based screening policies on a large screening mammography dataset from Massachusetts General Hospital (MGH) USA and validated them on held-out patients from MGH, and on external datasets from Emory USA, Karolinska Sweden and Chang Gung Memorial Hospital (CGMH) Taiwan. Across all test sets, we found that a Tempo policy combined with an image-based AI risk model was significantly more efficient than current regimes used in clinical practice in terms of simulated early detection per screen frequency. Moreover, we showed that the same Tempo policy can be easily adapted to a wide range of possible screening preferences, allowing clinicians to select their desired early detection to screening cost trade-off without training a new policy. Finally, we demonstrated Tempo policies based on AI-based risk models out performed Tempo policies based on less accurate clinical risk models. Altogether, our results show that pairing AI-based risk models with agile AI-designed screening policies has the potential to improve screening programs, advancing early detection while reducing over-screening.

Rationale and Objectives Mobile mammography units provide preventive health care to patients facing barriers to annual screening. This study reviews the outcomes of a mobile mammography service during a recent 5-year period. Materials and Methods This retrospective study analyzed the examinations by mobile mammography during a 5-year period (9327 examinations). The patients recalled, biopsies performed, and cancers detected were tallied. The race, age, breast cancer size, lymph node involvement, and metastases were recorded. The positive predictive value (PPV) and cancer detection rate metrics were calculated as outlined by the American College of Radiology Breast Imaging Reporting and Data System Atlas. Results The program identified cancer in 14 cases (cancer detection rate = 1.5 per 1000 examinations [95% confidence interval [CI], 0.9–2.5]) with 11 being invasive. The majority of these cancers were small and of low stage. Lymph node status was determined in 11 of the 14 cases (1 as N1mi, 5 as N0, 4 as N1,1 as N2a). Abnormalities led to 1686 examinations recalled (Recall Rate = 17.8%; PPV 1 = 0.8% [95% CI, 0.5%–1.4%]). One hundred and one were recommended for biopsy (PPV 2 = 13.9% [95% CI, 8.4%–21.9%]), and 98 pursued biopsy (PPV 3 = 14.3% [95% CI, 8.7%–22.6%]). Patient age ranged from 41 to 67 years with an average of 50.6 years. Conclusion The program detected many cancers in an asymptomatic population facing barriers to breast cancer screening. These findings are underscored by the cancers detected at an early stage with a favorable prognosis and support the need for the development of similar programs.

Summary: Breast cancer screening has seen an increase in the detection of non-palpable breast lesions. Wire guided localisation (WGL) and Radio-guided occult lesion localisation (ROLL) are well established modalities of localisation of non-palpable breast lesions in the UK. We aimed to compare the outcomes of WGL and ROLL in this updated meta-analysis. We searched Cochrane Central Register of Controlled Trials (CENTRAL), and LILACS using free text search words as well as relevant MESH-terms. We also searched Medline (02/03/2021), Embase and registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. Outcomes considered were re-excision rates, margin involvement, specimen volume and weight, accurate localisation of lesions and operative time. We assessed the risk of bias in included studies and performed random effects meta-analyses using Review Manager (version 5.3). Heterogeneity was estimated using the I2-statistic. Nine included studies enrolled 1096 patients undergoing localization in breast surgery (534 in WGL and 562 in ROLL). There was a statistically significant benefit in favour of ROLL for non-involved resection margins (OR 0.60; 95% CI, 0.44–0.97); based on seven studies. Nine trials assessed operative time favouring ROLL (OR 1.95; 95% CI, 0.27–3.63). No significant difference in re-excision rates was reported (OR 1.42; 95% CI, 0.83–2.43) based on seven studies. Current evidence favourably supports ROLL, compared to WGL, with respect to margin involvement, localisation and operative time in the treatment of non-palpable breast lesions.

Aim:Breast cancer is the most prevalent cancer diagnosed in women. Screening programs to diagnose breast anomalies increase the likelihood of early diagnosis and survival. This study describes the most extensive breast cancer screening program in Istanbul/Turkey between 2018 and 2019 and offers recommendations for nationwide programs.Methods:We collected data from the Istanbul Health Directorate’s cancer surveillance database from May 2018 to December 2019. We analyzed data on patients referred for further investigation due to suspicion of possible tumors in their screening radiography. The database included socio-demographic information and further examination details (tests, outcomes, and planned treatment).Results:The mean age of the 3,577 women who were invited for further examination was 52.3 [standard deviation (SD): 7.5]. The age group with the highest percentage of further investigation invitations was between 50 and 54. The mean time between the results of screening mammography was 16.2 days (SD: 15.3). 5.1% of the women referred were diagnosed with some sort of cancer. Women who went to the place of scheduled appointments, instead of getting an appointment in another place of their choosing, were diagnosed and treated earlier.Conclusion:For a breast screening program to reach the entirety of the target population, a comprehensive approach to every step of the process (screening, diagnosis, treatment) needs to be considered together.

Population health management (PHM) is the holistic process of improving health outcomes of groups of individuals through the support of appropriate financial and care models. Radiologists' presence...

