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Background Breast cancer is the most prevalent cancer worldwide and the leading cause of cancer mortality in women. Uptake of breast cancer screening and early-detection practices in low- and middle-income countries (LMIC) has not been synthesized. We aimed to systematically quantify uptake of breast cancer screening in LMIC. Methods We performed a systematic review and meta-analysis of observational population-based studies that reported the uptake of screening or early-detection practices. We searched the PubMed, Scopus, Embase, and Web of Knowledge databases to January 2024. We pooled data using random-effects meta-analysis and explored heterogeneity using subgroup analyses. Results We included 174 population-based studies encompassing more than 78 million women. Pooled prevalence of self-reported uptake of screening mammography was 22.7% (95% confidence interval = 18.6% to 27.2%), of self-reports of having had a clinical breast examination for screening was 23.1% (95% confidence interval = 19.5% to 27.0%), and of self-reported regular breast self-examination (relevant for breast awareness in LMIC) was 14.6% (95% confidence interval = 11.6% to 17.9%). Uptake of breast cancer screening practices was lowest in Africa and low- and lower-middle income countries. Uptake of breast cancer screening practices remained stable over time or decreased slightly. Women who lived in rural area, were single, had lower income levels, had low educational attainment, were unemployed, were uninsured, and had no family history of breast cancer were generally least likely to self-report uptake of breast cancer screening. Conclusion This meta-analysis identified concerningly low uptake of breast cancer screening practices in LMIC. Governments should prioritize developing context-appropriate strategies to address this low uptake to support population-level stage shifting of breast cancer in LMIC. [ABSTRACT FROM AUTHOR]

Background The US Preventive Services Task Force (USPSTF) recommend lung cancer screening for individuals aged 50-80 years with at least 20 pack-years and no more than 15 quit-years, but uptake is low. The risk and benefit profiles of screening attendees are unknown; consequently, the impact and lost opportunity of ongoing lung cancer screening in the United States remains unclear. Methods We estimated lung cancer death risk (using the Lung Cancer Death Risk Assessment Tool) and life gained from screening (using the Life Years Gained From Screening-Computed Tomography model) for individuals aged 50-79 years who ever-smoked in the US representative 2022 Behavioral Risk Factor Surveillance System. We compared lung cancer death risk and life gained among USPSTF-eligible individuals by screening status (self-reported screened vs not screened in past year) and estimated the number of lung cancer deaths averted and life-years gained under current screening levels and if everyone eligible was screened. Results USPSTF eligibility was 33.7% (95% confidence interval [CI] = 33.1% to 34.4%), of whom 17.9% (95% CI = 17.0% to 18.8%) self-reported screening. Screening uptake increased with increasing lung cancer death risk quintile (Q1 = 5.2%, 95% CI = 3.0% to 8.8%; Q5 = 21.8%, 95% CI = 20.3% to 23.3%) and life-gain from screening quintile (Q1 = 6.2%, 95% CI = 3.8% to 9.9%; Q5 = 20.8%, 95% CI = 19.5% to 22.2%). Screened individuals had higher lung cancer death risk (risk ratio [RR] = 1.35, 95% CI = 1.26 to 1.46) and life-years gained (RR = 1.19, 95% CI = 1.12 to 1.25) than unscreened individuals. Currently, screening averts 19 306 lung cancer deaths and gains 237 564 life-years; screening everyone eligible would additionally avert 56 956 lung cancer deaths and gain 751 850 life-years. Two-thirds of USPSTF lung-eligible women were up to date with breast cancer screening, but only 17.3% attended lung screening in the past year. Conclusions Eligible screening attendees had higher lung cancer death risk and benefit from screening. Higher rates of screening could substantially increase the number of lung cancer deaths prevented. [ABSTRACT FROM AUTHOR]

Background Social risks are negatively associated with receipt of cancer preventive care. As knowledge is lacking on the pathways underlying these associations, we investigated associations between patient-reported social risks and colorectal cancer (CRC), cervical cancer, and breast cancer screening order provision and screening completion. Methods This study included patients eligible for CRC, cervical cancer, or breast cancer screening at 186 community-based clinics between July 1, 2015, and February 29, 2020. Outcomes included up-to-date status for indicated cancer screenings at baseline; percentage of subsequent study months in which patients were up-to-date on screenings; screening order receipt; and screening completion. Independent variables were patient-reported food insecurity, transportation barriers, and housing instability. Analyses used covariate-adjusted generalized estimating equation models, stratified by social risk. Results Patients with documented social risks were less likely to be up-to-date on any cancer screening at baseline and in most cases had a lower rate of total study months up-to-date on screenings. All cancer screenings were ordered less often for food-insecure patients. Cervical cancer screening was ordered less often for transportation-insecure patients. The likelihood of completing a screening test differed statistically significantly by select social risks: Cervical cancer and CRC screening rates were lower among food-insecure patients, and CRC screening rates were lower among transportation-insecure patients. The likelihood of breast cancer screening completion did not differ by social risk status. Conclusion Social risks affect both the ordering and the receipt of cancer screening. Research is needed on strategies to mitigate the impact of different social risks on cancer early-detection services. [ABSTRACT FROM AUTHOR]

