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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.

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.

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.

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

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.

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.

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.

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.

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.

Purpose We conducted a systematic review and meta-analysis to compare the screening performance of synthesized mammography (SM) plus digital breast tomosynthesis (DBT) with digital mammography (DM) plus DBT or DM alone. Methods Medline, Embase, Web of Science, and the Cochrane Library databases were searched from January 2010 to January 2021. Eligible population-based studies on breast cancer screening comparing SM/DBT with DM/DBT or DM in asymptomatic women were included. A random-effect model was used in this meta-analysis. Data were summarized as risk differences (RDs), with 95 % confidence intervals (CIs). Results Thirteen studies involving 1,370,670 participants were included. Compared with DM/DBT, screening using SM/DBT had similar breast cancer detection rate (CDR) (RD = −0.1/1000 screens, 95 % CI = −0.4 to 0.2, p = 0.557, I2 = 0 %), but lower recall rate (RD = −0.56 %, 95 % CI = −1.03 to −0.08, p = 0.022, I2 = 90 %) and lower biopsy rate (RD = −0.33 %, 95 % CI = −0.56 to −0.10, p = 0.005, I2 = 78 %). Compared with DM, SM/DBT improved CDR (RD = 2.0/1000 screens, 95 % CI = 1.4 to 2.6, p, Highlights • Screening using SM/DBT has similar breast cancer detection but reduces recall and biopsy when compared with DM/DBT. • Screening using SM/DBT improves cancer detection rate when compared with DM/DBT alone. • There was no significant difference in interval cancer rate between SM/DBT and DM. • SM/DBT could replace DM/DBT in breast cancer screening to reduce radiation dose.

This article discusses the current breast cancer screening guidelines and the impact of the development and implementation of a Breast Cancer Screening Algorithm (BCSA). The BCSA combined the most conservative screening guidelines from the Centers for Disease Control and Prevention and the Breast Cancer Genetics Referral Screening Tool. Implementation occurred at an employer-based health center in Indiana with an order rate of 5.6% for screening mammograms among women ages 40 to 74. Compared with the Healthy People 2030 target of 77.1% for screening mammograms, this employer-provided health center demonstrated need for improvement. Use of the BCSA significantly increased the breast cancer screening rate within the health center.

Objective To evaluate whether, with access to free screening services, uninsured minority women in NYC are able to successfully manage existing barriers to breast cancer screening. Methods This is a retrospective cohort study, with permission to use de-identified data received from Project Renewal's ScanVan in 2019. Project Renewal ScanVan provides clinical breast exams, mammograms, and health education to low-income women. The screening mammograms were conducted in the ScanVan and read by a board-certified radiologist. The electronic medical records were reviewed with respect to the patients' BI-RADS category, insurance status, race, and age. Descriptive statistics were performed and cancer detection rate, recall rate, and positive predictive values (PPV1, PPV2, PPV3) were calculated. Results In 2019, 66% (2499 of 3745) of patients who used the ScanVan were Hispanic & African American. 43% (1627 of 3745) of the women were uninsured, 15% (579 of 3745) of the women had Medicare, and 18% (676 of 3745) classified as other. 17 out of 3745 patients screened received a new diagnosis of breast cancer, corresponding to a cancer detection rate of 4.5/1000 screened. 258 were recalled, corresponding with a recall rate of 7%. The PPV1 was 6.5% (17/258); PPV2 was 29.8% (17/57); and PPV3 was 34% (17/50). Conclusion Barriers to breast cancer screening include lack of medical insurance, limited access to care, and the absence of a primary care physician. The mobile mammography screening van successfully overcame such barriers, providing uninsured women from racial minority groups with vital breast cancer screening and follow up care.

Over the past two decades, the US Asian population has increased 72%, representing the fastest growth rate of any major racial group. Currently, there are over 20 million Asian and Asian American women in the United States, who identify with at least 1 of 19 different origin groups. Although women of Asian ancestry have traditionally been considered low risk for experiencing adverse breast cancer-specific outcomes, aggregated data may mask health disparities seen among subgroups. In the United States, recent data demonstrate that the burden of breast cancer among Asian women has increased each year over the past decade. We aim to characterize challenges faced by Asian and Asian American women in the United States related to cultural stigma, socioeconomic status, and overall access to breast cancer care. An increased understanding of barriers to breast cancer prevention and treatment efforts is needed to develop more effective strategies aimed at reducing disparities in care among segments of this heterogenous population.

