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

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

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

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

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

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

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

Background Digital breast tomosynthesis (DBT) has become a prevalent mode of breast cancer screening in recent years. Although older women are commonly screened for breast cancer, little is known about screening outcomes using DBT among older women. Objective To assess proximal screening outcomes with DBT compared to traditional two-dimensional(2-D) mammography among women 67–74 and women 75 and older. Design Cohort study. Participants Medicare fee-for-service beneficiaries aged 67 years and older with no history of prior cancer who received a screening mammogram in 2015. Main Measures Use of subsequent imaging (ultrasound and diagnostic mammography) as an indication of recall, breast cancer detection, and characteristics of breast cancer at the time of diagnosis. Analyses used weighted logistic regression to adjust for potential confounders. Key Results Our study included 26,406 women aged 67–74 and 17,001 women 75 and older who were screened for breast cancer. Among women 75 and older, the rate of subsequent imaging among women screened with DBT did not differ significantly from 2-D mammography (91.8 versus 97.0 per 1,000 screening mammograms, p=0.37). In this age group, DBT was associated with 2.1 additional cancers detected per 1,000 screening mammograms compared to 2D (11.5 versus 9.4, p=0.003), though these additional cancers were almost exclusively in situ and stage I invasive cancers. For women 67–74 years old, DBT was associated with a higher rate of subsequent imaging than 2-D mammography (113.9 versus 100.3, p=0.004) and a higher rate of stage I invasive cancer detection (4.7 versus 3.7, p=0.002), but not other stages. Conclusions Breast cancer screening with DBT was not associated with lower rates of subsequent imaging among older women. Most additional cancers detected with DBT were early stage. Whether detecting these additional early-stage cancers among older women improves health outcomes remains uncertain. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-07132-6.

The breast thermography process is a physiological investigation that gives data dependent on the heat variations in the breast. It accounts for the heat circulation of a body utilizing the infrared radiation produced by the outside of that body. Precancerous tissue and the zone around a carcinogenic tumor have greater heats because of angiogenesis, and higher substance and blood vein action than a healthy breast; consequently, breast thermography can possibly recognize early strange changes in breast tissues. Thermography can identify the earliest indication of cancer initiation before mammography can notice. For the extraction of the scarce data from the breast, features like Energy, Effective information, Multi quadratic, Sigmoid, and Age of the patient are determined and applied to the neural network as inputs. Resilient backpropagation algorithm (RBPA) is a worldwide methodology managing weights; it is hard to get better subtleties from the breast image. To overcome the problems of RBPA, the artificial neural network (ANN) classifier is being used as a new derived Extension of Resilient backpropagation algorithm (ERBPA) for validation purposes. In this paper three ANN-based algorithms are used: Gradient descent, RBPA, and ERBPA are discussed and compared. As per the outcomes, the recently determined ERBPA is a progressively exact methodology to classify benign and malignant pathology. An accuracy of 99.90% has been obtained to bring about an effective strategy, which can recognize and cure breast cancer at an early stage.

BACKGROUND: While guidelines recommend against routine screening for breast, prostate, and colorectal cancers in older adults (65+ years) with

Dedicated breast CT is being increasingly used for breast imaging. This technique provides images with no compression, removal of tissue overlap, rapid acquisition, and available simultaneous assessment of microcalcifications and contrast enhancement. In this second installment in a 2-part review, the current status of clinical applications and ongoing efforts to develop new imaging systems are discussed, with particular emphasis on how to achieve optimized practice including lesion detection and characterization, response to therapy monitoring, density assessment, intervention, and implant evaluation. The potential for future screening with breast CT is also addressed. KEY POINTS: • Dedicated breast CT is an emerging modality with enormous potential in the future of breast imaging by addressing numerous clinical needs from diagnosis to treatment. • Breast CT shows either noninferiority or superiority with mammography and numerical comparability to MRI after contrast administration in diagnostic statistics, demonstrates excellent performance in lesion characterization, density assessment, and intervention, and exhibits promise in implant evaluation, while potential application to breast cancer screening is still controversial. • New imaging modalities such as phase-contrast breast CT, spectral breast CT, and hybrid imaging are in the progress of R & D.

