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

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

Introduction Arab American women (AAW) have significantly low mammography screening (MS) rates; religious and sociocultural factors may serve as facilitators or barriers to screening. Understanding associations with screening practices and attitudes is imperative. The purpose of this study was to examine associations of sociodemographic characteristics with perceived benefits and barriers to MS and explore relationships of MS with sociodemographics, and perceived benefits and barriers in Muslim and Christian AAW from three Arab countries, Jordan, Lebanon, and Egypt. Method In this exploratory, cross sectional study, a convenience sample of 316 AAW completed a survey that combined sociodemographics and the Arab Specific-Culture Barriers instrument. Results Religion was significantly associated with perceived benefits and country of birth had a significant association with perceived barriers. Significant relationships were found between some variables and MS. Discussion This study provided insights into facilitators and barriers influencing behaviors and attitudes regarding MS in AAW. Additional efforts are to be made to overcome barriers within a religious and cultural context to empower these women.

Aims: To explore attitudes, motivations and intentions about attending for mammography among women who cancelled or postponed breast cancer screening, which had remained open in Denmark during the COVID-19 pandemic. Methods: A telephone interview study was conducted at the end of April 2020. A qualitative, phenomenological approach was chosen to identify themes and concepts and a semi-structured interview guide was developed. The analysis was structured according to constructs from the theory of planned behaviour, including attitudes to breast cancer screening, norms and motivations to comply with breast cancer screening, perceived control and anticipated regret. Results: Interviews were carried out with 33 women aged 50–69 (mean 62) years. The women felt that screening was of secondary importance during the height of the pandemic and they felt low perceived control over transportation to the screening clinic and over the screening situation itself, where social distancing was impossible. They perceived messages from the authorities as conflicting regarding the request for social distancing and a lack of recommendations about using face masks at the screening clinic. Conclusions: Women who postponed or cancelled breast cancer screening during the COVID-19 pandemic felt that public recommendations appeared contradictory. Uncertainty about the ‘new norm(al)’ of COVID-19 made them stay at home, although the screening clinics remained open. The findings point to the importance of addressing perceived inconsistency between recommendations from the World Health Organization and the national management of these recommendations, and to secure univocal information from the authorities about the recommended use of healthcare services in a time of crisis.

Despite overwhelming evidence of a major reduction in deaths, the debate about the efficacy of breast cancer screening has continued for over 50 years. The poor results in the Canadian National Breast Screening Studies (CNBSS) have been used to challenge the benefits shown by the other randomized, controlled trials. They continue to be used in assessing the value of breast cancer screening despite their unblinded allocation process, which first identified women with breast abnormalities and then assigned them on open lists allowing for nonrandom assignment, compromising the trials and rendering their results unreliable. There were, statistically significantly, more women with advanced cancers who were assigned to the screening arm in CNBSS1. The early results for CNBSS1 showed an excess of women dying in the screening arm, and an (otherwise inexplicable) greater than 90%, 5-year survival for the control women. The failure of random assignment also explains why the clinically evident cancers were larger in the screening arms than the cancers in the “usual care” arms, despite the fact that the screened women underwent very intense clinical breast examinations each year by highly skilled examiners. The claim that balanced demographic factors prove random assignment is also false. Nonrandom allocation of a hundred or more women with clinically evident abnormalities would have no detectable influence on the distribution of demographic factors. In summary, policy decisions about mammography should not be influenced by the results of the CNBSS.

Objective To examine the breast cancer detection rate by single reading of an experienced radiologist supported by an artificial intelligence (AI) system, and compare with two-dimensional full-field digital mammography (2D-FFDM) double reading. Materials and methods Images (3D-tomosynthesis) of 161 biopsy-proven cancers were re-read by the AI algorithm and compared to the results of first human reader, second human reader and consensus following double reading in screening. Detection was assessed in subgroups by tumour type, breast density and grade, and at two operating points, referred to as a lower and a higher sensitivity threshold. Results The AI algorithm method gave similar results to double-reading 2D-FFDM, and the detection rate was significantly higher compared to single-reading 2D-FFDM. At the lower sensitivity threshold, the algorithm was significantly more sensitive than reader A (97.5% vs. 89.4%, p = 0.02), non-significantly more sensitive than reader B (97.5% vs. 94.4%, p = 0.2) and non-significantly less sensitive than the consensus from double reading (97.5% vs. 99.4%, p = 0.2). At the higher sensitivity threshold, the algorithm was significantly more sensitive than reader A (99.4% vs. 89.4%, p Conclusion In this proof of principle study, we show that sensitivity using single reading with a suitable AI algorithm is non-inferior to that of standard of care using 2D mammography with double reading, when tomosynthesis is the primary screening examination.