Our purpose is to understand patient preferences towards contrast-enhanced imaging such as CEM or MRI for breast cancer screening.An anonymous survey was offered to all patients having screening mammography at a single academic institution from December 27 th 2019 to March 6 th 2020. Survey questions related to: (1) patients' background experiences (2) patients' concern for aspects of MRI and CEM measured using a 5-point Likert scale, and (3) financial considerations.75% (1011/1349) patients completed the survey. 53.0% reported dense breasts and of those, 47.6% had additional screening. 49.6% had experienced a callback, 29.0% had a benign biopsy, and 13.7% had prior CEM/MRI. 34.7% were satisfied with mammography for screening. A majority were neutral or not concerned with radiation exposure, contrast allergy, IV line placement, claustrophobia, and false positive exams. 54.7% were willing to pay at least $250-500 for screening MRI. Those reporting dense breasts were less satisfied with mammography for screening (p0.001) and willing to pay more for MRI (p0.001). If patients had prior CEM/MRI, there was less concern for an allergic reaction (p0.001), IV placement (p=0.025), and claustrophobia (p=0.006). There was less concern for false positives if they had a prior benign biopsy (p=0.029) or prior CEM/MRI (p=0.005) and less concern for IV placement if they had dense breasts (p=0.007) or a previous callback (p=0.013).The screening population may accept CEM or MRI as a screening exam despite its risks and cost, especially patients with dense breasts and patients who have had prior CEM/MRI.

Purpose: Risk-stratified screening has potential to improve the cost effectiveness of national breast cancer screening programs. This study aimed to inform a socially acceptable and equitable implementation framework by determining what influences a woman's decision to accept a personalized breast cancer risk assessment and what the relative impact of these key determinants is. Methods: Multicriteria decision analysis was used to elicit the relative weights for 8 criteria that women reported influenced their decision. Preference heterogeneity was explored through cluster analysis. Results: The 2 criteria valued most by the 347 participants related to program access, “Mode of invitation” and “Testing process”. Both criteria significantly influenced participation (P

Breast cancer screening through periodic mammography has been effective in decreasing mortality and reducing the impact of this disease. However, adherence to screening does not meet the desired expectations from all populations. The main objective of this review is to explore the barriers that affect adherence to breast cancer–screening programs in vulnerable populations according to race and/or ethnicity in order to propose measures to reduce the lack of adherence. We conducted a search of publications in the PubMed Central and Scopus databases. The eligible criteria for the articles were as follows: original quantitative studies appearing in SJR- and/or JCR-indexed journals from 2016 to 2021 in English or Spanish. Most of them present common barriers, such as race/ethnicity (47%), low socioeconomic (35.3%) and educational levels (29.4%), no family history of cancer and being single (29.4%), medical mistrust and a health information gap (23.5%), lack of private health insurance (17.6%) and not having annual health checks (17.6%). The target populations with the lowest adherence were Black, Asian, Hispanic and foreign women. Implementing awareness campaigns focused on these populations should be promoted, as well as working on diversity, cultural acceptance and respect with healthcare workers, in order to improve breast cancer–screening adherence worldwide.

The burgeoning eHealth campaigns and the emerging daughter-to-mother health communication necessitate a close examination of the intricate mechanism behind recommending preventive behaviors in online settings. The present study addresses existing gaps by investigating how message characteristics and platform-generated virality cues jointly influence younger females’ intention to recommend breast cancer screening to their mothers. Drawing on the extended parallel process model (EPPM) as the theoretical basis, a 2 (threat: low vs. high) × 2 (efficacy: low vs. high) × 2 (virality: low vs. high) randomized between-subjects experiment (n = 269) was performed. Results revealed a three-way interaction effect between threat, efficacy, and virality on message involvement. Message involvement was positively associated with recommendation intention and mediated the three-way interaction effect on recommendation intention. This study demonstrates that a high threat can initiate message involvement but fail to trigger recommendation intention. In contrast, a low-threat, high-efficacy, high-virality combination would yield a salutary outcome. Besides, the indispensable role of message involvement in the underlying psychological mechanism behind recommending preventive behaviors was reaffirmed. Theoretical and practical implications are further discussed.

Introduction Informed decision making is recommended in breast cancer screening. Decision aids with balanced information on harms and benefits are recommended to support informed decision making. However, informed screening decision making may be challenged by overly positive attitudes toward cancer screening. We hypothesized that a substantial proportion of Danish women would want to participate in screening regardless of the presented information. Therefore, we aimed to estimate the prevalence of Danish women wanting to participate in a hypothetical breast cancer screening offering no reduction in breast cancer mortality but potential harms related to unnecessary treatment. Methods In a cross-sectional study, we invited a random sample of 751 women in the nonscreening population aged 44 to 49 y in the Central Denmark Region to an online questionnaire using the official digital mailbox system. The questionnaire included a description of a hypothetical screening and questions about thoughts on breast cancer, health literacy, and questions on the assessment of the hypothetical screening including intended participation, understanding, and belief in information. Data were linked to register data on sociodemographic factors. Results In total, 43.0% (323/751) responded to the questionnaire. Of these, 247 (82.3% [95% confidence interval: 77.5–86.5]) wanted to participate in the hypothetical breast cancer screening (participation group). More than two-thirds in both the participation group and nonparticipation group seemed to understand the presented information. Half of the women who understood the information disbelieved it. Conclusions Exceeding our expectations, a majority of women wanted to participate in a hypothetical screening with potential harms but no reduction in breast cancer mortality. A large proportion understood but disbelieved the screening information. This could indicate that Danish women make their screening decisions based on beliefs rather than presented screening information. This study was registered at ClinicalTrials.gov (Identifier: NCT04509063) Highlights The majority of Danish women wanted to participate in a hypothetical breast cancer screening with potential harms related to unnecessary treatment but no reduction in mortality. A large proportion of women understood but disbelieved the hypothetical screening information. Informed decision making may be challenging when women disbelieve the information they receive. Enthusiasm for cancer screening and potential disbelief in information are important factors when developing and improving screening information and invitation.