Canadian breast cancer screening guidelines state that mammography screening for women 40–49 should be individualized based on risk assessment and preferences. This retrospective cohort study describes the frequency of screening in women aged 40–49 and identifies patient and provider-level associations with screening. Administrative databases were linked. The overall cohort included Ontario women aged 40–49 between April 1, 2009 and March 31, 2019. Subgroups were created: the “screen” group included women who received a mammogram defined as screening (using a set of exclusion criteria) and the “routine screen” group included women with three or more screening mammograms. A multivariable multilevel logistic regression model accounting for patient and provider characteristics was fit to determine characteristics associated with routine screening. The intracluster correlation co-efficient was used to quantify the degree of variation across providers. Of approximately 2 million eligible women, there were 532,596 (25.5%) in the screen group and 90,651 (4.3%) the routine screen group. There was an average of 0.30 and 0.52 screening mammograms per woman year, in the screen and routine screen groups, respectively. Routine screening was associated with periodic health exams (OR 1.21, 95% CI 1.20–1.22), receiving pap smears (OR 1.38, 95% CI 1.37–1.39), and fee-for-service models of care (OR 1.32, 95% CI 1.27–1.36). Over 20% of the variation in screening was due to systematic between-provider differences. Approximately 4.3% of women aged 40–49 in Ontario received routine breast cancer screening with substantial variation across providers. Routine screening is associated with periodic health examinations, receipt of pap smears, and fee-for-service models of care.

Routine health checkup and cancer screening rates among women are suboptimal, partially due to the health care disparities by race/ethnicity in the USA. This study examined the previously understudied associations between routine health checkup, cervical cancer screening, and breast cancer screening by race/ethnicity using the national representative sample of women. Data were obtained from three cycles (2017, 2018, and 2019) of the Health Information National Trends Survey (HINTS) (n = 12,227). Survey-weighted logistic regressions were evaluated to assess associations between routine health checkup and cervical and breast cancer screening compliance with the established guidelines with the age criteria and frequency of screening by race/ethnicity (Black, White, Hispanic, and Other). This study included 6,941 women in the cervical cancer screening and 8,005 women for breast cancer screening, considering the age criteria. Women who had received routine health checkups were more likely to meet the cervical cancer screening guideline (Odds ratio 3.24, p

Most breast cancers in Oman are diagnosed at advanced stages and therefore early detection is important. The Oman Cancer Association (OCA) initiated a mobile mammography program in 2009, but no studies have evaluated its impact. This study aimed at estimating the proportion and predictors of OCA-screened women who had repeated mammography (adherence) and the sensitivity and specificity of the program. Demographic, screening, diagnosis, and treatment data of 13,079 women screened in the OCA mammography clinic from 2009 to 2016, and medical records of all breast cancer patients seen at Royal and Sultan Qaboos University hospitals during the same period were retrieved. Logistic regression analysis was conducted to identify predictors of adherence. A total of 8278 screened women over age 42 years (median age of 50 ± 8 years) were included in the study. Only 18% of initially negative screened women were compliant with recommended subsequent screening. Predictors of adherence included age (50–69 years), family history of cancer, family history of breast cancer, and breast self-examination. The overall cancer detection rate was 4.1/1000 screened women. Positive predictive value of screening was 4.7% with a sensitivity rate of 53% and specificity of 92%. This study showed a low mammography adherence among previously screened women. The study revealed low sensitivity, high specificity, and an acceptable cancer detection rate. Future programs should focus on improving data collection of screened women, maintaining the linkage of databases of screening and treatment clinics, and developing guidelines for breast cancer screening in Oman. The recommendations based on the study results should be incorporated into future professional, patient, and public cancer education programs.

The Society of Surgical Oncology is committed to reducing health disparities adversely affecting sexual and gender minorities. Transgender persons represent a socially disadvantaged group who frequently experience discrimination and receive disparate care, resulting in suboptimal cancer outcomes. The rate of breast cancer development in transgender individuals differs from rates observed in their cisgender counterparts, however there is little evidence to quantify these differences and guide evidence-based screening and prevention. There is no consensus for breast cancer screening guidelines in transgender patients. In this review, we discuss barriers to equitable breast cancer care, risk factors for breast cancer development, and existing data to support breast cancer screening in transgender men and women.

Background Barriers to breast cancer screening remain despite Medicaid expansion for preventive screening tests and implementation of patient navigation programs under the Affordable Care Act. Women from underserved communities experience disproportionately low rates of screening mammography. This study compares barriers to breast cancer screening among women at an inner-city safety-net center (City) and those at a suburban county medical center (County). 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 40 years of age or older delinquent in breast cancer screening were offered patient navigation services between October 2014 and September 2019. Four different screening time-to-event intervals were investigated: time from patient navigation acceptance to screening mammography, to diagnostic mammography, to biopsy, and overall screening completion time. Barriers to complete breast cancer screening between the two centers were compared. Results Women from lowest income quartiles took significantly longer to complete breast cancer screening when compared to women from higher income quartiles when a barrier was present, regardless of barrier type and center. Transportation was a major barrier to screening mammography completion, while fear was the major barrier to abnormal screening work up. Conclusion Disparity in breast cancer screening and management persists despite implementation of a patient navigation program. In the presence of a barrier, women from the lowest income quartiles have prolonged breast cancer screening completion time regardless of center or barrier type. Women who experience fear have longest screening time completion. Future directions aim to increase resource allocation to ameliorate wait times in overburdened safety-net hospitals as well as advanced training for patient navigators to alleviate women’s fears.