Objective To compare outcome metrics of digital breast tomosynthesis (DBT) breast cancer screening with full-field digital mammogram (FFDM); specifically, to compare recall rates by the type of recalled finding, and to assess if screening with DBT versus FFDM changes biopsy recommendations and if the likelihood of malignancy varied by lesion type, if detected on DBT or FFDM screening mammogram. Methods The outcomes of 22,055 FFDM and DBT screening mammograms were retrospectively reviewed. The exams were performed at an academic institution between August 2015 and September 2016. Performance of screening with FFDM versus DBT was compared in terms of recall rate and percentage of recalled lesions resulting in a cancer diagnosis, with subset analyses performed for specific mammographic findings. Results The recall rate was 10.6% for FFDM and 8.0% for DBT ( p Conclusions DBT screening confers an advantage in detection of architectural distortion representing malignancy. Recall rate of asymmetries are reduced with screening DBT, probably due to reduction of tissue superimposition. Calcifications pose a particularly difficult diagnostic challenge for breast imagers, regardless of screening mammogram type.

Background New York’s statewide “Get Screened, No Excuses” campaign has been one of the nation’s most aggressive actions to improve access to breast cancer screening. Inner city and suburban county medical centers’ initiatives were studied to compare outcomes of breast cancer screening and factors that influence access to care. Methods Women delinquent in breast cancer screening one year or greater were offered patient navigator services to aid in timely breast cancer screening. Time-to-event completion rates among different stages of breast cancer screening stages in City and County women were compared. Time-to-event completion rates among different stages of breast cancer screening stages. Results 2505 women aged ≥40 years accepted PN services. Mean (SD) age of patients was 56.2 (10) years. The mean (SD) age of those who completed breast screening vs. those who did not was 56.8 (10) and 52.5 (.9) years, respectively ( P < .01). The rates of screening completion during physical examination, mammography and biopsy stages were 74%, 78% and 100% in City vs. 98%, 85% and 100% in County, respectively ( P < .001). Screening phase was the significant predictor of time to completion for breast cancer screening in Cox regression analysis. Over 85% of women completed the breast cancer screening, 74% in City and 97.6% in County ( P < .001). Discussion Screening phase is an important predictor of time-to complete breast cancer screening. Center location served as the effect modifier of the relationship. The rate of completing the screening was significantly higher and faster among Suburban County compared to Inner City women.

Breast cancer is the most common cause of premature mortality among women, and screening is one of the most important means of early diagnosis of breast cancer. This qualitative study was conducted to explore strategies for promoting breast cancer screening behaviors from the perspective of health volunteers in south-east Iran. Data collection was performed through focus groups. Using the purposive sampling method, 35 participants were selected and data were analyzed using a specific qualitative content analysis framework. By analyzing the data to provide strategies for promoting breast cancer screening behaviors, the main theme of “organizational transformation” with five subthemes including the promotion of health-centered beliefs in society, the development of culture-based training, the media revolution, financial support, and the provision of efficient health-care providers were extracted. According to the results of the study, the development of organizational transformation plays an important role in planning for the promotion of breast cancer screening.

Racial disparities in breast cancer screening, morbidity, and mortality persist for Black women. This study examines Black women’s mammography beliefs and experiences with specific focus on barriers to mammography access in an urban city in the South East, United States. This retrospective, qualitative study used Penchansky and Thomas’ conceptualization of health care access as the framework for the data analysis. In-depth, semistructured interviews were conducted with 39 Black women. Structural and personal factors continue to create barriers to mammography among Black women. Barriers to mammography were identified for each of the Penchansky and Thomas five dimensions of access to care: accessibility, affordability, availability, accommodation, and acceptability. Clinical practice strategies to increase mammography screening in Black women must be multifactorial, patient-centered, and culturally congruent. Policy development must address the structural barriers to mammography screening through expansion of health insurance coverage and increased accessibility to health care.

Background African American women continue to have higher mortality rates of breast cancer when compared to other women, and evidence suggests that early detection of breast cancer can lead to favorable outcomes, yet there remains a paucity of literature about health beliefs and the utilization of three screening practices, namely breast self-examination, clinical breast examination and mammography in California, a state that currently has one of the highest breast cancer mortality rates among African American women. Purpose To investigate the relationship between health beliefs and three breast cancer detection practices, e.g. breast self-examination, clinical breast examination, and mammography in a cohort of African American women. Methods Using a descriptive correlational design, a convenience sample of two hundred and eighty-two (n = 282) self-identified women from six regional chapters of a national Black women’s political organization in California, completed a Demographic Data Questionnaire and Champion’s Health Belief Model Scale which assessed the hypothesized relationships of health beliefs and breast cancer detection practices. Results Among this culturally diverse group of women (49.8% American, 28.8% African, 21.4% West Indian), health motivation was positively related to the practice of BSE and annual physician visitation for clinical breast examinations. Health locus of control was positively related to the practice of BSE. Having relatives and friends who were diagnosed with breast cancer was strongly associated with having a mammogram and annual physician visitation for clinical breast examinations. Conclusion These findings may be used to target and develop interventions that are tailored to the unique characteristics of these diverse women.