Breast cancer is a leading cause of mortality among women. Many young women in the Kyrgyzstan have poor knowledge about breast cancer screening, including risk factors and warning signs/symptoms. We investigated awareness about breast cancer and breast self examination (BSE) as a screening tool among female students at international school of medicine. This article contains the result of Survey fact and figures regarding breast carcinoma Although most participants were aware of breast cancer, knowledge about risk factors and warning signs/symptoms was relatively poor. Knowledge about performing BSE was particularly low. This highlights the importance of increasing awareness about breast cancer and BSE among young women in Kyrgyzstan., Рак молочной железы является ведущей причиной смертности среди женщин. Многие молодые женщины в Кыргызстане плохо осведомлены о скрининге рака молочной железы, включая факторы риска и настораживающие признаки/симптомы. Мы исследовали осведомленность о раке молочной железы и самообследовании молочной железы (ГГЭ) в качестве инструмента скрининга среди студенток Международной школы медицины. Эта статья содержит результаты исследования, факты и цифры, касающиеся карциномы молочной железы. Хотя большинство участников знали о раке молочной железы, знания о факторах риска и настораживающих знаках симптомах были относительно низкими. Знания о выполнении были особенно низкими., Эмчек безинин рагы аялдардын өлүмүнүн негизги себеби болуп саналат. Кыргызстандагы көптөгөн жаш аялдар эмчек безинин рагынын скрининги жөнүндө, анын ичинде тобокелдик факторлору жана эскертүү белгилери/симптомдору жөнүндө начар маалыматка ээ. Биз эмчек безинин рагы жөнүндө маалымдуулукту жана эмчек безин өзүн өзү текшерүүнү (BSE) Эл аралык Медицина мектебинин студенттери арасында скрининг куралы катары изилдедик. Бул макалада эмчек безинин рагына байланыштуу изилдөөлөрдүн жыйынтыктары, фактылар жана сандар камтылган. Көпчүлүк катышуучулар эмчек безинин рагы жөнүндө билишсе да, тобокелдик факторлору жана эскертүү белгилери/симптомдору жөнүндө билимдер салыштырмалуу төмөн болгон. BSE көрсөткүчтөрү жөнүндө билим өзгөчө төмөн болгон. Бул Кыргызстандын жаш аялдарынын эмчек безинин рагы жана БСЕ жөнүндө маалымдуулугун жогорулатуунун маанилүүлүгүн көрсөтөт ., Вестник Кыргызcкого национального аграрного университета, Выпуск 1 (64) 2023, Pages 108-113

Area of residence influences clinical outcomes due to its impact on access to and quality of care. For breast cancer patients, place of residence influences screening, stage, treatment, and mortality. Individuals residing in neighborhoods with high deprivation or rurality face significant hurdles to accessing and receiving care. Consequently, they experience later stages of disease at presentation, lower rates of guideline-concordant care, and higher mortality rates than their financially affluent or urban counterparts. With the evolving management of breast cancer, the implications of place on clinical outcomes warrant continued investigation. Moreover, literature gaps about geographic disparities in locoregional management and systemic treatment warrant further inquiry.

BACKGROUND: The U.S. Preventive Services Task Force (USPSTF) modified breast cancer screening guidelines in November 2009. The impact has been studied among privately and Medicare insured populations, but not among universally insured women. MATERIALS AND METHODS: This study compared the proportion of TRICARE beneficiaries aged 40–64 receiving mammograms from fiscal years 2006 to 2015 using an interrupted time series analysis to determine the impact of the 2009 USPSTF guideline changes. Stratified analyses evaluated differences by age (ages 40–49, 50–64), race, care setting, beneficiary type, and military status. RESULTS: The proportion of women receiving mammograms increased from October 2005 through September 2009. A small, but significant decrease of 65–66 fewer women screened per 10,000 occurred in the first quarter of 2010 (October 1 to December 31) following the screening guideline update publication. The proportion screened then remained unchanged through 2015. Comparative analysis revealed no differences in impact between age groups, blacks and whites, or military dependents and active-duty/retirees. CONCLUSIONS: This study determined that the USPSTF guideline updates had a small, but immediate and lasting impact that was not different across age groups, beneficiary type, or race. No racial disparities in the proportion screened or in the impact of the guideline change were noted in our universally insured population.

Transgender women are increasingly evaluated in breast imaging centers. Radiologists should be familiar with a range of imaging findings related to feminizing hormone therapy and breast augmentations as well as benign and malignant lesions seen in this population. A growing body of literature has suggested that feminizing hormone therapy may increase the risk of breast cancer, prompting professional organizations to develop screening guidelines. The aim of this paper is to review common breast imaging findings in transgender women, recent data on the association between feminizing hormone therapy and breast cancer, and guidelines for breast cancer screening. Knowing these unique imaging features in transgender women is essential for providing competent care and reducing health care disparities.