Purpose In order to facilitate targeted outreach, we sought to identify patient populations with a lower likelihood of returning for breast cancer screening after COVID-19-related imaging center closures. Methods Weekly total screening mammograms performed throughout 2019 (baseline year) and 2020 (COVID-19-impacted year) were compared. Demographic and clinical characteristics, including age, race, ethnicity, breast density, breast cancer history, insurance status, imaging facility type used, and need for interpreter, were compared between patients imaged from March 16 to October 31 in 2019 (baseline cohort) and 2020 (COVID-19-impacted cohort). Census data and an online map service were used to impute socioeconomic variables and calculate travel times for each patient. Logistic regression was used to identify patient characteristics associated with a lower likelihood of returning for screening after COVID-19-related closures. Results The year-over-year cumulative difference in screening mammogram volumes peaked in week 21, with 2962 fewer exams in the COVID-19-impacted year. By week 47, this deficit had reduced by 49.4% to 1498. A lower likelihood of returning for screening after COVID-19-related closures was independently associated with younger age (odds ratio (OR) 0.78, p

Compare four groups being screened: women without breast implants undergoing digital mammography (DM), women without breast implants undergoing DM with digital breast tomosynthesis (DM/DBT), women with implants undergoing DM, and women with implants undergoing DM/DBT. Mammograms from February 2011 to March 2017 were retrospectively reviewed after 13,201 were excluded for a unilateral implant or prior breast cancer. Patients had been allowed to choose between DM and DM/DBT screening. Mammography performance metrics were compared using chi-square tests. Six thousand forty-one women with implants and 91,550 women without implants were included. In mammograms without implants, DM (n = 113,973) and DM/DBT (n = 61,896) yielded recall rates (RRs) of 8.53% and 6.79% (9726/113,973 and 4204/61,896, respectively, p 0.999), and PPV1s of 4.29% and 6.0% (17/396 and 15/250, respectively, p > 0.999), respectively. DM/DBT significantly improved recall rates, cancer detection rates, and positive predictive values for recall compared to DM alone in women without implants. DM/DBT performance in women with implants trended towards similar improvements, though no metric was statistically significant. • Digital mammography with tomosynthesis improved recall rates, cancer detection rates, and positive predictive values for recall compared to digital mammography alone for women without implants. • Digital mammography with tomosynthesis trended towards improving recall rates, cancer detection rates, and positive predictive values for recall compared to digital mammography alone for women with implants, but these trends were not statistically significant — likely related to sample size.

Background Women with aesthetic prostheses must be included in the target population of mammography screening programmes. Breast implants are radiopaque and partially obscure the breast tissue. This can be avoided with the use of the Eklund technique, which causes an increased radiation exposure. In this study, augmented women undergoing a dedicated protocol within a population-based screening programme were compared according to selected indicators with the standard screening population. Essential dosimetric parameters and their time trend were also assessed. Materials and methods The study was conducted in a screening centre in Milan in the years 2009–2016. The screening protocol for women with breast implants included a double-read mammography with the Eklund views, ultrasound and clinical breast examination. Results A total of 28,794 women were enrolled, including 588 (2%) women with breast implants and 28,206 (98%) undergoing the standard screening protocol. The invasive assessment rate was 9.0‰ for women with breast implants vs. 15‰ in the standard cohort. The surgical referral rate was 2.2% vs. 0.9%. The detection rate was similar in the two groups (4.0 and 4.5‰, respectively). There were significant differences in the average glandular dose according to the mammography equipment. The use of the Eklund views increased over time. Conclusions Screening of augmented women according to a specific protocol in the contexts of population-based programmes is feasible. Observed differences in screening indicators relative to the standard screening population require further research. The increasing use of Eklund views probably results from quality assurance measures associated with screening programmes.

In recent years, with the change of lifestyle in Europe and America, the incidence of breast cancer in Chinese women is increasing. In order to find the model of breast cancer image screening and diagnosis with higher accuracy and better classification performance, this paper mainly constructs the breast cancer CT image detection model and the breast cancer screening model based on the convolution and deconvolution neural network (CDNN) through the convolution neural network (CNN). In this paper, the fuzzy C-means clustering algorithm (FCM) is used to improve and optimize the image of breast cancer, and the experimental results are analyzed. The optimized kernel fuzzy C-means clustering algorithm was tested on a common dataset to segment the region of interest more accurately. Our experiments show that the new deep learning model of this paper improves the automatic classification performance of breast cancer. In this paper, the research results of deep learning are applied to the medical field, and a new method based on CNN model for breast cancer screening and diagnosis is proposed, which provides a new idea for improving the artificial intelligence assisted medical diagnosis method.