The early detection of breast cancer has been shown to reduce deaths through randomized, controlled trials. Numerous observational studies, failure analyses, and "incidence of death" studies have confirmed that screening reduces deaths in the general population. Digital Breast Tomosynthesis (DBT) which collects mammographic images from different angles and uses them to synthesize planes through the breast is simply another advance in mammography among others that have been made over the years. DBT "absolutely" detects more cancers at a time when cure is more likely while also having the advantage of reducing recall rates. The Tomosynthesis Mammographic Imaging Screening Trial (TMIST) has been designed to compare DBT with 2-Dimensional Full Field Digital Mammography (FFDM), but it's major design issues may provide misleading results. Instead of using a reduction in deaths as the endpoint, benefit in TMIST is predicated on a reduction in advanced cancers in the DBT group. This is a questionable "endpoint" (a reduction in advanced cancers is not necessary as proof of benefit). In addition, the trial may be underpowered so that even if DBT shows a benefit it may not be able to achieve "statistical significance". The six CISNET models of the National Cancer Institute have shown that annual mammography beginning at the age of 40 will save the most lives. Yet TMIST will only include women ages 45 and over and will screen postmenopausal women every two years instead of annually. Consequently, TMIST results may be used, inappropriately, to limit access to breast cancer screening starting at the age of 45, and only offer biennial screening for post-menopausal women.

The purpose of this study was to evaluate the readability of breast cancer online patient educational materials (OPEM) written in Spanish and to compare to equivalent English-language OPEM.The breast cancer-related terms cáncer de seno (breast cancer), detección de cáncer de seno (breast cancer screening), and biopsia de seno (breast biopsy) were queried using an online search engine. After each query, educational information related to the queried term was downloaded from each website appearing on the first five search engine result pages. Readability of Spanish-language OPEM was evaluated using the Crawford reading grade score. When available, equivalent English-language OPEM from the same website was then evaluated using the mean of five validated readability indices. Differences in readability, word count, and reading time between Spanish- and English-language OPEM were compared using an unpaired t test. The Fisher exact test was used to compare the proportion of websites meeting AMA recommendations for patient educational resources.Queries for cáncer de seno, detección de cáncer de seno, and biopsia de seno yielded 27, 31, and 30 results of term-specific OPEM. Equivalent English-language versions were available for 19 (70.4%), 18 (58.1%), and 20 (66.7%) websites, respectively. Spanish-language OPEM were written at a lower grade reading level than equivalent English-language versions overall (5.49 ± 0.50 versus 7.77 ± 1.95, P.01). Spanish-language OPEM were also more likely than English-language OPEM to meet AMA recommendations (82.9% versus 40.4%, P.01).Breast cancer-related Spanish-language OPEM were written at a significantly lower grade reading level compared with equivalent information written in English.

Breast cancer is the most common malignant disease in women, and early screening of breast cancer is crucial for improving the survival rate. Mammography is one of the most popular imaging methods for breast cancer screening with the characteristics of practicality, effectiveness, and low cost. However, the classification of mammograms suffers from large image sizes, indistinct image characteristics of lesions, small proportion of abnormalities, and class imbalance. To address these difficulties, the multi-view input and weighted multi-instance learning (MIL) methods are proposed. A novel model called the weighted MIL DenseNet with multi-view input (WMDNet) is presented that integrates the two methods above. The multi-view inputs method is used to enhance the abnormalities of mammograms and obtain more potential features from mammograms with different views, simultaneously. The weighted MIL is designed to extract the most suspicious lesions from mammograms to resolve the problems of small proportion of abnormalities and class imbalance. To verify the effectiveness of the proposed methods, three binary classification models are evaluated on two public datasets, the INbreast and MIAS datasets. The experimental results demonstrate that the proposed methods can achieve preferably results compared with several other state-of-the-art approaches, especially the proposed WMDNet model gains the best classification results on both datasets.

PURPOSE Digital breast tomosynthesis (DBT) in conjunction with digital mammography (DM) is becoming the preferred imaging modality for breast cancer screening compared with DM alone, on the basis of improved recall rates (RR) and cancer detection rates (CDRs). The aim of this study was to investigate racial differences in the utilization and performance of screening modality. METHODS Retrospective data from 63 US breast imaging facilities from 2015 to 2019 were reviewed. Screening outcomes were linked to cancer registries. RR, CDR per 1,000 examinations, and positive predictive value for recall (cancers/recalled patients) were compared. RESULTS A total of 385,503 women contributed 542,945 DBT and 261,359 DM screens. A lower proportion of screenings for Black women were performed using DBT plus DM (referred to as DBT) (44% for Black, 48% for other, 63% for Asian, and 61% for White). Non-White women were less likely to undergo more than one mammographic examination. RRs were lower for DBT among all women (8.74 versus 10.06, P < .05) and lower across all races and within age categories. RRs were significantly higher for women with only one mammogram. CDRs were similar or higher in women undergoing DBT compared with DM, overall (4.73 versus 4.60, adjusted P = .0005) and by age and race. Positive predictive value for recall was greater for DBT overall (5.29 versus 4.45, adjusted P < .0001) and by age, race, and screening frequency. CONCLUSIONS All racial groups had improved outcomes with DBT screening, but disparities were observed in DBT utilization. These data suggest that reducing inequities in DBT utilization may improve the effectiveness of breast cancer screening.