Objective: Many older adults (aged 75+) continue cancer screening despite guidelines suggesting they should not. Using mixed-methods, we examined psychosocial and clinical factors associated with continued breast/prostate screening. Methods: We conducted an online, scenario-based, randomized study in Australia with participants aged 65+ years. The primary outcome was screening intention (10-point scale, dichotomized: low (1-5) and high (6-10)). We also measured demographic, psychosocial, and age-related clinical variables. Participants provided reason/s for their screening intentions in free-text. Results: 271 eligible participants completed the survey (aged 65-90 years, 71% adequate health literacy). Those who reported higher cancer anxiety, were men, screened more recently, had family history of breast/ prostate cancer and were independent in activities of daily living, were more likely to intend to continue screening. Commonly reported reasons for intending to continue screening were grouped into six themes: routine adherence, the value of knowing, positive screening attitudes, perceived susceptibility, benefits focus, and needing reassurance. Conclusions: Psychosocial factors may drive continued cancer screening in older adults and undermine efforts to promote informed decision-making. Practice implications: When communicating benefits and harms of cancer screening to older adults, both clinical and psychosocial factors should be discussed to support informed decision-making. (c) 2021 Elsevier B.V. All rights reserved.

Background The reliability and validity of the Champion’s Health Belief Model Scale (CHBMS) used in assessing the belief of women regarding breast cancer (BC) and breast cancer screening (BCS) have been examined on various populations. However, the use of this tool has not been adequately assessed for its validity in ethnic minorities. This study assessed the validity and reliability of CHBMS by analyzing the factor structure and internal reliability of the factors among Yemeni women in Malaysia. Methods A survey was conducted among 103 female teachers from 10 schools. SPSS version 22.0 was utilized in analyzing the data. Descriptive statistics were computed for the socio-demographic characteristics. The Cronbach’s alpha coefficients were used in assessing the internal reliability. The Exploratory Factor Analysis (EFA) was used to analyze the factor structure of the translated items. Parallel analysis was performed to determine the number of factors accurately. Results The alpha coefficients of the factors had acceptable values ranging between 0.76 and 0.87. The factor analysis yielded six and five factors for breast self-examination (BSE) and mammography (MMG), with a total explained variance of 47.69% and 52.63%, respectively. The Kaiser–Meyer–Olkin (KMO) index values of 0.64 and 0.72, and the Bartlett’s Test of Sphericity (P = 0.0001) for BSE and MMG, respectively, verified the normality distribution and the adequacy of the sample size for EFA. All the items on each factor were from the same construct that were consistent with the number of factors obtained in the scale development study. The items achieved adequate factor loadings that ranged between 0.47 and 0.88. Conclusions The translated version of the CHBMS is a validated scale used in assessing the beliefs related to BC and BCS among Yemeni women living in Malaysia. Healthcare workers could use the scales to assess women’s beliefs on BC and BCS. This instrument could be used to test the effectiveness of the intervention programs.

Background: While breast cancer is the leading cause of cancer death among Thai women, breast self-examination (BSE), mammography, and ultrasound use are still underutilized. There is a need to assess women’s beliefs about breast cancer and screening in different cultural settings. As a result, a tool to measure the beliefs that influence breast-cancer-screening practices is needed. Champion’s Health Belief Model Scale (CHBMS) is a valid and reliable tool for assessing individuals’ attitudes toward breast cancer and screening methods, but it has not been validated in Thai women. The study aimed to translate and validate the CHBMS for breast self-examination and mammography among Thai women and to modify the original scale by adding ultrasound items for breast cancer screening. In addition, the purpose of this study was to create a modified Thai version of the CHBMS which could be used to better understand patients’ beliefs regarding breast cancer screening in Thailand, in order to develop practical and effective interventions suited to their beliefs. Methods: The CHBMS was translated into Thai, validated by a panel of experts, back-translated, modified by adding content about ultrasound for screening breast cancer, and pretested. Confirmatory factor analysis was used with a sample of 130 Thai women aged 40 to 70 years old. Result: The final MT-CHBMS consisted of 64 items determining ten subscales: susceptibility, seriousness, benefits—breast self-examination, benefits—mammogram, barriers—BSE, barriers—mammogram, confidence, health motivation, benefits—ultrasound, and barriers—ultrasound. The MT-CHBMS demonstrated excellent internal consistency. The ten-factor model was best fitted to the data. Conclusion: The MT-CHBMS was found to be a reliable and valid tool for measuring individuals’ attitudes toward breast cancer and screening methods. The scale could be easily used by healthcare providers to determine the beliefs before planning appropriate interventions to increase early detection.