BackgroundThe novel coronavirus disease 2019 (COVID-19) undermines the benefits of cancer screening. To date, no study has identified specific infection control methods. We aimed to provide practical methods for COVID-19 risk reduction during breast cancer screening mammography (MMG) by examining an overview of potential contamination routes of aerosols and possible risks for patients and health care providers.MethodsComputational fluid dynamics (CFD) simulations were conducted for airflow and aerosol dispersion in a 3D virtual model of a mobile MMG laboratory room. This model was constructed based on the actual mobile screening MMG bus ‘Cosmos’ in the Chiba Foundation for Health Promotion & Disease Prevention. Examiner and patient geometries were obtained by scanning an actual human using a 3D Scanner. Contamination of the room was evaluated by counting the numbers of suspended and deposited aerosols.ResultsWe applied the CFD simulation model to the exhalation of small or large aerosols from a patient and examiner in the MMG laboratory. Only 14.5% and 54.5% of large and small aerosols, respectively, were discharged out of the room with two doors open. In contrast, the proportion of large and small aerosols discharged out of the room increased to 96.6% and 97.9%, respectively, with the addition of forced gentle wind by the blower fan. This simulation was verified by a mist aerosol experiment conducted in the mobile MMG laboratory.ConclusionAdding forced ventilation to a MMG laboratory with two doors open may enable risk reduction dramatically. This could be applied to other clinical situations.

The prevalence of breast cancer cases in Malaysia is 1 in every 20 women. Comprehending the risk factors and causation of breast cancer as well as enabling early diagnosis and treatment are important to prevent possible recurrence and fatality. Education on breast cancer plays a pivotal role in raising awareness and overcoming skepticism towards breast examination regimens. The present study aims to compare the awareness and knowledge levels between genders among the local residents of Klang Valley area, Malaysia. A cross-sectional descriptive study was conducted between October 2018 and January 2019, utilising a random convenient sampling technique. Recruitment of participants was undertaken at population-concentrated locations around the Klang Valley area. A total of 440 volunteers, 198 men and 242 women aged 18 years and above, completed the questionnaire via Google link using several electronic gadgets. Results have revealed that the majority of the residents, regardless of gender, have moderate knowledge or awareness with regard to breast cancer (76.5%), breast cancer symptoms (76.8%), and breast cancer risk factors (74.3%). However, female respondents possessed higher knowledge levels than male respondents with regard to breast cancer symptoms (p = 0.005), whereas a significant difference regarding the knowledge on breast cancer risk factors between genders is absent (p = 0.702). In terms of breast cancer screening methods, more females than males possessed sufficient knowledge about breast self-examination and mammography, constituting 50.8% and 68.2% respectively among the female demographic. Nevertheless, we perceived that the reluctance of breast examination may be due to cultural stigma and self-induced fear. This contemporary research certainly demonstrates an insufficiency of knowledge on breast cancer among the general population irrespective of gender, which further emphasises the relevance of literacy and awareness among the public to help conquer cancer.

Breast cancer is the most commonly diagnosed cancer among Latinas. Dominican women in particular have a higher lifetime risk of breast cancer than do other Latinas in the U.S. This study examines how gender, ethnic, and language concordance between providers and patients are associated with recent mammography screening for Latina immigrant women from the Dominican Republic. We conducted structured interviews, in Spanish, with 419 Dominican women aged 40 years or older living in New York City. Using bivariate analysis and logistic regressions, we tested whether patient-provider gender, ethnic, and language concordance was associated with recent mammography when controlling for demographic covariates, breast cancer screening knowledge, and self-rated health. Gender concordance predicted recent mammography after controlling for covariates (β = 0.13). Neither ethnic nor language concordance significantly predicted recent mammography. Our findings suggest that promotion of patient-provider gender concordance may help reduce health disparities among Latinos/as and other minority groups across the United States.