Objective To assess the determinants of the participation rate in breast cancer screening programs by conducting a systematic review of reviews. Methods We conducted a systematic search in PubMed via Medline, Scopus, Embase, and Cochrane identifying the literature up to April 2019. Out of 2258 revealed unique abstracts, we included 31 reviews, from which 25 were considered as systematic. We applied the Walsh & McPhee Systems Model of Clinical Preventive Care to systematize the determinants of screening participation. Results The reviews, mainly in high-income settings, reported a wide range for breast cancer screening participation rate: 16–90%. The determinants of breast cancer screening participation were simple low-cost interventions such as invitation letters, basic information on screening, multiple reminders, fixed appointments, prompts from healthcare professionals, and healthcare organizational factors (e.g. close proximity to screening facility). More complex interventions (such as face-to-face counselling or home visits), mass media or improved access to transport should not be encouraged by policy makers unless other information appears. The repeated participation in mammography screening was consistently high, above 62%. Previous positive experience with screening influenced the repeated participation in screening programs. The reviews were inconsistent in the use of terminology related to breast cancer screening participation, which may have contributed to the heterogeneity in the reported outcomes. Conclusions This study shows that consistent findings of systematic reviews bring more certainty into the conclusions on the effects of simple invitation techniques, fixed appointments and prompts, as well as healthcare organizational factors on promoting participation rate in screening mammography.

Objectives To estimate the impact on the effectiveness of Swedish breast cancer screening program in women aged 40–49 years of shortening the screening interval from 21 months to 18 or 12 months. Methods The reduction in breast cancer mortality among participants in screening with mammography was previously estimated in the Swedish SCReening of Young women (SCRY) study to be 29%. The expected increased effectiveness with a hypothetical shorter screening interval than the average of 21 months in SCRY was calculated using data about the women who died from breast cancer even though they participated in the SCRY program. Results During the study period, 547 women who participated in the index screening round died from breast cancer. Shortening the screening interval to 18 months led to an improved effectiveness of 0.7–3.9% considering interval cancers only and of 1.3–7.6% considering screening-detected cancers only, and for both interval and screening-detected cancers the improvement was 1.9–11.5% when the assumed mortality reduction for the deceased cases varied from 5% to 30%. Shortening the screening interval to 12 months increased the effectiveness by 1.6–9.8% for interval cancers and by 2.9–17.4% for both interval and screening-detected cancers. Conclusion Shortening the screening interval for women aged 40–49 years to 18 or 12 months might further reduce the breast cancer mortality rate.

Although mammography screening significantly reduces breast cancer mortality, women could present different morphological characteristics that do not allow the correct vision of their breasts and the detection of cancer, resulting in a delay of diagnosis and an increase in the risk of mortality. The present study aims at analyzing potential areas of improvement of the current screening programs and then hypothesizing alternative technologies to use within the diagnostic phase, from an economic point of view. A Budget Impact Analysis approach was implemented, considering the Italian National Healthcare Service perspective, and representing the healthcare expenditure evolution, over three years. In the Budget Impact Analysis model, two distinct phases of the screening programs were considered: (1) the screening/diagnosis phase and (2) the phase related to cancer care and treatments of patients. The results provide clinicians and policy makers with a rational method to forecast economic resources in the screening programs in a general context of limited resources. In particular, results of the Budget Impact Analysis showed that, while the introduction of the ABUS InveniaTM technology into the screening programs would lead to an increase in the screening phase expenditure, it would generate an economic advantage related to the patients treatment and care.

Patients presenting with localized breast cancer have a five-year survival of 99 per cent, whereas survival falls to 27 per cent in advanced disease. This obviates the importance of early diagnosis and treatment. Our study evaluates the impact of Ohio's Medicaid expansion and the passage of the Affordable Care Act (ACA) on the stage at which Ohioans were diagnosed with breast cancer. Data were collected for 3056 patients presenting with breast cancer between 2006 and 2016 in the Dayton area. Patients were divided into groups based on cancer stage. The percentage of patients presenting with advanced disease (stage 3 or 4) was compared both before and after ACA implementation and Ohio Medicaid expansion. These results were also compared with statewide data maintained by the Ohio Department of Health. Compared with pre-ACA, the number of uninsured patients post-ACA was noted to fall 83 per cent, the number of patients presenting with Medicaid increased by five times, and the proportion of patients younger than 65 years presenting with breast cancer increased by approximately 7 per cent. These changes notwithstanding, no difference was identified in the percentage of patients presenting with advanced breast cancer before and after ACA implementation or Ohio Medicaid expansion ( P = 0.56). Statewide data similarly demonstrated no change ( P = 0.88). Improved insurance access had a smaller-than-anticipated impact on the stage at which Ohioans presented with breast cancer. As significant morbidity and mortality can be avoided by earlier presentation, additional research is appropriate to identify factors affecting patients’ decision to seek breast cancer screening and care.

Interval cancers are a commonly seen problem in organized breast cancer screening programs and their rate is measured for quality assurance. Artificial intelligence algorithms have been proposed to improve mammography sensitivity, in which case it is likely that the interval cancer rate would decrease and the quality of the screening system could be improved. Interval cancers from negative screening in 2011 and 2012 of one regional unit of the national German breast cancer screening program were classified by a group of radiologists, categorizing the screening digital mammography with diagnostic images as true interval, minimal signs, false negative and occult cancer. Screening mammograms were processed using a detection algorithm based on deep learning. Of the 29 cancer cases available, artificial intelligence identified eight out of nine of those classified as minimal signs, all six false negatives and none of the true interval and occult cancers. Sensitivity for lesions judged to be already present in screening mammogram was 93% (95% confidence interval 68–100) and sensitivity for any interval cancer was 48% (95% confidence interval 29–67). Using an artificial intelligence algorithm as an additional reading tool has the potential to reduce interval cancers. How and if this theoretical advantage can be reached without a negative effect on recall rate is a challenge for future research.