Background The detection of cancer in its early latent stages can improve patients’ chances of recovery and thereby reduce the overall burden of the disease. Our objectives were to investigate factors (geographic accessibility and deprivation level) affecting mammography screening participation variation and to determine how much geographic variation in participation rates can be explained by spillover effects between adjacent areas, while controlling for covariates. Methods Mammography screening participation rates between 2015 and 2016 were calculated by census blocks (CB), for women aged 50–74 years, residing in Lyon metropolitan area. Global spatial autocorrelation tests were applied to identify the geographic variation of participation. Spatial regression models were used to incorporate spatial structure to estimate associations between mammography participation rate and the combined effect (geographic accessibility and deprivation level) adjusting for modes of travel and social cohesion. Results The mammography participation rate was found to have a statistically significant and positive spatial correlation. The participation rate of one CB was significantly and positively associated with the participation rates of neighbouring CB. The participation was 53.2% in residential and rural areas and 46.6% in urban areas, p Conclusions This study makes an important methodological contribution in measuring geographical access and understanding better the combined effect of deprivation and the degree of urbanization on mammography participation and other contextual factors that affect the decision of using mammography screening services -which is a critical component of healthcare planning and equity.

Two randomized trials were conducted in Canada in the 1980s to test the efficacy of breast cancer screening. Neither of the trials demonstrated benefit. Concerns were raised regarding serious errors in trial design and conduct. Here we describe the conditions that could allow subversion of randomization to occur and the inclusion of many symptomatic women in a screening trial. We examine anomalies in data where the balance would be expected between trial arms. “Open book” randomization and performance of clinical breast examination on all women before allocation to a trial arm allowed women with palpable findings to be mis-randomized into the mammography arm. Multiple indicators raising suspicion of subversion are present including a large excess in poor-prognosis cancers in the mammography trial arm at prevalence screen. Personnel described shifting of women from the control group into the mammography group. There is compelling evidence of subversion of randomization in Canadian National Breast Screening Study. Mis-randomization of even a few women with advanced breast cancer could markedly affect measured screening efficacy. The Canadian National Breast Screening Study trials should not influence breast screening policies.

The amount of ultrasound (US) breast examinations continues to grow rapidly because of the wider endorsement of breast cancer screening programs. Cysts are the most commonly diagnosed breast lesions. Atypical breast cysts can be a serious differentiation problem in the US. Our goal was to develop noninvasive automated US grayscale image analysis for the cystic and solid breast lesion differentiation based on mathematical image post-processing. We used a set of 217 ultrasound images of proven 107 cystic (including 53 atypical) and 110 solid lesions. Empirical statistical and morphological models of the lesions were used to obtain features. The AUC indicator and Student’s t test were used to assess the quality of the individual features. The Pearson correlation matrix was used to calculate the correlation between various features. The LASSO and stepwise regression methods were used to determine the most significant features. Finally, the lesion classification was carried out by the various methods. The use of LASSO regression for the feature selection made it possible to select the most significant features for classification. The sensitivity increased from 87.1% to 89.2% and the specificity—from 92.2 to 94.8%. After the correlation matrix construction, it was found that features with a high value of the correlation coefficient (0.72; 0.75) can also be used to improve the quality of the classification. The construction of the empirical model of the lesion pixels brightness behavior can provide parameters that are important for the correct classification of ultrasound images. The optimal set of features with the maximum discriminant characteristics may not be consistent with the correlation of features and the value of the AUC index. Features with a low AUC index (in our case 0.72) can also be important for improving the quality of the classification.

Background Supporting well-informed decisions about breast cancer screening requires communicating that inconsequential disease may be detected, leading to overdiagnosis and overtreatment. Having previously shown that telling women about overdetection improved informed choice, we investigated effects on screening knowledge and participation over 2 years. Methods We conducted a community-based, parallel-group, randomized controlled trial in Australia. Participants were women aged 48-50 years, without personal or strong family history of breast cancer, who had not undergone mammography in the past 2 years. We randomly assigned 879 women to receive the intervention decision aid (evidence-based information on overdetection, breast cancer mortality reduction, and false-positives) or control decision aid (identical but without overdetection information). We interviewed 838 women postintervention and recontacted them for follow-up at 6 months and 1 and 2 years. Main outcomes for this report are screening knowledge and participation. Results We interviewed 790, 746, and 712 participants at 6 months, 1, and 2 years, respectively. The intervention group demonstrated superior knowledge throughout follow-up. After 2 years, conceptual knowledge was adequate in 123 (34.4%) of 358 women in the intervention group compared with 71 (20.1%) of 354 control participants(odds ratio = 2.04, 95% confidence interval = 1.46 to 2.85). Groups were similar in total screening participation (200 [55.1%] vs 204 [56.0%]; = 0.97, 95% confidence interval = 0.73 to 1.29). Conclusions A brief decision aid produced lasting improvement in women’s understanding of potential consequences of screening, including overdetection, without changing participation rates. These findings support the use of decision aids for breast cancer screening.