Low health literacy is one of the social health determinants associated with cancer-related disparities. The aim of this study is to explore the relationships between health literacy and theory of planned behavior in performance of cancer screening tests by person undercover of rural health centers in Fasa, Fars Province, Iran in 2018. In this cross-sectional study, 850 persons older than 18 years of age were selected with cluster sampling. Data were collected by a questionnaire consisting of four sections evaluating demographic information, cancer screening behaviors, subjects’ health literacy and constructs of theory of planned behavior. The frequency of acceptable health literacy was respectively in Comprehension (39.41%), Reading (37.41%), Decision making (36.70%), Availability (36.23%) and Evaluation (35.76%). 37.65% of subjects (n = 320) had an acceptable health literacy level (n = 320), 46% (n = 391) had medium level and 16.35% (n = 139) had weak level. Results indicated that, there is significant relationship between health literacy and undergoing breast self-examination, Pap smear test, prostate specific antigen test (PSA) and Fecal occult blood test (FOBT). Also, theory of planned behavior predicted 41% variance in breast cancer screening behavior, 39% in cervical cancer screening, 40% PSA, 37% in mammography and 42% in FOBT. In each four cases, the role of behavioral intention was considerable. This study confirmed the correlation between cancer screening behaviors, health literacy and constructs of theory of planned behavior. Therefore, for promoting cancer screening behaviors and health literacy, theory of planned behavior can be used as a principle in health education and promotion programs.

To investigate the value of full-field digital mammography-based deep learning (DL) in predicting malignancy of Breast Imaging Reporting and Data System (BI-RADS) 4 microcalcifications. A total of 384 patients with 414 pathologically confirmed microcalcifications (221 malignant and 193 benign) were randomly allocated into the training, validation, and testing datasets (272/71/71 lesions) in this retrospective study. A combined DL model was developed incorporating mammography and clinical variables. Model performance was evaluated by using areas under the receiver operating characteristic curve (AUC) and compared with the clinical model, stand-alone DL image model, and BI-RADS approach. The predictive performance for malignancy was also compared between the combined model and human readers (2 juniors and 2 seniors). The combined DL model demonstrated favorable AUC, sensitivity, and specificity of 0.910, 85.3%, and 91.9% in predicting BI-RADS 4 malignant microcalcifications in the testing dataset, which outperformed the clinical model, DL image model, and BI-RADS with AUCs of 0.799, 0.841, and 0.804, respectively. The combined model achieved non-inferior performance as senior radiologists (p = 0.860, p = 0.800) and outperformed junior radiologists (p = 0.155, p = 0.029). The diagnostic performance of two junior radiologists was improved after artificial intelligence assistance with AUCs increased to 0.854 and 0.901 from 0.816 (p = 0.556) and 0.773 (p = 0.046), while the interobserver agreement was improved with a kappa value increased to 0.843 from 0.331. The combined deep learning model can improve the malignancy prediction of BI-RADS 4 microcalcifications in screening mammography and assist junior radiologists to achieve better performance, which can facilitate clinical decision-making. • The combined deep learning model demonstrated high diagnostic power, sensitivity, and specificity for predicting malignant BI-RADS 4 mammographic microcalcifications. • The combined model achieved similar performance with senior breast radiologists, while it outperformed junior breast radiologists. • Deep learning could improve the diagnostic performance of junior radiologists and facilitate clinical decision-making.

Nurses play an important role in educating patients on breast cancer and have a positive influence in encouraging women to participate in breast screening. This current study aimed to use a train-the-trainer model to improve the level of knowledge of nurses on breast cancer and screening in Ras Al Khaimah, United Arab Emirates. The study also focused on the nurses’ ability to train other nurses in assisting women to engage in breast screening. This interventional study used a mixed-method design. Seventeen female nurses (aged 28–60 years) were recruited from public and private health centers and participated in a breast cancer train-the-trainer workshop. They completed a survey before and after the workshop. The surveys included a series of open and closed questions to assess their knowledge of breast cancer symptoms, risk factors, diagnosis, and patient communication. The study found that nurse participants had good baseline knowledge of breast cancer topics, including breast self-examinations, clinical breast examinations, and mammography. Responses were deemed accurate if they answered open-ended questions without incorrect information and correct options were selected in the quantitative sections. However, training improved the detail and accuracy of the participant responses. Training also improved the confidence of nurse participants to teach other women and nurses how to perform breast self-examinations and provide breast cancer information. There were significant increases in nurse participants’ knowledge of risk factors (p

Although much deep learning research has focused on mammographic detection of breast cancer, relatively little attention has been paid to mammography triage for radiologist review. The purpose of this study was to develop and test DeepCAT, a deep learning system for mammography triage based on suspicion of cancer. Specifically, we evaluate DeepCAT’s ability to provide two augmentations to radiologists: (1) discarding images unlikely to have cancer from radiologist review and (2) prioritization of images likely to contain cancer. We used 1878 2D-mammographic images (CC & MLO) from the Digital Database for Screening Mammography to develop DeepCAT, a deep learning triage system composed of 2 components: (1) mammogram classifier cascade and (2) mass detector, which are combined to generate an overall priority score. This priority score is used to order images for radiologist review. Of 595 testing images, DeepCAT recommended low priority for 315 images (53%), of which none contained a malignant mass. In evaluation of prioritizing images according to likelihood of containing cancer, DeepCAT’s study ordering required an average of 26 adjacent swaps to obtain perfect review order. Our results suggest that DeepCAT could substantially increase efficiency for breast imagers and effectively triage review of mammograms with malignant masses.