Objective Despite a growing body of evidence suggesting inequalities in breast cancer screening uptake in the United States for women with disabilities, few attempts have been made to examine whether this association applies to the United Kingdom. We conducted the first population-wide study investigating the impact of disability on uptake of breast cancer screening in Northern Ireland. Methods Breast screening records extracted from the National Breast Screening System were linked to the Northern Ireland Longitudinal Study. This identified a cohort of 57,328 women who were followed through one complete three-year screening cycle of the National Health Service Breast Screening Programme in Northern Ireland. The presence of disability was identified from responses to the 2011 Census. Results Within this cohort, 35.8% of women reported having at least one chronic disability, and these individuals were 7% less likely to attend compared with those with no disability (odds ratio 0.93; 95% confidence interval 0.89–0.98). Variation in the degree of disparity observed was evident according to the type and number of comorbid disabilities examined. Conclusion This is the first population-wide study in Northern Ireland to identify disparities in breast screening uptake for women with chronic disabilities, in particular, those with multimorbidity. This is of particular concern, given the projected rise in the prevalence of disability associated with the ageing population.

Purpose To examine the relation between breast cancer location and screening mammogram sensitivity, and assess whether this association is modified by body mass index (BMI) or breast density. Methods This study is based on all interval cancers (n = 481) and a random sample of screen-detected cancers (n = 481) diagnosed in Quebec Breast Cancer Screening Program participants in 2007. Film-screening mammograms, diagnostic mammograms, and ultrasound reports (when available) were requested for these cases. The breast cancer was then localised in mediolateral oblique (MLO) and craniocaudal (CC) projections of the breast by 1 experienced radiologist. The association between cancer location and screening sensitivity was assessed by logistic regression. Adjusted sensitivity and sensitivity ratios were obtained by marginal standardisation. Results A total of 369 screen-detected and 268 interval cancers could be localised in MLO and/or CC projections. The 2-year sensitivity reached 68%. Overall, sensitivity was not statistically associated with location of the cancer. However, sensitivity seems lower in MLO posterior inferior area for women with BMI ≥ 25 kg/m2 compared to sensitivity in central area for women with lower BMI (adjusted sensitivity ratio: 0.58, 95% confidence interval [CI]: 0.17–0.98). Lower sensitivity was also observed in subareolar areas for women with breast density ≥ 50% compared to the central areas for women with lower breast density (for MLO and CC projections, adjusted sensitivity ratio and 95% CI of, respectively, 0.54 [0.13–0.96] and 0.46 [0.01–0.93]). Conclusions Screening sensitivity seems lower in MLO posterior inferior area in women with higher BMI and in subareolar areas in women with higher breast density. When interpreting screening mammograms, radiologists need to pay special attention to these areas.

Comparisons of survival times between screen-detected and symptomatically detected breast cancer cases are subject to lead time and length biases. Whilst the existence of these biases is well known, correction procedures for these are not always clear, as are not the interpretation of these biases. In this paper we derive, based on a recently developed continuous tumour growth model, conditional lead time distributions, using information on each individual's tumour size, screening history and percent mammographic density. We show how these distributions can be used to obtain an individual-based (conditional) procedure for correcting survival comparisons. In stratified analyses, our correction procedure works markedly better than a previously used unconditional lead time correction, based on multi-state Markov modelling. In a study of postmenopausal invasive breast cancer patients, we estimate that, in large (>12 mm) tumours, the multi-state Markov model correction over-corrects five-year survival by 2–3 percentage points. The traditional view of length bias is that tumours being present in a woman's breast for a long time, due to being slow-growing, have a greater chance of being screen-detected. This gives a survival advantage for screening cases which is not due to the earlier detection by screening. We use simulated data to share the new insight that, not only the tumour growth rate but also the symptomatic tumour size will affect the sampling procedure, and thus be a part of the length bias through any link between tumour size and survival. We explain how this has a bearing on how observable breast cancer-specific survival curves should be interpreted. We also propose an approach for correcting survival comparisons for the length bias.

Objectives Incidence-based mortality quantifies the distribution of cancer deaths and life-years lost, according to age at detection. We investigated the temporal distribution of the disease burden, and the effect of starting and stopping ages and interval between screening mammography examinations, on incidence-based mortality. Methods Incidence-based mortality was estimated using an established breast cancer simulation model, adapted and validated to simulate breast cancer incidence, screening performance, and delivery of therapies in Canada. Ten strategies were examined, with varying starting age (40 or 50), stopping age (69 or 74), and interval (1, 2, 3 years), and “No Screening.” Life-years lost were computed as the difference between model predicted time of breast cancer death and that estimated from life tables. Results Without screening, 70% of the burden in terms of breast cancer deaths extends between ages 45 and 75. The mean of the distribution of ages of detection of breast cancers that will be fatal in an unscreened population is 61.8 years, while the mean age of detection weighted by the number of life-years lost is 55, a downward shift of 6.8 years. Similarly, the mean age of detection for the distribution of life-years gained through screening is lower than that for breast cancer deaths averted. Conclusion Incidence-based mortality predictions from modeling elucidate the age dependence of the breast cancer burden and can provide guidance for optimizing the timing of screening regimens to achieve maximal impact. Of the regimens studied, the greatest lifesaving effect was achieved with annual screening beginning at age 40.