Background Despite evidence of the benefit of routine cancer screenings, data show a concerning decline in cancer screening uptake for multiple cancers. This analysis aimed to examine rural-urban differences in recent trends for being up-to-date with screenings for breast, cervical, and colorectal cancers. Methods We used 2018, 2020, and 2022 Behavioral Risk Factor Surveillance System data to assess up-to-date cancer screening status among eligible adults in the United States. We calculated weighted prevalence estimates overall and stratified by county-level rural-urban classification. We used survey-weighted multivariable logistic regression models to examine rural-urban disparities in cancer screening up-to-date status by year. Results Prevalence of being up-to-date with each cancer screening was lower in 2022 than it was in 2018. The largest decline in screening overall was for cervical cancer, which dropped from 81.89% in 2018 to 47.71% in 2022. Rural-urban disparities were observed for breast cancer screening from 2018 to 2022, with the odds of up-to-date screening being 14% to 27% lower for rural populations than for urban populations. For colorectal and cervical cancers, the odds of being up-to-date with screenings were lower for rural populations in 2018 and 2020, but no statistically significant difference was observed in 2022 (colorectal screening odds ratio = 0.96, 95% CI = 0.90 to 1.02; cervical screening odds ratio = 0.97, 95% CI = 0.93 to 1.03). Conclusion There is a concerning trend of decreasing uptake of cancer screenings that will challenge future efforts in cancer prevention and control. There is a need to better understand the factors contributing to the decline in cancer screening update. [ABSTRACT FROM AUTHOR]

Background High breast density is an independent risk factor for breast cancer and decreases the sensitivity of mammography. This systematic review synthesizes the international clinical guidelines and the evidence base for screening and supplemental screening recommendations in women with dense breasts. Methods A systematic search of CINHAL, Embase, and Medline databases was performed in August 2023 and grey literature searched in January 2024. Two authors independently assessed study eligibility and quality (Appraisal of Guidelines for Research and Evaluation II instrument). Results Of 3809 articles, 23 guidelines published from 2014 to 2024 were included. The content and quality varied between the guidelines; the average AGREE II total score was 58% (range = 23%-87%). Most guidelines recommended annual or biennial screening mammography for women more than 40 years old with dense breasts (n = 16). Other guidelines recommended breast tomosynthesis (DBT, n = 6) or magnetic resonance imaging (MRI, n = 1) as the preferred screening modality. One third of the guidelines (n = 8) did not recommend supplemental screening for women with dense breasts. Of those that recommended supplemental screening (n = 14), ultrasound was the preferred modality (n = 7), with MRI (n = 3), DBT (n = 3), and contrast-enhanced mammography (n = 2) also recommended. Conclusions Consensus on supplemental screening in women with dense breasts is lacking. The quality of the guidelines is variable, and recommendations are based largely on low-quality evidence. As evidence of the benefits versus harms of supplemental screening in women with dense breasts is evolving, it is imperative to improve the methodological quality of breast cancer screening and supplemental screening guidelines. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the utilization of hematopathology resources within our enterprise on axillary lymph node core biopsy (AxLNCB) specimens, particularly those obtained in the context of breast cancer screening. Methods The utilization of hematopathology resources was determined for all AxLNCB specimens over a 30-month period from across our enterprise, and chart review was performed for select patient demographics and radiographic features. The AxLNCB cases with benign histology were reviewed for subtyping of histologic patterns. Results Of the total 594 AxLNCB specimens, 61.6% were benign and 38.6% malignant. Of malignant cases, only 9.3% contained any hematologic malignancy, yet 94% of all cases received tissue triage for lymphoma, and 81% were reviewed at least in part by a hematopathologist. Six clinical parameters were found to independently predict risk of hematologic malignancy: male sex (P =.041), bilateral lymphadenopathy (P =.004), diffuse cortical thickening (P =.005), lack of breast cancer (P =.001), older age (P <.001), and history of hematologic malignancy (P <.001). Conclusions Our enterprise overused hematopathology resources in the evaluation of AxLNCB performed in the study period. Our process could improve from the application of a simple tool generated from this cohort to predict percent risk of the specimen containing hematologic malignancy using patient characteristics easily found via routine chart review. [ABSTRACT FROM AUTHOR]