There are over 1.4 million individuals who identify as transgender in the USA, and these individuals are frequently treated with cross-sex hormonal therapy (CSH) to acquire their desired phenotype. Simultaneously, breast cancer is one of the most common cancers in the USA, and there are mixed data on how CSH may influence breast cancer development in transgender individuals. Here, we review the barriers that exist to health access in this population, the current evidence of breast cancer risk in transgender individuals, and breast cancer screening guidelines for both transgender women and men. A large portion of the transgender population report barriers that exist to accessing appropriate healthcare, some of which are directly related to poor interactions with healthcare providers. From both systemic reviews and large retrospective studies, it appears that while transgender females have a lower rate of breast cancer development compared to cis-gender females, transgender males have a higher rate of breast cancer development compared to cis-gender males. While several organizations have released screening guidelines for transgender persons, there is a lack of consensus on optimal screening regimens. In addition, there are no formal recommendations by the American Cancer Society or the United States Preventative Task Force for breast cancer screening in transgender persons. The risk of breast cancer development in transgender individuals is different compared to that of the cis-gender population. Further prospective data are needed to appropriately quantify these risks and to assess what is the appropriate breast cancer screening recommendations for this population.

The aim of our study was, first, to measure association between radiologists and facilities characteristics and DCIS detection. Second, to assess whether those characteristics affect differently the likelihood of detection of DCIS versus invasive breast cancer. When applicable, we examined whether the identified characteristics were similarly associated with low-grade and high-grade DCIS detection. This retrospective cohort study included 1,750,002 digital screening mammograms (2145 screen-detected DCIS) performed in the Quebec breast cancer screening program between 2007 and 2015 inclusively. The associations between radiologists’ and facilities’ characteristics and (1) the DCIS detection rate, (2) the invasive detection rate, and (3) the odds of DCIS on invasive detection were assess. For statistically significant associations in the latter analysis, analyses stratified by DCIS grade were performed. Multivariable logistic regression with generalized estimating equations estimates to account for correlation among mammograms was used. Compared to radiologists with recall rate between 5.0 and 9.9%, radiologists with recall rate between 15.0–19.9% and ≥ 20% reached a higher DCIS detection rate, with adjusted detection ratios of, respectively, 1.33 (95% confidence interval = 1.15–1.53) and 1.43 (95% confidence interval = 1.13–1.81). Increase in radiologist’ recall rate was statistically significantly associated with an increase in detection of low/intermediate-grade DCIS (P

Mammography is the only screening method with evidence in support of reduced breast cancer mortality, but yields poor accuracy outcomes in women with dense breast tissue. The Japan Strategic Anti-cancer Randomized Trial (J-START) was conducted as part of the measures implemented to deal with women with dense breast tissue. Although the sensitivity was increased, the specificity was significantly lower in the intervention group because further examination was required in all positive cases classified by either mammography or ultrasound in the J-START. To address the issue, an overall assessment system of combined mammography and adjunctive ultrasound for breast cancer screening has been developed in Japan. The basic concept is based on a comprehensive assessment that includes a mammography assessment followed by an adjunctive assessment for ultrasound similar to the clinical setting. Currently, mammography alone is recommended for population-based breast cancer screening in Japan, but additional ultrasonography is extensively available for women, especially for women with dense breasts with shared decision-making for personalized breast cancer screening. The overall assessment system is recommended for use in Japan when breast cancer screening is conducted using both mammography and ultrasonography. In this article, we summarize the advantages of the overall assessment and the simultaneous mammography/ultrasound method, the basic approach used in Japan to assign the overall assessment category for breast cancer screening, and we outline the future directions of adjunctive screening ultrasound.