Objective Understanding whether states’ breast density notifications are associated with desired effects, or disparities, can inform federal policy. We examined self-reported receipt of personal breast density information, breast density discussions with providers, knowledge about density’s masking effect, and association with increased breast cancer risk by state legislation status and women’s sociodemographic characteristics. Methods Cross-sectional observational population-based telephone survey of women aged >40 years who underwent mammography within prior 2 years, had no history of breast cancer, and had heard the term “breast density.” Results Among 2,306 women, 57% received personal breast density information. Multivariate regression models adjusted for covariates indicated that women in notification states were 1.5 times more likely to receive density information, and older Black and Asian women of lower income and lower health literacy were less likely. Overall, only 39% of women discussed density with providers; women in notification states were 1.75 times as likely. Older and Asian women were less likely to have spoken with providers; women with high literacy or prior biopsy were more likely. State legislation status was not associated with differences in density knowledge, but Hispanic women and women of lower income or low health literacy had less knowledge regarding density’s masking effects; older women were more knowledgeable. Hispanic women and women of lower income or low health literacy were more likely, and middle-aged women less likely, to recognize increased breast cancer risk. Discussion Some positive effects were observed, but sociodemographic disparities suggest tailoring of future breast density communications for specific populations of women to ensure equitable understanding.

Population-based breast cancer screening programs are efficacious in reducing the mortality due to breast cancer. These programs use mammography to screen the women who are invited to participate. Digital mammography makes it possible to develop computer-assisted diagnosis (CAD) systems that promise to reduce the workload of radiologists participating in screening programs. However, various studies have shown that CAD results in a high rate of false positive diagnoses. Systems based on artificial intelligence are being more widely implemented, and studies have shown that these systems have better diagnostic performance than traditional CAD systems. This article explains the fundamentals of artificial intelligence systems and an overview of possible applications of these systems within the framework of breast cancer screening programs.

Introduction: Although there is evidence of disparities in breast cancer screening for women with mental illness in the United States (US), there is a dearth of studies examining this association in the United Kingdom (UK) where healthcare is provided free at the point of access. This population-based study examines the influence of mental illness, as assessed by uptake of psychotropic medications, on breast screening uptake in the UK.Methods: A cohort of 57,328 women identified from 2011 Census records within the Northern Ireland Longitudinal Study (NILS) was followed through one three-year screening cycle (2011-2014) of the National Health Service (NHS) breast screening programme. Mental illness was identified by receipt of psychotropic medication in the three months preceding screening invite. Individual and household-level attributes were derived from Census records. Data were analyzed in 2019.Results: Over a third of women received at least one prescription for psychotropic medication in the three months preceding screening invite. The odds of attendance in these individuals were reduced by 15% (OR= 0.85; 95% CI 0.81 – 0.88). Attendance was particularly low for women prescribed antipsychotics (OR= 0.63; 95% CI 0.56 – 0.70), anxiolytics (OR= 0.61; 95% CI 0.57 – 0.66), and hypnotics (OR= 0.68; 95% CI 0.63 – 0.72). Conclusions: These findings confirm the existence of significant disparities in breast screening uptake for women with mental illness. Targeted interventions are warranted to prevent avoidable breast cancer deaths in these individuals, particularly given the increasing prevalence of mental illness.

Objective The United States Preventive Services Task Force recommends against breast self-examination. However, racial disparities exist in mammogram screening. We aimed to evaluate the presentation of women with newly diagnosed breast cancer in the underserved African-American and Hispanic community to provide insight regarding breast cancer screening in this population. Methods This retrospective cohort study included women newly diagnosed with breast cancer from 1/1/2016 to 1/1/2018 in an inner city public community hospital. Data was collected via chart review. Patients were divided based on whether they presented with self-detected breast mass. Logistic regression was used for analysis. Results 59 women were newly diagnosed with breast cancer. 34 women (58%) were African-American, 20 (34%) were Hispanic, and 5 (8%) were other race. Of 59 women, 36 (61%) presented with self-detected breast mass, and only 21 (36%) reported prior mammography. For women who presented with breast mass, the odds of having prior mammography were 78% lower (OR = 0.22, 95% CI 0.07–0.69, p = 0.009), while the odds of having invasive ductal carcinoma were 4.33 times higher (OR = 4.33, 95% CI 1.09–17.25, p = 0.037), as compared to the odds for women not presenting with breast mass. Conclusion Many of our newly diagnosed breast cancer patients were African-American or Hispanic women presenting with self-detected breast mass without prior screening mammography. Further studies should evaluate whether supplemental screening methods, such as breast self-examination or clinical examination, can help with early breast cancer detection in minority women with limited access to care, and such disparities should be considered by organizations when creating screening guidelines.