Introduction: Although breast cancer (BC) rates are declining in White non-Hispanic American women, they are increasing among Vietnamese American women (VAW) at 1.2% (95% confidence interval [0.1, 2.2]) per year. BC screening rates (64%) are below the national rates (81.1%). This article explores VAW’s beliefs about BC and screening. Method: Using community-based participatory qualitative descriptive methods, 40 VAW were recruited from Oregon, and four focus groups were conducted. A directed content analysis was used. Results: Main themes were as follows: deferred to a health care provider or relying on self-detection and symptoms; fear of BC versus fear of procedural pain; limited knowledge; motivation by observing others’ journey in BC death or survivorship; body image concern; “living carefree,” “good fortune—having good health”; and coverage for a mammogram expense means health care access. Discussion: Tailored interventions should address mammogram knowledge, fear, erroneous information, body image, fate and luck, and promoting access.

Background. We present updated features to a model developed by Dana-Farber investigators within the Cancer Intervention and Surveillance Modeling Network (CISNET). The initial model was developed to evaluate the impact of mammography screening strategies. Methods. This major update includes the incorporation of ductal carcinoma in situ (DCIS) as part of the natural history of breast cancer. The updated model allows DCIS in the pre-clinical state to regress to undetectable early-stage DCIS, or to transition to invasive breast cancer, or to clinical DCIS. We summarize model assumptions for DCIS natural history and model parameters. Another new development is the derivation of analytical expressions for overdiagnosis. Overdiagnosis refers to mammographic identification of breast cancer that would never have resulted in disease symptoms in the patient’s remaining lifetime (i.e., lead time longer than residual survival time). This is an inevitable consequence of early detection. Our model uniquely assesses overdiagnosis using an analytical formulation. We derive the lead time distribution resulting from the early detection of invasive breast cancer and DCIS, and formulate the analytical expression for overdiagnosis. Results. This formulation was applied to assess overdiagnosis from mammography screening. Other model updates involve implementing common model input parameters with updated treatment dissemination and effectiveness, and improved mammography performance. Lastly, the model was expanded to incorporate subgroups by breast density and molecular subtypes. Conclusions. The incorporation of DCIS and subgroups and the derivation of an overdiagnosis estimation procedure improve the model for evaluating mammography screening programs.

A coherent and helpful public policy based on science is difficult to achieve for at least three reasons. First, there are purely practical problems—for example, that scientific experts often disagree on policy-relevant questions and their debates often continue well beyond policy appropriate timelines. Second, there are epistemic problems—for example, that science is hardly the neutral supplier of factual information (free of contested social values) that traditionally has been supposed. And third, there are social problems: given the commercialization of today’s science and its enduring limitations (sexism, racism, homophobia, ableism, etc.), much of scientific research today fails to meet the moral and political standards one would expect it to meet in order to inform public policy. In this paper, we examine such problems in the context of breast cancer screening policy and suggest the role philosophy of science should play in dealing with the situation.

Men with BRCA1 or BRCA2 gene mutations are at increased risk of developing breast cancer and may have an indication for breast cancer screening using mammography. Since breast cancer is often viewed as a woman’s disease, visibilizing and understanding men’s experience of having a BRCA mutation and specifically, of screening for breast cancer through mammography, were the objectives of this research study. The theoretical framework of interpretive phenomenology guided the process of data collection, coding, and analysis. Phenomenology is both a philosophy and research method which focuses on understanding the nature of experience from the perspectives of people experiencing a phenomenon, the essence of and commonalities among people’s experiences, and the ways in which people experience the world through their bodies. Data were collected via in-depth interviews with a purposive sample of 15 male participants recruited from the Male Oncology Research and Education (MORE) Program. This article reports findings about participants’ use of gender-specific language to describe their breasts, awareness of the ways in which their bodies changed overtime, and experiences of undergoing mammograms. This study is the first to describe men with BRCA’s perceptions of their breasts and experiences of mammography in a high-risk cancer screening clinic. This study sheds light on an under-researched area—breasts and masculinities—and could potentially lead to improved clinical understanding of men’s embodied experiences of BRCA, as well as suggestions for improving the delivery of male breast cancer screening services.

Cancer screening can detect cancer that would not have been detected in a patient’s lifetime without screening. Standard methods for analyzing screening data do not explicitly account for the possibility that a fraction of tumors may remain latent indefinitely. We extend these methods by representing cancers as a mixture of those that progress to symptoms (progressive) and those that remain latent (indolent). Given sensitivity of the screening test, we derive likelihood expressions to simultaneously estimate (1) the rate of onset of preclinical cancer, (2) the average preclinical duration of progressive cancers, and (3) the fraction of preclinical cancers that are indolent. Simulations demonstrate satisfactory performance of the estimation approach to identify model parameters subject to precise specifications of input parameters and adequate numbers of interval cancers. In application to four breast cancer screening trials, the estimated indolent fraction among preclinical cancers varies between 2% and 35% when assuming 80% test sensitivity and varying specifications for the earliest time that participants could plausibly have developed cancer. We conclude that standard methods for analyzing screening data can be extended to allow some indolent cancers, but accurate estimation depends on correctly specifying key inputs that may be difficult to determine precisely in practice.