Background: the MyPeBS study is an ongoing randomised controlled trial testing whether a risk-stratified breast cancer screening strategy is non-inferior, or eventually superior, to standard age-based screening at reducing incidence of stage 2 or more cancers. This large European Commission-funded initiative aims to include 85,000 women aged 40 to 70 years, without prior breast cancer and not previously identified at high risk in six countries (Belgium, France, Italy, Israel, Spain, UK). A specific work package within MyPeBS examines psychological, socio-economic and ethical aspects of this new screening strategy. It compares women's reported data and outcomes in both trial arms on the following issues: general anxiety, cancer-related worry, understanding of breast cancer screening strategy and information-seeking behaviour, socio-demographic and economic characteristics, quality of life, risk perception, intention to change health-related behaviours, satisfaction with the trial. Methods: at inclusion, 3-months, 1-year and 4-years, each woman participating in MyPeBS is asked to fill online questionnaires. Descriptive statistics, bivariate analyses, subgroup comparisons and analysis of variations over time will be performed with appropriate tests to assess differences between arms. Multivariate regression models will allow modelling of different patient reported data and outcomes such as comprehension of the information provided, general anxiety or cancer worry, and information seeking behaviour. In addition, a qualitative study (48 semi-structured interviews conducted in France and in the UK with women randomised in the risk-stratified arm), will help further understand participants' acceptability and comprehension of the trial, and their experience of risk assessment. Discussion: beyond the scientific and medical objectives of this clinical study, it is critical to acknowledge the consequences of such a paradigm shift for women. Indeed, introducing a risk-based screening relying on individual biological differences also implies addressing non-biological differences (e.g. social status or health literacy) from an ethical perspective, to ensure equal access to healthcare. The results of the present study will facilitate making recommendations on implementation at the end of the trial to accompany any potential change in screening strategy. MyPeBS project is funded by the European Union’s Horizon 2020 research and innovation programme under grant agreement N°755394 and underwent a full external peer review process at this step. MyPeBS has received funding from the PHRC-K research-funding programme (17–154) for the conduct of the study in France. DPF is supported by the NIHR Biomedical Research Centre in Manchester (IS-BRC-1215–20007). FJG is supported by the NIHR Cambridge Biomedical Research Centre (BRC-1215–20014). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. XC is supported by grants from Instituto de Salud Carlos III FEDER (PI19/00007). MyPeBS is supported by the French health insurance systems (CNAM, MSA, MGEN, CPRPSNCF) for the covering of screening exams extra-costs, and by the Malakoff Humanis social protection group through the financing of the equipment of the recruiting centres with digital tablets to inform women about the study.

To evaluate the design and plan of execution of the “WISDOM” trial. The rationale and reasoning behind the WISDOM Trial were reviewed and analyzed. The published parameters of the trial were reviewed. The study is based on a failed understanding of the available data about breast cancer screening and is based on faulty assumptions, false reasoning, a scientifically unsupportable study design, ignoring advances in screening, a questionable endpoint, the likely lacking of power to answer the primary question, and support by insurance companies whose primary goal is almost certainly to reduce their costs. A major part of the premise is that there is a “debate” about the efficacy of screening. WISDOM ignores the fact that the “debate” has been manufactured and is not science-based. The results of the WISDOM Trial may be misleading.

The purpose of this study is to confirm the position of DBT in breast cancer screening in Japan, to assess cancer detection rates, recall rates, positive predictive value (PPV), and to evaluate the type of mammographic findings of cancer with the use of digital mammography alone (2DDM) and combined with digital breast tomosynthesis (DBT). 11,894 examinations of the opportunistic breast cancer screening using only 2DDM and 2DDM plus DBT were performed from May 1, 2017 to March 31, 2019. The 11,894 women [3535 women who received DBT in addition to 2DDM (3D group) and 8359 who received 2DDM only (2D group)] participated in this study. The study was approved by the Institute's Ethics Committee and all participants provided written informed consent. The recall rate was 2.6% for the 3D group and 3.6% for the 2D group (p

Purpose To estimate the effectiveness of tailored physical activity and dietary interventions amongst adults attending colorectal and breast cancer screening. Methods Five literature databases were systematically searched to identify randomised controlled trials (RCTs) of tailored physical activity and/or dietary interventions with follow-up support initiated through colorectal and breast cancer screening programmes. Outcomes included markers of body fatness, physical activity, and dietary intake. Mean differences (MDs) or standardised mean differences (SMDs) with 95% confidence intervals (CIs) were pooled using random effects models. Results Five RCTs met the inclusion criteria encompassing a total of 722 participants. Diet and physical activity interventions led to statistically significant reductions in body mass (MD − 1.6 kg, 95% CI − 2.7 to − 0.39 kg; I2 = 81%; low quality evidence), body mass index (MD − 0.78 kg/m2, 95% CI − 1.1 to − 0.50 kg/m2; I2 = 21%; moderate quality evidence), and waist circumference (MD − 2.9 cm, 95% CI − 3.8 to − 1.91; I2 = 0%; moderate quality evidence), accompanied by an increase in physical activity (SMD 0.31, 95% CI 0.13 to 0.50; I2 = 0%; low quality evidence) and fruit and vegetable intake (SMD 0.33, 95% CI 0.01 to 0.64; I2 = 51%; low quality evidence). Conclusion There is low quality evidence that lifestyle interventions involving follow-up support lead to modest weight loss and increased physical activity and fruit and vegetable intake. Due to the modest intervention effects, low quality of evidence and small number of studies, further rigorously designed RCTs with long-term follow-up of modifiable risk factors and embedded cost–benefit analyses are warranted (PROSPERO ref: CRD42020179960).