We offer a framework and exemplify how to integrate multiple community perspectives in research to develop breast cancer screening interventions among Latinas non-adherent to national guidelines. We leverage members of an academic institution's community consultative service [community engagement advisory board (CEAB) members]; study team members [community health workers (CHWs)] and study-eligible individuals (non-adherent Latinas). First, we asked what was needed from CEAB members (N =17), CHWs (N =14) and non-adherent Latinas (N =20) in one-time semi-structured group consultations and focus groups. Second, we drafted materials. Third, we conducted group consultations and focus groups with a new set of CEAB members (N =13), CHWs (N =17) and non-adherent Latinas (N =16) to reflect on our initial analysis and draft materials. Fourth, we finalized interventions. Certain recommendations were shared across stakeholders and simple to integrate (e.g. costs → access to free services). Some recommendations varied, but complementary integration was possible (e.g. location versus recruitment → multiple recruitment in multiple community areas). Others were distinct across stakeholders and resulted in strategies to recognize participants' agency and inform their choices about breast cancer screening (e.g. differences in preferred information about screening → personalized information and evidence about all screening options). [ABSTRACT FROM AUTHOR]

Background The outcome of breast cancer treatment largely depends on the timing of detection. The health promotion interventions have an immense contribution to early detection and improved survival. Therefore, this review aimed to provide evidence on the efficacy of the health promotion interventions to increase the uptake of breast cancer screening and to develop effective interventions targeting women. Methods Online databases (PubMed/MEDLINE/PubMed Central, Ovid/MEDILINE, EMBASE, Web of Science and Google Scholar) were searched for studies published between January 2005 and January 2017. A quality coding system was assessed using Cochrane checklists for randomized controlled trial (RCT) and Downs and Black checklists for non-RCT. The score was rated for the included articles by each researcher independently and the average score is given accordingly. This study was registered in PROSPERO as [PROSPERO 2017: CRD42017060488]. Results The review dovetailed 22 studies. Thirteen studies (59.10%) were conducted in the Unite States, 4 in Iran (18.18%), 2 in India (9.09%) and 1 each in Turkey, Saudi Arabia and Israel. The interventions were classified as 'individual-based', 'community-based', 'group-based teachings and training' and 'behavioral model based'. The majority of the studies showed favorable outcomes after health promotion interventions, including improvements in women's view of breast screening, breast self-examination and knowledge of breast screening. Conclusion The review confirmed that most of the health promotion interventions targeting women boosted the breast screening in one or another way. However, the limited quality of the included studies showed that further research is needed to improve the trials in the next future. [ABSTRACT FROM AUTHOR]

Background: Tomosynthesis approximates a 3D mammogram of the breast, reducing parenchymal overlap that masks cancers or creates false "lesions" on 2D mammography, and potentially enabling more accurate detection of breast cancer. We compared breast cancer screening detection and recall in asymptomatic women for tomosynthesis vs 2D mammography.Methods: A systematic review and random effects meta-analysis were undertaken. Electronic databases (2009-July 2017) were searched for studies comparing tomosynthesis and 2D mammography in asymptomatic women who attended population breast cancer screening and reporting cancer detection rate (CDR) and recall rate. All statistical tests were two-sided.Results: Seventeen studies (1 009 790 participants) were included from 413 citations. The pooled incremental CDR for tomosynthesis was 1.6 cancers per 1000 screens (95% confidence interval [CI] = 1.1 to 2.0, P < .001, I2 = 36.9%). Incremental CDR was statistically significantly higher for European/Scandinavian studies, all using a "paired" design where women had both tests (2.4 per 1000 screens, 95% CI = 1.9 to 2.9, P < .001, I2 = 0.0%) compared with US ("unpaired") studies (1.1 per 1000 screens, 95% CI = 0.8 to 1.5, P < .001, I2 = 0.0%; P < .001 between strata). The recall rate for tomosynthesis was statistically significantly lower than for 2D mammography (pooled absolute reduction = -2.2%, 95% CI = -3.0 to -1.4, P < .001, I2 = 98.2%). Stratified analyses showed a decrease in US studies (pooled difference in recall rate = -2.9%, 95% CI = -3.5 to -2.4, P < .001, I2 = 92.9%) but not European/Scandinavian studies (0.5% increase in recall, 95% CI = -0.1 to 1.2, P = .12, I2 = 93.5%; P < .001 between strata). Results were similar in sensitivity analyses excluding studies with overlapping cohorts.Conclusions: Tomosynthesis improves CDR and reduces recall; however, effects are dependent on screening setting, with greater improvement in CDR in European/Scandinavian studies (biennial screening) and reduction in recall in US studies with high baseline recall. [ABSTRACT FROM AUTHOR]