Purpose The study sought to examine the association between clinical image quality of mammograms and screening sensitivity. Methods Four radiologists evaluated the clinical image quality of 374 invasive screen-detected cancers and 356 invasive interval breast cancers for which quality evaluation of screening mammograms could be assessed from cancers diagnosed among participants in the Quebec Breast Cancer Screening Program in 2007. Quality evaluation was based on the Canadian Association of Radiologists accreditation criteria, which are similar to those of the American College of Radiology. The association between clinical quality and screening sensitivity was assessed by logistic regression. Adjusted sensitivity and adjusted sensitivity ratios were obtained through marginal standardization. No institutional review board approval was required. Results A proportion of 28% (206 of 730) of screening mammograms had lower overall quality for the majority of assessments. Positioning was the quality attribute that was the most frequently deficient. The 2-year screening sensitivity reached 68%. Sensitivity of screening was not statistically associated with the overall quality (ratio of 2-year sensitivity = 1.03; 95% confidence interval: 0.93-1.15) or with any quality attributes (positioning, exposure, compression, sharpness, artifacts, contrast). Results were similar for the 1-year sensitivity. Conclusions Although not all mammograms in the Quebec screening program met the optimum quality required by the Canadian Association of Radiologists or American College of Radiology accreditation, the screening mammograms produced in this population-based organized screening program reached a high enough level of quality so that the remaining variation in quality is too little to impair screening sensitivity.

Lower rates of screening for early detection of cancer were reported among ethnic minorities and faith-based communities. The purpose of the article is to assess the effect of a culturally based intervention program intended to increase breast cancer screening adherence among two groups in Israel: ultra-Orthodox Jewish and Arab women. Using a randomized controlled study design, 598 participants completed the 3-month follow-up questionnaire regarding adherence to screening and perceived effect of intervention. Results show that having a lower level of religious beliefs and gaining a better understanding of the importance of screenings were significant predictors of performing breast awareness practice (BAP) and undergoing clinical breast examination (CBE) in both groups. We conclude that interventions should be specifically tailored to cultural groups to reduce barriers stemming from unique beliefs and perceptions, which prevent individuals in these groups from undergoing screening. Special efforts should be made to increase CBE among young women.

Objective The Norwegian Breast Cancer Screening Programme invites women aged 50–69 to biennial mammographic screening. Although 84% of invited women have attended at least once, attendance rates vary across the country. We investigated attendance rates among various immigrant groups compared with non-immigrants in the programme. Methods There were 4,053,691 invitations sent to 885,979 women between 1996 and 2015. Using individual level population-based data from the Cancer Registry and Statistics Norway, we examined percent attendance and calculated incidence rate ratios, comparing immigrants with non-immigrants, using Poisson regression, following women's first invitation to the programme and for ever having attended. Results Immigrant women had lower attendance rates than the rest of the population, both following the first invitation (53.1% versus 76.1%) and for ever having attended (66.9% versus 86.4%). Differences in attendance rates between non-immigrant and immigrant women were less pronounced, but still present, when adjusted for sociodemographic factors. We also identified differences in attendance between immigrant groups. Attendance increased with duration of residency in Norway. A subgroup analysis of migrants' daughters showed that 70.0% attended following the first invitation, while 82.3% had ever attended. Conclusions Immigrant women had lower breast cancer screening attendance rates. The rationale for immigrant women's non-attendance needs to be explored through further studies targeting women from various birth countries and regions.

Objectives: Breast cancer contributes substantially to morbidity and mortality in Namibia as is the case in most countries in Sub-Saharan Africa (SSA). However, there is a dearth of nationally representative studies that examine the odds of screening for breast cancer in Namibia and SSA at large. This paper aims to fill this gap by examining the determinants of breast cancer screening guided by the Health Belief Model. Methods: We applied hierarchical binary logit regression models to explore the determinants of breast cancer screening using the 2013 Namibia Demography and Health Survey (NDHS). We accounted for the effect of unobserved heterogeneity that may affect breast cancer, testing behaviours among women cluster level. The NDHS is a nationally representative dataset that has recently started to collect information on cancer screening. Results: The results show that women who have health insurance coverage (odds ratio (OR) = 1.62, p ≤ 0.01), maintain contact with health professionals (OR = 1.47, p = 0.01), and who have secondary (OR = 1.38, p = 0.01) and higher (OR = 1.77, p ≤ 0.01) education were more likely to be screened for breast cancer. Factors that influence women’s perception of their susceptibility to breast cancer such as birthing experience, age, region and place of residence were associated with screening in this context. Conclusions: Overall, the health belief model predicted women’s testing behaviours and also revealed the absence of relevant risk factors in the NDHS data that might influence screening. Overall, our results show that strategies for early diagnosis of breast cancer should be given major priority by cancer control boards as well as ministries of health in SSA. These strategies should centre on early screening and may involve reducing or eliminating barriers to health care, access to relevant health information and encouraging breast self-examination.