Objective The study aimed to determine the effect of motivational interviewing on the change of breast cancer screening behaviors among rural Iranian women. Methods This Randomized controlled trial (RCT) was performed on 120 Iranian rural women selected through cluster random sampling method. Out of all 20 rural health centers of Abish Ahmad District, in the northwest of Iran, about one third (six clusters) were randomly selected; out of which three were randomly assigned to the control group and three to the intervention group. A list of women aged 40–69 years in the selective health centers was prepared and 60 participants were selected for each group through the convenience sampling method based on the inclusion and exclusion criteria. Then, six group sessions (two educational and four motivational interviewing sessions) were held for the intervention group. The data were collected using demographic and obstetric questionnaire, paper-based health records, and the stages of change checklist and analyzed in SPSS 24. The groups were compared through the chi square test, homogeneity test, and the sequential logistic regression with generalized estimating equations. Results Two months after the intervention, a significant difference was found between the two groups in terms of the stages of change for clinical breast examination and mammography by taking into account the pre-intervention stages (p = 0.001). Conclusion MI-based counseling increased the Iranian rural women’s motivation for displaying breast cancer screening behaviors. Practice implications The application of MI for enhancing cancer screening programs among Iranian women is suggested.

Breast MR imaging is the most sensitive imaging method for the detection of breast cancer and detects more aggressive malignancies than mammography and ultrasound examination. Despite these advantages, breast MR imaging has low use rates for breast cancer screening. Abbreviated breast MR imaging, in which a limited number of breast imaging sequences are obtained, has been proposed as a way to solve cost and patient tolerance issues while preserving the high cancer detection rate of breast MR imaging. This review discusses abbreviated breast MR imaging, including protocols, multicenter clinical trial results, clinical workflow implementation challenges, and future directions.

Contrast-enhanced mammography (CEM) is an emerging breast imaging technology that provides recombined contrast-enhanced images of the breast in addition to low-energy images analogous to a 2-dimensional full-field digital mammogram. Because most breast imaging centers do not use CEM at this time, a detailed overview of CEM implementation and performance is presented. Thereafter, the potential use of CEM for supplemental screening is discussed in detail, given the importance of this topic for the future of the CEM community. Diagnostic performance, safety, and cost considerations of CEM for dense breast tissue supplemental screening are discussed.

Magnetic Resonance (MR) imaging is the most sensitive modality for breast cancer detection but is currently limited to screening women at high risk due to limited specificity and test accessibility. However, specificity of MR imaging improves with successive rounds of screening, and abbreviated approaches have the potential to increase access and decrease cost. There is growing evidence to support supplemental MR imaging in moderate-risk women, and current guidelines continue to evolve. Functional imaging has the potential to maximize survival benefit of screening. Leveraging MR imaging as a possible primary screening tool is therefore also being investigated in average-risk women.

In an increasingly competitive and passionate health care environment, radiology advocacy is imperative, now more than ever. Arguably, it is particularly more crucial in the world of breast cancer, as we as a breast cancer community are tirelessly assembling to advocate for our patients on a variety of levels, whether it is including but not limited to, breast cancer screening, diagnosis, and treatment, access-to-care, education, or research funding. As breast radiologists, it is no longer simply enough to clock in our normal work hours; we must ALL make a concerted effort to vociferously advocate for our patients and profession.

OBJECTIVE: To investigate the general population's view on the use of artificial intelligence (AI) for the diagnostic interpretation of screening mammograms.METHODS: Dutch women aged 16 to 75 years were surveyed using the Longitudinal Internet Studies for the Social sciences panel, representative for the Dutch population. Attitude toward AI in mammography screening was measured by means of five items: necessity of a human check; AI as a selector for second reading; AI as a second reader; developer is responsible for error; and radiologist is responsible for error.RESULTS: Of the 922 participants included, 77.8% agreed with the necessity of a human check, whereas the item AI as a selector for a second reading was more heterogeneously answered, with 41.7% disagreement, 31.5% agreement, and 26.9% responding with "neither agree nor disagree." The item AI as a second reader was mostly responded with "neither agree nor disagree" (37.1%) and "agree" (37.6%), whereas the two last items on developer's and radiologist' responsibilities were mostly answered with "neither agree nor disagree" (44.6% and 39.2%, respectively).DISCUSSION: Despite recent breakthroughs in the diagnostic performance of AI algorithms for the interpretation of screening mammograms, the general population currently does not support a fully independent use of such systems without involving a radiologist. The combination of a radiologist as a first reader and an AI system as a second reader in a breast cancer screening program finds most support at present. Accountability in case of AI-related diagnostic errors in screening mammography is still an unresolved conundrum.

Since its widespread introduction 30 years ago, screening mammography has contributed to substantial reduction in breast cancer-associated mortality, ranging from 15% to 50% in observational trials. It is currently the best examination available for the early diagnosis of breast cancer, when survival and treatment options are most favorable. However, like all medical tests and procedures, screening mammography has associated risks, including overdiagnosis and overtreatment, false-positive examinations, false-positive biopsies, and radiation exposure. Women should be aware of the benefits and risks of screening mammography in order to make the most appropriate care decisions for themselves.