Breast cancer screening recommendations for transgender and gender nonconforming individuals are based on the sex assigned at birth, risk factors, and use of exogenous hormones. Insufficient evidence exists to determine whether transgender people undergoing hormone therapy have an overall lower, average, or higher risk of developing breast cancer compared to birth-sex controls. Furthermore, there are no longitudinal studies evaluating the efficacy of breast cancer screening in the transgender population. In the absence of definitive data, current evidence is based on data extrapolated from cisgender studies and a limited number of cohort studies and case reports published on the transgender community. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Breast cancer is one of the most challenging health problems in women worldwide. Early detection and regular breast cancer screening can considerably improve the survival rate. Many advanced imaging technologies are currently being used in the detection of breast malignancy. However, these methods are costly, uncomfortable, and time-consuming. Therefore, in this work, a simple and noninvasive thermographic technique, based on a Fiber Bragg Grating (FBG) thermal sensor array, has been developed to detect breast cancer. Breast tissue is simulated using agar gel phantom, and the heaters are embedded inside the phantom in different locations to mimic the tumors. FBG thermal sensor array is employed to acquire the surface temperature distribution of the simulated breast phantom. Also, modeling of the tissue-mimicking phantom and tumor in COMSOL Multiphysics software is carried out to provide a detailed 3D thermal view of the proposed prototype. Both experimental and simulated results are found to be in agreement and display the same trend as expected. Experimental results show that a temperature variation of ≥0.3°C is detected at the location of the tumor’s presence, which can be easily picked up by FBG interrogators which have sensitivity of ~1 pm, indicating the efficacy of the proposed sensing prototype as a potential screening tool for the diagnosis of breast cancer.

Introduction More than a third of hospitalized women are overdue or nonadherent to breast cancer screening guidelines, and almost a third of them are also at high risk for developing breast cancer. The purpose of this study is to evaluate the feasibility of coordinating inpatient breast cancer screening mammography for these women before their discharge from the hospital. Methods A prospective intervention study was conducted among 101 nonadherent women aged 50–74 years who were hospitalized to a general medicine service. Sociodemographic, reproductive history, family history of breast cancer, and medical comorbidities data were collected for all patients from January 2015 to October 2016. The data were analyzed in March 2018. Fisher's exact tests and unpaired t-tests were utilized to compare the characteristics of the study population. Results Of the 101 women enrolled who were nonadherent to breast cancer screening recommendations, their mean age was 59.3 (SD=6) years, the mean 5-year Gail risk score was 1.63 (SD=0.69), and 29% of the women were African American. Almost 80% (n=79) underwent inpatient screening mammography. All women who underwent screening mammography during their inpatient stay were extremely satisfied with the experience. The convenience of having screening mammography while hospitalized was reported to be a major facilitator of completing the overdue screening. All nurses (100%) taking care of these women believed that this practice should become part of the standard of care, and most hospitalist physicians (66%) agreed that this practice is feasible. Conclusions This study shows that it is possible to coordinate mammography for hospitalized women who were overdue for screening and at high risk for developing breast cancer. Trial registration This study is registered at www.clinicaltrials.gov NCT04164251.

Ultrasound is commonly used in breast cancer screening and diagnosis. The use of ultrasound features to predict the subtypes of invasive breast cancer is of great clinical significance, since it facilitates a fast and early diagnosis and treatment. The correlation between breast lesion ultrasound features and the breast cancer subtypes requires further investigation.388 patients with invasive breast cancer were retrospectively analyzed by two sonographers. The tumor size, shape, margin, echogenicity, echotexture, posterior echo attenuation microcalcification, and blood vessel density were recorded. The correlation between the tumor ER, PR, HER2, and Ki67 status, the molecular subtypes, and the ultrasound features was analyzed using the chi-square test, Fisher's exact test, and multiple logistic regression.ER and PR positivity were correlated with a low histologic grade, lymph node metastasis, and smaller-sized tumors. A hyperechoic or a mixed echogenicity was rare in the tumors of all groups but was enriched in the ER and PR tumors (9.57% and 7.64%, respectively, p 0.01). A high percentage of posterior echo attenuation was found in the Ki67 low (53.94%) and ER+ (51.28%) tumors. Furthermore, heterogeneous and microcalcifications were enriched in HER2-positive tumors. In terms of the molecular subtypes, the luminal A subtype group had the lowest lymph node positivity and the smallest primary tumor size. The luminal B subtype had the lowest percentage of hyperechoic or mixed tumors. The HER2 subtype was positively correlated with microcalcification. Finally, TNBC showed the highest percentage of hyperechoic or mixed tumors and the lowest percentage of posterior echo attenuation and microcalcification.Tumor pathologic and ultrasound features were correlated with invasive breast tumor molecular marker positivity and its molecular subtypes.

Please see the Editorial Comment by Bethany L. Niell discussing this article. BACKGROUND. The success of adjunct breast cancer screening of women with dense breasts can be enhanced by identifying a...

We report a case of breast cancer in a transgender woman (assigned male sex at birth, gender identity female) of Ashkenazi Jewish descent with BRCA2 mutation who had been taking cross-sex hormone therapy for 2 years. In addition to demonstrating breast cancer imaging findings and risk factors, this case draws attention to the paucity of research and data regarding breast cancer in transgender women and exemplifies the need for evidence-based consensus breast cancer screening recommendations for transgender women.

Breast cancer is becoming increasingly prevalent in the women greater than 65 years of age. Most tumors are hormone receptor-positive in this group. Breast cancer screening recommendations for older women should be tailored based on life expectancy. Early stage breast cancer should be treated with conservative surgery followed by adjuvant endocrine therapy in HR+ patients. Primary endocrine therapy is a low-risk option for those with limited life expectancy. Adjuvant radiation therapy can be avoided in early stage, low-risk cancers. Evaluation should include comprehensive geriatric assessment. Treatment with less cytotoxic chemotherapy, HER-2 targeted therapies, and other biomarker-driven, molecularly targeted therapies should be sought whenever possible.