Introduction: The study hypothesized that sociocultural factors would be associated with breast cancer screening within the past 2 years among Latina immigrant women. Method: This study employed a survey design and included 82 Latina immigrant female participants 40 to 64 years of age for the analysis. Two multivariable binary logistic regression models were estimated, one for the sociocultural deterrents and the other for the symptomatic deterrents from the Cultural Cancer Screening Scale. Results: The results indicated two constructs of the Cultural Cancer Screening Scale, sociocultural deterrents (odds ratio = 2.00; 95% confidence interval = 1.04-3.86) and symptomatic deterrents (odds ratio = 1.65; 95% confidence interval = 1.08-2.54), were associated with screening in the past 2 years, when adjusting for sociodemographic and health-related characteristics. Conclusion: These findings provide evidence for the importance of sociocultural factors in Latina immigrant women’s timely mammography screening.

Background Breast radiologists of the Norwegian Breast Cancer Screening Program subjectively classified mammographic density using a three-point scale between 1996 and 2012 and changed into the fourth edition of the BI-RADS classification since 2013. In 2015, an automated volumetric breast density assessment software was installed at two screening units. Purpose To compare volumetric breast density measurements from the automated method with two subjective methods: the three-point scale and the BI-RADS density classification. Material and Methods Information on subjective and automated density assessment was obtained from screening examinations of 3635 women recalled for further assessment due to positive screening mammography between 2007 and 2015. The score of the three-point scale (I = fatty; II = medium dense; III = dense) was available for 2310 women. The BI-RADS density score was provided for 1325 women. Mean volumetric breast density was estimated for each category of the subjective classifications. The automated software assigned volumetric breast density to four categories. The agreement between BI-RADS and volumetric breast density categories was assessed using weighted kappa (kw). Results Mean volumetric breast density was 4.5%, 7.5%, and 13.4% for categories I, II, and III of the three-point scale, respectively, and 4.4%, 7.5%, 9.9%, and 13.9% for the BI-RADS density categories, respectively ( P for trend w = 0.5 (95% CI = 0.47–0.53; P Conclusion Mean values of volumetric breast density increased with increasing density category of the subjective classifications. The agreement between BI-RADS and volumetric breast density categories was moderate.

The impact of breast screening awareness campaigns on mammography attendance among British women was explored. British Nursing Index, Medline, PsycINFO, Embase and Cumulative Index to Nursing and Allied Health were searched between October 2012 and February 2013. Searches identified research on breast cancer awareness interventions and breast self-examination. In total, 867 articles were identified and 14 met criteria for review. Breast cancer awareness interventions were found to increase the uptake of breast self-examination behaviours and increase the likelihood of breast cancer screening attendance. Predicting the impact of these interventions on survivability and general morbidity/mortality outcomes remains a challenge due to a shortage of suitably evaluated campaigns.

Introduction:Social support and fear have been shown to be important factors affecting women’s participation in breast cancer screening. This study aimed to determine the effect of women’s perceived breast cancer fear and social support on participating in the breast cancer screening process, and to investigate the relationship between the perception of breast cancer fear and social support.Methods:This is a descriptive study, carried out in a state hospital on 198 women. The data were collected through a Socio-Demographic Data Form, Multidimensional Scale of Perceived Social Support (MSPSS), and Breast Cancer Fear Scale (BCFS) by the researchers by means of face-to-face interview.Results:There was no statistically significant difference between the women’s perceptions of social support and breast cancer fear and screening behaviors ( p > 0.05). It was found that the mean BCFS score of those who had a family history of breast cancer was high, and the MSPSS score was lower ( p < 0.05). There was a quite weak and statistically insignificant positive relationship between the women’s BCFS scores and perceived social support ( r = 0.08, p > 0.05), friend support ( r = 0.04, p > 0.05) and support from a special person ( r = 0.14, p > 0.05).Conclusion:We found no statistically significant difference between breast cancer fear, social support and the women’s screening behavior. However, breast cancer fear and the effect of social support on screening attitude may be important. Nurses and other health workers should particularly focus on social support and breast cancer fear in their health education programs. Formative research into the use of social support to promote positive empowering messages should be carried out and incorporated in future health promotion campaigns to improve the breast cancer screening process.

Background: Pakistani immigrant women in Norway have lower attendance rates in the national breast cancer screening program (BreastScreen Norway) compared to non-immigrants and immigrants from most other countries. Purpose: To identify and explore human and non-human actors that play a role for Pakistani immigrant women’s attendance in the program. Material and Methods: Qualitative interviews with 16 Norwegian-Pakistani women in 2017 and 2018. Inspired by Latour, we explored how human and non-human actors act and interact when Pakistani immigrant women consider attendance in BreastScreen Norway. Results: Among the actors found to play a significant role in the relationship between Pakistani immigrant women and the screening program were trust in the healthcare system and breast cancer screening, the gender of the screening radiographer, the written information received from the screening program, family life, daughters, general practitioners, non-governmental organizations, religious beliefs, private service providers, monetary expenses, accessibility, worries, and digital tools. Conclusion: Many human and non-human actors work to shape and influence Pakistani immigrant women’s screening attendance, or lack thereof, for instance by creating thoughts, promoting opportunities, raising doubts and generating worries, thus variously encouraging, enabling, facilitating, discouraging or preventing attendance in organized breast cancer screening. The authors received the following financial support for the research, authorship, and/or publication of this article: This project was supported by a grant from the Norwegian Breast Cancer Society, funded by the Norwegian ExtraFoundation for Health and Rehabilitation (2016/FO76429)