Breast cancer screening is a recognized tool for early detection of the disease in asymptomatic women, improving treatment efficacy and reducing the mortality rate. There is raised awareness that a "one-size-fits-all" approach cannot be applied for breast cancer screening. Currently, despite specific guidelines for a minority of women who are at very high risk of breast cancer, all other women are still treated alike. This article reviews the current recommendations for breast cancer risk assessment and breast cancer screening in average-risk and higher-than-average-risk women. Also discussed are new developments and future perspectives for personalized breast cancer screening.

Breast cancer is the primary cause of cancer mortality, worldwide, and in Indonesian women. Late stage cancer is an important predictor of cancer mortality. Breast self-examination (BSE) is recommended as a way to potentially allow for early detection of any breast anomalies. A previous study found that only 39.5% of nurses reported practicing BSE on a regular monthly basis. Cancer-related stigma among non-cancer patients is an important predictor of cancer screening. This study aimed to identify the relationship between cancer stigma and BSE among nurses. The study applied a cross-sectional analytic design. A total of 88 nurses were selected via random sampling. The Chi-square test was used to analyze the data. The results showed that there is a significant association between cancer stigma and BSE among nurses (p

The aim of this study was to analyse if breast cancer survivors without other breast imaging surveillance attend population-based screening differently than women not previously diagnosed with breast cancer. Further, to analyse if any differences depended on the women’s age and years since previous cancer diagnosis. The study was a register-based retrospective cohort study of all women invited to participate in the national breast cancer screening programme in 2015–2016. Participation rates were calculated for breast cancer survivors without breast imaging within 21 months (2–4 years, 4–6 years, 6–10 years and more than 10 years after diagnosis) and for women without previous breast cancer. Relative differences in participation rates between the two groups were calculated. A total of 679,990 women were included in the study (2.6% breast cancer survivors). For breast cancer survivors, participation rates increased with increasing number of years since the previous cancer diagnosis peaking at 80.3% if the cancer diagnosis was more than 10 years ago. For women with no previous breast cancer, participation rate was 80.3%. The relative difference in participation was highest close to the breast cancer diagnosis and for the youngest women participation rates remained lower among breast cancer survivors even more than 10 years after the diagnosis. In conclusion, regardless of age and years since previous breast cancer diagnosis, breast cancer survivors had lower or similar participation rates than women with no previous cancer diagnosis. This indicated that as many as one fifth of the breast cancer survivors are at risk of inadequate surveillance., Highlights • Breast cancer surveillance needs to be optimised owing to the amount of survivors. • No evidence contradicts surveillance could be within organised screening programmes. • One fifth of survivors do not participate entailing a risk of suboptimal surveillance. • Surveillance in organised screening requires attention to the special needs of survivors.

High participation by target populations is one of the key success factors of publicly funded and population-based cancer screening programs. Patient preferences are a major factor distinguishing preventive screening from treatment, specifically regarding participation and choice of facility. Here, we explore the effect of facility attributes on patients’ choices for cancer screening and propose a quantitative modeling framework to study the impact of various system- and facility-level interventions by incorporating the choice behaviors of heterogeneous patient populations. EPPM integrates an empirical study on patient preferences and a simulation-based optimization model that incorporates the preferences of multiple patient types into an M/G/s queuing network of facilities, each working with appointment. Based on our framework's application via an extensive case study on the Quebec Breast Cancer Screening Program in Montreal, we provide insights into improving participation in cancer screening networks. Specifically, we identify trade-offs that women make when choosing facilities with different attribute configurations and show the heterogeneity in patient preferences. We also find that facility-level interventions, such as providing free parking and improving staff manners, are more effective and less expensive than system-level interventions.

Purpose The aim of this study was to evaluate the implementation and utilization of the Pink Card program, which links a physician-delivered reminder that a woman is due for screening mammography (SM) during an office visit with the opportunity to undergo walk-in screening. Methods In 2016, the authors’ community-based breast imaging center provided physicians from three primary care and obstetrics and gynecology practices located in the same outpatient facility business card–sized Pink Cards to offer women due for SM during office visits. The card includes a reminder that screening is due and can be used to obtain SM on a walk-in basis. The primary outcome measure was the proportion of women who used Pink Cards among all screened women over 2 years. Independent predictors of Pink Card utilization were evaluated using multivariate logistic regression analyses. Results Among 3,688 women who underwent SM, Pink Cards were used by 19.9% (733 of 3,688). Compared with women with prescheduled screening visits, Pink Card users were more likely to be Asian (odds ratio [OR], 1.37; P =.032), Black (OR, 2.05; P = .002), and Medicaid insured (OR, 1.71; P = .013) and less likely to use English as their primary language (OR, 2.75; P = .003). Additionally, Pink Card users were less likely to be up to date for biennial SM compared with women with prescheduled visits (31.9% [234 of 733] versus 66.6% [1,968 of 2,955], P Conclusions The Pink Card walk-in SM program can improve screening access, particularly for racial/ethnic minorities and Medicaid-insured patients. Expansion of this program may help reduce disparities and increase engagement in breast cancer screening.