Background Breast cancer is the second most common cancer in women worldwide and contributes to a significant amount of mortality annually. It also contributes significantly to cancer-related morbidity in Bali especially in Gianyar district where most of the breast cancers are diagnosed at an advanced stage. Therefore, we aimed to evaluate the correlation between the levels of knowledge with the attitude of local-productive age women toward SADARI (breast self-assessment). Methods A family-based cross-sectional study was conducted in August 2018 in the Pejeng Kaja village, Ubud, Bali. The level of knowledge such as the definition of breast cancer, risk factors, therapy, prevention and several aspects of SADARI method was examined using a validated questionnaire. All of the data were subsequently recorded into SPSS for analysis. Results 122 respondents were enrolled in this study with a mean age of 45.65±9.51 years. More than half of the respondents were having at least high school education and 55% know breast cancer. However, 46.7% were known about SADARI. 5 variables were significantly associated with the status of SADARI knowledge namely: level of education, knowledge about breast cancer, breast cancer prevention, and how to perform SADARI as well as the frequency of SADARI performance by respondents (p < 0.05). Risk assessment for each variable showed that all variables had OR > 5 with the biggest OR on the level of education (OR: 7.2; 95%CI: 3.56-14.75). Conclusions We conclude that the level of education, knowledge about breast cancer, early symptoms of breast cancer, breast cancer prevention, and how to perform SADARI as well as frequency of SADARI performance influenced the performance rate of SADARI in reproductive women in Pejeng Kaja with low level of education posed the greatest risk of not performing SADARI. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

Background Stereotactic vacuum-assisted breast biopsy (SVAB) is widely used to evaluate predominantly mammograhic microcalcifications without specific ultrasound abnormalities. Recently however, there raise the problem that screening mammography detect the indolent low grade ductal carcinoma in situ (DCIS), and such diseases don't necessarily have to be diagnosed by invasive SVAB examination. Moreover, breast magnetic resonance imaging (MRI) has increasingly been performed over the past 10 years and reveals high sensitivity for detecting breast cancer, especially tumor undetectable by ultrasound. The purpose of this study was to assess the optimal indications for SVAB. Methods Five hundred and eighty-one patients with mammographic microcalcifications underwent SVAB between 2008 and 2014 in our hospital. All calcification lesions were classified into several groups according to the calcification categories (CC) and the presence of suspicions MRI abnormalities. We examined the rate of malignant disease in the subgroups. BI-RADS 4 and 5 MRI lesions were defined as suspicious MRI abnormality (SMA). We considered high grade DCIS and invasive ductal carcinoma (IDC) as worrisome disease ought to be diagnosed. Results The rate of malignancy was 6.3 % in CC2, 14.3% in CC3, 30.3% in CC4, and 80.0% in CC5 altogether. Of 581 patients, two hundred and thirty-three patients were underwent contrast enhanced MRI. Among category 3 or 4 microcalcifications without SMA (134 lesions), results of SVAB revealed 22 malignant lesions (16.4%), including 21 low grade DCIS and only one high grade DCIS and no IDC. If the lesions were accompanied by SMA, the rate of malignancy in these categories was increased to 66.2% (51/77), including 8 high grade DCIS and 14 IDC. If the regions were classified to category 5, about three forth cases were accompanied by SMA (17/23). Half of the category 5 lesions without SMA was malignant (3/6), including one high grade DCIS. Table: 7P   MRI (-)  MRI (-)  MRI (-)  MRI (+)  MRI (+)  MRI (+)    category 3  category 4  category 5  category 3  category 4  category 5  Benign  75  33  3  17  6  0  ADH  4  0  0  1  2  0  Low grade DCIS  13  8  2  11  18  6  High grade DCIS  1  0  1  3  5  5  IDC  0  0  0  6  8  8    MRI (-)  MRI (-)  MRI (-)  MRI (+)  MRI (+)  MRI (+)    category 3  category 4  category 5  category 3  category 4  category 5  Benign  75  33  3  17  6  0  ADH  4  0  0  1  2  0  Low grade DCIS  13  8  2  11  18  6  High grade DCIS  1  0  1  3  5  5  IDC  0  0  0  6  8  8  Table: 7P   MRI (-)  MRI (-)  MRI (-)  MRI (+)  MRI (+)  MRI (+)    category 3  category 4  category 5  category 3  category 4  category 5  Benign  75  33  3  17  6  0  ADH  4  0  0  1  2  0  Low grade DCIS  13  8  2  11  18  6  High grade DCIS  1  0  1  3  5  5  IDC  0  0  0  6  8  8    MRI (-)  MRI (-)  MRI (-)  MRI (+)  MRI (+)  MRI (+)    category 3  category 4  category 5  category 3  category 4  category 5  Benign  75  33  3  17  6  0  ADH  4  0  0  1  2  0  Low grade DCIS  13  8  2  11  18  6  High grade DCIS  1  0  1  3  5  5  IDC  0  0  0  6  8  8  Conclusions Mammographic microcalcification classified as 3 or 4 without suspicious MRI abnormal lesion were not be recommended for stereotactic vacuum-assisted biopsies. Legal entity responsible for the study Naoki Sato. Funding Has not received any funding. Disclosure The author has declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