Objectives: Benefit and cost effectiveness of breast cancer screening are still matters of controversy. Risk-adapted strategies are proposed to improve its benefit-harm and cost–benefit relations. Our objective was to perform a systematic review on economic breast cancer models evaluating primary and secondary prevention strategies in the European health care setting, with specific focus on model results, model characteristics, and risk-adapted strategies. Methods: Literature databases were systematically searched for economic breast cancer models evaluating the cost effectiveness of breast cancer screening and prevention strategies in the European health care context. Characteristics, methodological details and results of the identified studies are reported in evidence tables. Economic model outputs are standardized to achieve comparable cost-effectiveness ratios. Results: Thirty-two economic evaluations of breast cancer screening and seven evaluations of primary breast cancer prevention were included. Five screening studies and none of the prevention studies considered risk-adapted strategies. Studies differed in methodologic features. Only about half of the screening studies modeled overdiagnosis-related harms, most often indirectly and without reporting their magnitude. All models predict gains in life expectancy and/or quality-adjusted life expectancy at acceptable costs. However, risk-adapted screening was shown to be more effective and efficient than conventional screening. Conclusions: Economic models suggest that breast cancer screening and prevention are cost effective in the European setting. All screening models predict gains in life expectancy, which has not yet been confirmed by trials. European models evaluating risk-adapted screening strategies are rare, but suggest that risk-adapted screening is more effective and efficient than conventional screening.

Diagnostic efficacy in medical imaging is ultimately a reflection of radiologist performance. This can be influenced by numerous factors, some of which are patient related, such as the physical size and density of the breast, and machine related, where some lesions are difficult to visualise on traditional imaging techniques. Other factors are human reader errors that occur during the diagnostic process, which relate to reader experience and their perceptual and cognitive oversights. Given the large-scale nature of breast cancer screening, even small increases in diagnostic performance equate to large numbers of women saved. It is important to identify the causes of diagnostic errors and how detection efficacy can be improved. This narrative review will therefore explore the various factors that influence mammographic performance and the potential solutions used in an attempt to ameliorate the errors made.

This article gives a brief overview of the development of artificial intelligence in clinical breast imaging. For multiple decades, artificial intelligence (AI) methods have been developed and translated for breast imaging tasks such as detection, diagnosis, and assessing response to therapy. As imaging modalities arise to support breast cancer screening programs and diagnostic examinations, including full-field digital mammography, breast tomosynthesis, ultrasound, and MRI, AI techniques parallel the efforts with more complex algorithms, faster computers, and larger data sets. AI methods include human-engineered radiomics algorithms and deep learning methods. Examples of these AI-supported clinical tasks are given along with commentary on the future.

Mammography remains the only validated screening tool for breast cancer, however, there are limitations to mammography. One of the limitations of mammography is the variable sensitivity based on breast density. Supplemental screening may be considered based on the patient’s risk level and breast density. For average-risk women with nondense breasts, the sensitivity of digital breast tomosynthesis (DBT) screening is high; additional supplemental screening is not warranted in this population. For average-risk women with dense breasts, given the decreased sensitivity of mammography/DBT, this population may benefit from additional supplemental screening with contrast-enhanced mammography, screening ultrasound (US), breast MRI, or abbreviated breast MRI. In intermediate-risk women, there is emerging evidence suggesting that women in this population may benefit from breast MRI or abbreviated breast MRI. In intermediate-risk women with dense breasts, given the decreased sensitivity of mammography/DBT, this population may benefit from additional supplemental screening with contrast-enhancedmammography or screening US. There is strong evidence supporting screening high-risk women with breast MRI regardless of breast density. Contrast-enhanced mammography, whole breast screening US, or abbreviated breast MRI may be also considered. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Although multiple studies have shown that resettled refugee women are less likely to receive preventative cancer screenings like pap smears and mammograms, a small number have demonstrated the opposite. This retrospective chart review, conducted between January 2017 and October 2018, compares pap smear and mammogram rates of patients seen in a refugee-specific OB/GYN clinic with patients from the general OB/GYN clinic at the same institution. Data from 298 patients (149 refugee and 149 general clinic patients matched by age and date-of-visit) were analyzed. Pap smear screening rates were 90.60% in the refugee group and 73.83% in the general group [p

Background Adherence to screening guidelines among transgender and non-binary (TGNB) populations is not well studied. This study examines breast cancer screening patterns among TGNB patients at an urban academic medical center. Methods Demographic information, risk factors, and screening mammography were collected. Mammography rates were calculated in populations of interest according to national guidelines, and mammogram person-years were also calculated. Univariate and multivariate logistic regression was performed. Results Overall, 253 patients were analyzed: 193 transgender women and non-binary people designated male at birth (TGNB DMAB) and 60 transgender men and non-binary people designated female at birth (TGNB DFAB). The median (interquartile range) age was 53.2 years (42.3-62.6). Most patients had no family history of breast cancer (n = 163, 64.4%) and were on hormone therapy (n = 191, 75.5%). Most patients where White (n = 164, 64.8%), employed (n = 113, 44.7%), and had public insurance (n = 128, 50.6%). TGNB DFAB breast screening rates were low, ranging from 2.0 to 50.0%, as were TGNB DMAB screening rates, ranging from 7.1 to 47.6%. The screening rates among the TGNB DFAB and TGNB DMAB groups did not significantly differ from one another. Among TGNB DFAB patients, univariate analyses showed no significant predictors for mammography. Among TGNB DMAB patients, not being on hormone therapy resulted in fewer odds of undergoing mammography. There were no significant findings on multivariate analyses. Conclusion Mammography rates in the TGNB population are lower than institutional and national rates for cisgender patients, which are 77.3% and 66.7-78.4%, respectively. Stage of transition, organs present, hormone therapy, and risk factors should be considered to guide screening.