Objective:Analysis of interval cancers is critical in determining the sensitivity of screening and represents an objective measure of the quality of mammography screening program (MSP).Methods:Period analyzed: from 2006 to 2012. The rate of screen-detected, interval cancers and program sensitivity were measured. A comparison of screen-detected and interval cancers was performed.Results:During the period of the study, 429 473 women were screened and 1297 were found to have cancer. The overall screen-detected cancer rate was 30.2 per 10 000 women screened. Four hundred thirty-one case of interval cancers have occurred during the period of the study. The interval cancer ratio (ICR) was 0.25. Overall sensitivity of MSP amounted to 75.1%. Slightly lower sensitivity was found among the youngest age-group, especially for those with lobular cancers. Interval cancers were bigger in size, more often with metastases in lymph nodes, than screen-detected cancers, but these differences were not statistically significant.Conclusions:Overall program sensitivity in Lithuania is about 75%, ICR is 0.25, and these parameters are comparable to other European countries.

Breast self-examination (BSE) is a simple, feasible, and suitable method for breast cancer screening in low–middle setting countries. The aim of this study was to assess the knowledge and practice of BSE among female textile workers in Vietnam. A cross-sectional study was conducted among 1036 female workers, aged 43.9 ± 3.1 years old, who were working in 4 textile enterprises in Hanoi and Ho Chi Minh City, in 2016. Overall, 22.7% of participants showed sufficient knowledge on BSE; 15.2% performed monthly BSE; and 7.7% completely performed all 5 steps of BSE. The prevalence of insufficient BSE knowledge was higher among participants with low level of education (odds ratio [OR]: 1.71; 95% confidence interval [CI]: 1.22-2.39, below vs above secondary school), and those whose husbands were farmers or workers (OR: 1.76; 95% CI: 1.27-2.45, compared to other sectors). This prevalence was, however, negatively associated with receiving information on BSE (OR: 0.16; 95% CI: 0.11-0.23, yes vs no). The prevalence of insufficient BSE practice was also higher among females with husbands who were farmers or workers (OR: 1.67; 95% CI: 1.15-2.43, compared to other sectors). In contrast, it was much lower among participants who had history of breast-related diseases (OR: 0.46; 95% CI: 0.24-0.88, yes vs no), received BSE information (OR: 0.13; 95% CI: 0.08-0.19, yes vs no), and had sufficient overall BSE knowledge (OR: 0.09; 95% CI: 0.06-0.13, yes vs no), compared to those who did not. There was a low prevalence of sufficient BSE knowledge (22.7%) and practice (15.8%) among female textile workers in Hanoi and Ho Chi Minh City. Low level of education and not being provided BSE information were associated with insufficient BSE knowledge and practice among Vietnamese female textile workers. Health education programs are essential to encourage and improve women’s knowledge and practice of BSE.

Introduction:Breast cancer (BC) is a major public health problem among women. However, BC screening uptake is abysmally low among Nigerian women. This study evaluated the association of BC fear and perceived self-efficacy with BC screening (clinical breast exam [CBE] and mammography) among middle-aged Nigerian women.Methods:A community-based cross-sectional study was conducted among middle-aged women in Enugu State, southeast Nigeria. The data were collected between September 2019 and February 2020. The BC screening uptake, fear, and self-efficacy were assessed using the validated Breast Cancer Screening Questionnaire (BCSQ), Champion Breast Cancer Fear Scale (CBCFS), and Champion’s Mammography Self-Efficacy Scale (CMSES). Data were analyzed using frequencies and percentages, chi-square test, and univariate analysis of variance. Bivariate and multivariable logistic regression models were used to examine independent associations between selected sociodemographic factors, cancer fear, perceived self-efficacy, and BC screening.Results:The mean age of the participants was 55.3 years (SD: 5.75). More than half of the women (51%) reported having a BC screening in the past 12 months. However, only 12.5% and 16.9% reported having a CBE or mammogram in the past 12 months. The prevalence of a high, moderate, and low level of fear was 68%, 22.3%, and 9.8%, respectively. The prevalence of a high, moderate, and low self-efficacy level was 50.6%, 37.5%, and 12.0%, respectively. The multivariable logistics regression analysis showed that women aged 50-59 years and 60-64 years were 3.5 times (adjusted odds ratio [AOR] = 3.50, 95% confidence interval [CI]: 2.07-5.89, P Conclusion:A low proportion of women underwent CBE or mammography. Women had a high level of BC fear and a moderate level of self-efficacy for BC screening. The findings emphasize the need for health educational and psychosocial interventions that improve self-efficacy and promote regular BC screening among middle-aged women.