Adult women require routine care for the acute and chronic health problems found in both sexes, and they require specialized care for women's health problems, including disease prevention, disease screening, and disease management. Internists should direct primary care and participate in specialized care and to the extent possible follow guidelines published by various professional organizations. They should understand the use of ultrasound in breast cancer screening, the management of pregnancy, and other gynecologic problems, including vaginal bleeding, pelvic pain, and investigation for pelvic malignancy. Finally, all management decisions need discussions on the potential benefit or harm in each step of a woman's care with an emphasis on personal preferences.

Metabolic syndrome is associated with an increased risk of diabetes mellitus (DM) and coronary heart disease. It may also be associated with a higher risk of some common cancers. The objective of this study was to determine the relationship between metabolic syndrome and breast cancer in postmenopausal women.We present a prospective cohort study of postmenopausal women. This cohort was divided into two groups: the «benign diagnosis group», including women who were studied after breast cancer screening; and the «malignant tumor group», including patients with breast cancer that had been diagnosed by biopsy. Age, weight, height, body mass index (BMI), abdominal perimeter, serum glucose, LDL, HDL and insulin levels were analyzed as variables under study. The HOMA-IR homeostatic model formula was used to assess insulin resistance. The differences were considered statistically significant when P.05.Two hundred women with a mean age of 61.5±9.6 (range: 37-93) were enrolled in the study, consisting of 150 (75%) patients with a benign diagnosis and 50 (25%) patients with a malignant tumor. BMI and abdominal perimeter were higher in the group with a malignant tumor (P.05). The incidence of DM and metabolic syndrome was higher in the malignant tumor group (P.005). In the malignant tumor group, much higher incidences correlated with fasting glycemic levels100mg/dL, insulin levels10mIU/L and HOMA-IR scores2.7 (P.05).There is a relationship between metabolic syndrome and postmenopausal breast cancer. More studies are needed to establish methods for the prevention of breast cancer in women with metabolic syndrome.

Background Female-to-male (FtM) transsexuals may use testosterone therapy for masculinization, which potentially influences the risk of breast cancer development. Guided by our case report, we aimed to investigate the evidence regarding the risk of testosterone therapy on breast malignancy in female-to-male transsexuals and evaluate breast cancer screening in this subgroup. Methods We conducted a systematic literature search according to the PRISMA checklist in June 2020 in PubMed/MEDLINE and Ovid/EMBASE. Reference lists of included articles were screened to find additional articles that met the inclusion criteria. All cohort studies and case reports evaluating breast cancer in FtM transsexuals after testosterone therapy were included. Results We found 23 cases of FtM transsexuals who developed breast cancer after testosterone therapy, including our own case. Moreover, we evaluated ten retrospective cohort studies investigating breast malignancy in the transsexual population. The cohort studies showed no elevated risk in FtM transsexuals compared to natal women. Including our own case, nine cases were described in which breast malignancy was incidentally found during routine histological examination after mastectomy. High-level evidence for a correlation between testosterone therapy and breast malignancy is missing. Conclusion Few cases are described of FtM transsexuals with breast malignancy. However, cases such as these make physicians aware of the possibility of breast cancer in FtM transsexuals. Radiological screening of FtM transsexuals for breast cancer prior to mastectomy and histological screening of the mammalian tissue after mastectomy should be considered; physicians should decide together with every individual FtM transsexual if screening is necessary., Highlights • Breast cancer malignancy after testosterone therapy in female to male (FtM) transsexuals is very rare, including our own case, we found 23 of such cases reported in literature. • Based on current evidence, it is not possible to conclude associations between FtM transsexuals using testosterone therapy and breast cancer. • Radiological screening FtM transsexuals for breast cancer prior to mastectomy and histological screening of the mammalian tissue after mastectomy should be considered; physician should decide together with every individual FtM transsexual if screening is necessary.

Background Discussions about whether to continue breast cancer screening in older women are complex, particularly for African American women. Decision aids may be helpful in guiding these conversations; however, little is known about the feasibility and acceptability of using breast cancer decision aids in older African American women. This study explored African American women's knowledge of breast cancer screening guidelines in older adults, prior conversations with providers regarding continuation of screening, and their understanding/willingness to engage in discussions about individualized breast cancer screening decision-making using two versions of tested decision aids. Methods Twenty-four African American women; (age m = 83) in urban geriatric practice. Interviews with African American women age 75+. Both DAs include age, health/functional status, and comorbidities questions to determine a BCS harms/benefit score. Results Most participants (75%) reported familiarity with current breast cancer screening guidelines. Twenty-nine percent reported prior discussions with providers about continuing breast cancer screenings. Sixty percent did not need assistance completing DAs while 40% did. 66.7% found the decision aids “very helpful” in reflecting their breast cancer screening thoughts; 58.3% had no preference regarding either decision aid version. 75% of participants were willing to complete the decision aid before a provider visit. Participants equally preferred a health educator or provider facilitating discussion of breast cancer screening harms and benefits and potential cessation. Conclusions Older African American women are willing to engage in discussions about whether or not to continue breast cancer screening and found decision aids helpful.