Background Cancer is now the leading cause of mortality for persons living with HIV (PLWH) in the United States, but it is uncertain whether PLWH access cancer screening that could lower this burden. We sought to assess cancer screening for breast, cervical, and colon cancer among PLWH compared with the HIV-uninfected population at a multicenter healthcare system over the past two decades. Methods Data were obtained from a prospective, observational HIV clinical care cohort comprised of PLWH engaged in care in the Partners Healthcare System. Patients eligible for cancer screening between the years 2002 and 2016 were included. Patients were matched in a maximum of 1:4 ratio with HIV-uninfected patients from the Massachusetts General Primary Care Practice-Based Research Network based on age, sex, race, year of study entry, and length of follow-up. The mean proportion of time in which eligible patients were guideline concordant for cervical, breast, and colon cancer screening was assessed. Non-parametric tests were used to compared screening rates between PLWH and HIV-infected and on the basis of multiple clinical and sociodemographic factors. Results During the observation period, a total of 495 PLWH were eligible for breast cancer screening, 1011 for cervical cancer screening, and 1965 for colon cancer screening. For each screening group, the majority of PLWH were on antiretroviral therapy (ART) and had relatively high CD4 cell counts (Table 1). Screening rates for PLWH compared with controls were 67.3% vs. 82.8% (P < 0.0001) for breast cancer, 49.0% vs. 73.3% (P < 0.0001) for cervical cancer, and 92.7% vs. 91.2% (P = 0.96) for colon cancer (Figure 1). Among PLWH, factors significantly associated with lower rates of screening guideline concordance were older age, lower CD4 count, HIV-1 RNA >1000 copies/mL, and HIV duration < 5 years for breast cancer, and older age, white race, English language, and lack of ART use for cervical cancer. Conclusion Among patients engaged in longitudinal care, PLWH had significantly lower rates of screening for breast and cervical cancer than HIV-uninfected. Disparity is not explained by racial or primary language differences. Further work to improve access to cancer screening for PLWH is needed. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background WISDOM (Women Informed to Screen Depending on Measures of Risk) is a randomized trial to assess whether personalized breast cancer screening—where women are screened biannually, annually, biennially, or not at all depending on risk and age—can prevent as many advanced (stage IIB or higher) cancers as annual screening in women ages 40–74 years across 5 years of trial time. The short study time in combination with design choices of not requiring study entry and exit mammograms for all participants may introduce different sources of bias in favor of either the personalized or the annual arm. Methods We designed a simulation model and performed 5000 virtual WISDOM trials to assess potential biases. Each virtual trial simulated 65 000 randomly assigned participants who were each assigned a risk stratum and a time to stage of at least IIB cancer sampled from an exponential distribution with the hazard rate based on the risk stratum. Results from the virtual trials were used to evaluate two candidate analysis strategies with respect to susceptibility for introducing bias: 1) difference between arms in total number of events over total trial time, and 2) difference in number of events within complete screening cycles. Results Based on the simulations, about 86 stage IIB or higher cancers will be detected within the trial and the total exposure time will be about 74 000 years in each arm. Potential ascertainment bias is introduced at study entry and exit. Analysis strategy 1 works better for the nonscreened stratum, whereas method 2 is considerably more unbiased for the strata of women screened biennially or every 6 months. Conclusion Combining the two candidate analysis approaches gives a reasonably unbiased analysis based on the simulations and is the method we will use for the primary analysis in WISDOM. Publishing the WISDOM analysis approach provides transparency and can aid the design and analysis of other individualized screening trials. [ABSTRACT FROM AUTHOR]