We present a retrospective cohort study evaluating the utilization and effectiveness of digital breast tomosynthesis (DBT) for breast cancer screening with a focus on racial differences. 46,236 females underwent screening mammography between 4/1/2013 and 3/30/2020, during which there was an increase in DBT utilization from 18.8% in year 1 to 89.6% in year 7. Black and Asian women were significantly less likely to have a screening study with DBT compared to White women. Overall, the DBT group had a lower recall rate (9.1% versus 11.2%, p < 0.001) and higher cancer detection rate (6.0 vs 4.1, p < 0.001) compared to the FFDM group.

Breast tumors are among the most common types of tumors that can affect both genders. It may spread to the whole breast without any symptoms. Therefore, the early detection and accurate diagnosis of breast tumors are significantly important. Current approaches for breast cancer screening such as positron emission tomography (PET) and magnetic resonance imaging (MRI) have some limitations of being time and money-consuming. In addition, mammography screening is not recommended for women under forty. Consequently, optical techniques have been introduced as safe and functional alternatives. Diffuse optical imaging is a non-invasive imaging technique that utilizes near-infrared light to examine biological tissues based on measuring the optical transmission and/or reflection at various locations on the tissue surface. In this paper, we propose a modified arrangement between the laser source and the detectors for distinguishing tumors from normal breast tissue. A three-dimensional model of the normal human breast with three types of tumors is developed using a COMSOL simulation software based on the finite element solution of Helmholtz equation to estimate optical fluence distribution. The breast model consists of four layers: skin, fat, glandular, and muscle, where the tumor is included in the glandular layer. Different wavelengths were used to determine the most proper wavelength for the discrimination between the normal tissue and tumor. The obtained results were verified using the receiver operating characteristic (ROC) method. The resultant fluence images show different features between normal breast and breast with tumor especially using 600-nm incident laser as demonstrated by the obtained ROC curves.

Introduction. Average glandular dose (AGD) values displayed by mammography units are often used to compare doses with diagnostic reference levels, with acceptable and achievable dose levels given with in the European guidelines on breast cancer screening, or between mammography units. The aim of the work was to check the reliability of displayed AGD values by comparing them with independently calculated values. Material and methods. The comparison was performed for five mammography units, for 20 groups of patients (50 patients each), examined in various periods between the years 2015 and 2020. AGD values were calculated independently for the same patients using the results of measurements. Results. Observed differences between displayed and calculated doses affected their comparison with acceptable and achievable dose levels. Conclusions. The displayed AGD values should be used with caution. If reliable information on AGD values is needed, they should be independently calculated using the results of measurements.

Background: Coronavirus disease 2019 (COVID-19) vaccine-induced lymphadenopathy is a critical side effect that should be a concern to clinicians, patients, radiologists, and oncologists. Vaccine-induced lymphadenopathy causes a diagnostic dilemma, especially for breast radiologists who examine both axillary regions during breast ultrasound examinations. Appropriate imaging guidelines are needed to manage vaccine-induced lymphadenopathy for patients undergoing screening examinations or symptomatic patients, including cancer patients.Current Concepts: For patients with axillary lymphadenopathy in the setting of recent ipsilateral vaccination, clinical follow-up is recommended. In other scenarios, short-term follow-up axillary ultrasound examinations are recommended if the clinical concerns persist for more than 6 weeks after vaccination. To mitigate the diagnostic dilemma of vaccine-induced lymphadenopathy, patients should schedule screening imaging examinations before the first vaccination or at least six weeks following the second vaccination. For clinicians and radiologists, documenting the patients’ vaccination status is critical to decreasing unnecessary follow-up imaging, biopsies, and patient’s anxiety.Discussion and Conclusion: Our proposal can help reduce patient anxiety, provider burden, and costs of unnecessary evaluation of enlarged lymph nodes in the setting of recent COVID-19 vaccination. Further, it can avoid delays in vaccination and breast cancer screening during the COVID-19 pandemic.

We investigated the effectiveness of inoculation and self-affirmation interventions in neutralizing effects of health misinformation. Women ( N=854) recruited via Prolific were randomly assigned to self-affirm (or not) and read an inoculation (versus control) message detailing five common attributes of misinformation. All participants read an article with misinformation about breast cancer screening and reported their reactions to the article. The inoculation (vs control) message reduced the negative effects of misinformation, as assessed by resistance-related measures, attitudes, and intentions. Experimentally induced self-affirmation did not show protective effects against misinformation, but the inoculation intervention was stronger among participants higher in self-reported spontaneous self-affirmation.