Guidelines recommend individualized breast cancer screening and prevention interventions for women in their 40s. Yet, few primary care clinicians assess breast cancer risk.Pretest-Posttest trial.Women aged 40-49 years were recruited from one large Boston-based academic primary care practice between July 2017 and April 2019.Participants completed a pretest, received a personalized breast cancer risk report, saw their primary care clinician, and completed a posttest.Using mixed effects models, changes in screening intentions (0-100 scale [0=will not screen to 100=will screen]), mammography knowledge, decisional conflict, and receipt of screening were examined. Analyses were conducted from June 2019 to February 2020.Patient (n=337) mean age was 44.1 (SD=2.9) years, 61.4% were non-Hispanic white, and 76.6% were college graduates; 306 (90.5%) completed follow-up (203 with 5-year breast cancer risk1.1%). Screening intentions declined from pre- to post-visit (79.3 to 68.0, p0.0001), especially for women with 5-year risk1.1% (77.2 to 63.3, p0.0001), but still favored screening. In the 2 years prior, 37.6% had screening mammography compared with 41.8% over a mean 16 months follow-up (p=0.17). Mammography knowledge increased and decisional conflict declined. Eleven (3.3%) women met criteria for breast cancer prevention medications (ten discussed medications with their clinicians), 22 (6.5%) for MRI (19 discussed MRI with their clinician), and 67 (19.8%) for genetic counseling (47 discussed with the clinician).Receipt of a personalized breast cancer report was associated with women in their 40s making more-informed and less-conflicted mammography screening decisions and with high-risk women discussing breast cancer prevention interventions with clinicians.This study is registered at www.clinicaltrials.govNCT03180086.

Background In the incidental pulmonary nodule and breast cancer screening settings, high-quality patient-centered communication can improve adherence to evaluation and mitigate patient distress. Although guidelines emphasize shared decision-making before lung cancer screening, little is known about patient-clinician communication after lung cancer screening. Research Question How do patients and clinicians perceive communication and results notification after lung cancer screening, and are there approaches that may mitigate or exacerbate distress? Study Design and Methods We conducted interviews and focus groups with 49 patients who underwent lung cancer screening in the prior year and 36 clinicians who communicate screening results (primary care providers, pulmonologists, nurses), recruited from lung cancer screening programs at 4 hospitals. We analyzed transcripts using conventional content analysis. Results Clinicians and patients diverged in their impressions of the quality of communication after lung cancer screening. Clinicians recognized the potential for patient distress and tailored their approach to disclosure based on how clinically concerning they perceived results to be. Disclosure of normal or low-risk findings usually occurred by letter; clinicians believed this process was efficient and well received by patients. Yet many patients were dissatisfied: several could not recall receiving results at all, and others reported that receiving results by letter left them confused and concerned, with little opportunity to ask questions. By contrast, patients with larger nodules typically received results during an immediate phone call or clinic visit, and both patients and clinicians agreed that these conversations represented high-quality communication that met patient needs. Regardless of their cancer risk, patients who learned their results in a conversation appreciated the opportunity to discuss both the meaning of the nodule and the evaluation plan, and to have their concerns addressed, preempting distress. Interpretation Tension exists between clinicians’ interest in efficiency of results notification by letter in low-risk cases and patients’ need to understand and be reassured about screening results, their implications, and the plan for subsequent screening or nodule evaluation—even when clinicians did not perceive results as concerning. Brief conversations to discuss lung cancer screening results may improve patient understanding and satisfaction while reducing distress.

The objective of this study was to survey current trends in supplemental screening across various practice types and to understand factors that affect these practice patterns.In this institutional review board-exempt study, a 12-question survey was sent out to ACR lead interpreting physicians. The survey inquired about practice features and the utilization of supplemental screening.A total of 902 of 4,688 lead interpreting breast imaging physicians (19.2%) responded to our survey. Of those respondents, 617 respondents (68.4%) worked in practices that offered supplemental breast cancer screening. Screening ultrasound was the most commonly utilized supplemental screening modality (53%). There was variability in methods of referral for supplemental screening, with referral through the ordering provider (56%) being the most common. Academic practices, private practices with breast specialization, and practices in the Northeast were more likely to provide supplemental screening (P.05). There were significant relationships between the presence of state density notification legislation, the number of breast imaging trained radiologists, and the volume of mammographic studies performed per day and the availability of supplemental screening (P.05). The use of automated breast density assessment software and patient education brochures about density and supplemental screening also had significant relationships with the availability of supplemental screening (P.05).The majority of practices surveyed are utilizing supplemental screening, but there is significant variability in the modalities used and the methods of referral. There are practice features that correlate with the availability of supplemental screening, and understanding these features provides further insight into current trends in supplemental screening utilization.

Multiple large-scale, randomized controlled trials throughout the world have demonstrated screening mammography significantly reduces a woman's risk of dying from breast cancer. Despite the known mortality reduction, the perceived harms of mammography are weighed against the known value. Multiple national guidelines have moved away from recommending all women have annual screening mammograms beginning at age 40. Instead, many now encourage women at average risk for developing breast cancer to engage in shared decision-making with their providers, carefully weighing the perceived harms against the known benefits of mammography. These factors should be incorporated into the decision about when to begin and how often to screen. This paradigm shift has been particularly controversial as it relates to women in the 40-49-year age group, considering their incidence of breast cancer and therefore derived benefit of screening is lower, yet the breast cancers that do occur tend to be more aggressive and often require intensive therapy. Thus, debates ensue over the appropriate age at which to begin screening for breast cancer, how often screening should occur, and when to stop.

Objective: To determine the government and out‐of‐pocket community costs (out‐of‐hospital medical services and prescription medicines) associated with screen‐detected and community‐detected cancers (i.e. cancers detected outside of Australia's organised screening program [BreastScreen]). Methods: We analyse administrative data on government‐subsidised medical services and prescription medicines for 568 Victorian women diagnosed with breast cancer or ductal carcinoma in situ (DCIS). Using multivariable regression analysis, we estimate the government and out‐of‐pocket community costs incurred in the three years after diagnosis for screen‐detected cancers and community‐detected cancers. Additionally, we estimate the government costs associated with diagnosis within and outside of BreastScreen. Results: Average government costs for breast cancer diagnosis were similar within and outside of BreastScreen [$808 (lower limit 676; upper limit 940) vs $837 (95%CI 671; 1,003) respectively]; however, women with community‐detected cancers incurred an additional $254 (95%CI 175; 332) out‐of‐pocket. Controlling for differences in known cancer characteristics, compared to screen‐detected cancers, community‐detected breast cancers were associated with an additional $2,622 (95%CI 644; 4,776) in government expenditure in the three years following diagnosis. Adverse cancer characteristics that were more prevalent in community‐detected cancers (high grade, lymph node involvement, HER2 positive receptor status) were associated with increased government and out‐of‐pocket costs. Conclusions: Community‐detected breast cancers were associated with increased government and out‐of‐pocket costs. Implications for public health: These costs should be considered when evaluating current and alternative breast cancer screening strategies.

Introduction Lung cancer mortality is increasing in women. In Spain, estimates suggest that lung cancer mortality may soon surpass breast cancer mortality, the main cause of cancer mortality among women. The aim of this study was to estimate the proportion of women at high risk of developing lung cancer in a group of participants in a population-based breast cancer screening program. Methods Cross-sectional study in a sample of women who participated in a population-based breast cancer screening program in 2016 in Hospitalet de Llobregat n = 1,601. High risk of lung cancer was defined according to the inclusion criteria of the National Lung Screening Trial (NLST) and the Dutch-Belgian randomized lung cancer screening trial (NELSON). Results Around 20% of smokers according to NLST and 40% of smokers according to NELSON criteria, and around 20% of former smokers according to both criteria, are at high risk of developing lung cancer. A positive and statistically significant trend is observed between the proportion of women at high risk and nicotine dependence measured with the brief Fagerstrom Test. Conclusions A high proportion of participants in this breast cancer screening program have a high risk of developing lung cancer and would be eligible to participate in a lung cancer screening program. Population-based breast cancer screening programs may be useful to implement lung cancer primary prevention activities.

Objectives Markov model simulation based on the natural history of disease is commonly employed for the comparative research of health interventions. The present study aims to simulate the natural progression of breast cancer and parameterize the initial and transition probabilities of multiple states of breast cancer development among Chinese women. Methods The age-specific incidence, mortality, and clinical stage distribution of breast cancer; and relapse rate of each clinical stage were collected from China's cancer registry yearbooks and clinical epidemiological studies to simulate the process from full health to breast cancer to death among Chinese women aged 30 to 80 through a Markov cohort study. The validity analysis was conducted to evaluate the accuracy of the model estimation. Results A Markov transition model with 7 states (no breast cancer, clinical stages 0-IV breast cancer, and death) was constructed for Chinese women. The age-specific incidence, mortality, and clinical stage distribution of breast cancer estimated by the initial and transition probabilities among different Markov states were highly consistent with the registered data and observed studies. Conclusion A breast cancer transition model for Chinese women has been established with validity. It could be a point of reference for further economic evaluations and breast cancer screening policy formulation.