PURPOSE: This study examines breast and cervical cancer screening uptake in a cancer education and patient navigation (PN) program for residents of rural and border counties in Texas by level of participation (education only, PN only, or education and PN). METHODS: Data collected from March 1, 2012 to November 5, 2016 included 6,663 follow-up surveys from participants aged 21–74. Logistic regression models assessed program participation on the odds of completing breast or cervical cancer screening. RESULTS: For women aged 40–74 years (N=4,942; mean age= 52 years), 58.4% reported a mammogram within 6 months on average from initial contact. In the breast cancer screening model, women who only received PN (OR: 6.06, CI: 4.87–7.53) or who participated in both the education plus PN program (OR: 3.33, CI: 2.77–4.02) had higher odds of mammogram screening compared to women who only received education. For women aged 21–64 years (N=6,169; mean age= 46 years), 37.7% received a Papanicolaou (Pap) test within 6 months on average from initial contact. In the Pap screening model, both education and PN (OR: 3.23, CI: 2.66–3.91) and PN only (OR: 2.35, CI: 1.88–2.93) groups had higher odds of screening for cervical cancer compared to those only receiving education. Graphed predicted probabilities examined significant interactions between race/ethnicity/language and program participation (P

Pursuing the overarching goal of saving both lives and healthcare costs, we introduce an approach to increase the expected participation in a preventive healthcare program, e.g., breast cancer screening. In contrast to sick people who need urgent medical attention, the clients in preventive healthcare decide whether to go to a specific facility (if this maximizes their utility) or not to take part in the program. We consider clients’ utility functions to include decision variables denoting the waiting time for an appointment and the quality of care. Both variables are defined as functions of a facility’s utilization. We employ a segmentation approach to formulate a mixed-integer linear program. Applying GAMS/CPLEX, we optimally solved instances with up to 400 demand nodes and 15 candidate locations based on both artificial data as well as in the context of a case study based on empirical data within one hour. We found that using a Benders decomposition of our problem decreases computational effort by more than 50%. We observe a nonlinear relationship between participation and the number of established facilities. The sensitivity analysis of the utility weights provides evidence on the optimal participation given a specific application (data set, empirical findings).

Purpose This study explores factors that are associated with the severity of breast cancer (BC) at diagnosis. Methods Interviews were conducted among women (n = 3326) aged 20–79 diagnosed with BC between 2011 and 2013 in Queensland, Australia. High-severity cancers were defined as either Stage II–IV, Grade 3, or having negative hormone receptors at diagnosis. Logistic regression models were used to estimate odds ratios (ORs) of high severity BC for variables relating to screening, lifestyle, reproductive habits, family history, socioeconomic status, and area disadvantage. Results Symptom-detected women had greater odds (OR 3.38, 2.86–4.00) of being diagnosed with high-severity cancer than screen-detected women. Women who did not have regular mammograms had greater odds (OR 1.78, 1.40–2.28) of being diagnosed with high-severity cancer than those who had mammograms biennially. This trend was significant in both screen-detected and symptom-detected women. Screen-detected women who were non-smokers (OR 1.77, 1.16–2.71), postmenopausal (OR 2.01, 1.42–2.84), or employed (OR 1.46, 1.15–1.85) had greater odds of being diagnosed with high-severity cancer than those who were current smokers, premenopausal, or unemployed. Symptom-detected women being overweight (OR 1.67, 1.31–2.14), postmenopausal (OR 2.01, 1.43–2.82), had hormone replacement therapy (HRT) 10 years. Conclusion Screen-detected women and women who had mammograms biennially had lower odds of being diagnosed with high-severity breast cancer, which highlighted the benefit of regular breast cancer screening. Women in subgroups who are more likely to have more severe cancers should be particularly encouraged to participate in regular mammography screening.

This investigation aimed to study breast cancer awareness based on health information literacy and influential factors of breast cancer awareness among female nursing students in Changchun city in China. A four-part self-report questionnaire including the participants’ general demographic characteristics, the participants’ specialized characteristics concerning breast cancer screening, the Chinese version of the Breast Cancer Awareness Measurement (C-BCAM), and the Chinese version of the Health Information Literacy Self-rating Scale (HILSS) was designed to investigate breast cancer awareness and health information literacy and influential factors of breast cancer awareness among 205 female nursing students in Year 1–Year 3 using convenience sampling. The data were analyzed with SPSS 26.0 using descriptive statistics, nonparametric tests, and multiple regression analysis. The nursing students had an average level of HIL (median = 101.00, (93.00, 107.00)) and a good level of breast cancer awareness (median = 82.00, (76.00, 88.00)). A significant positive correlation was found between the HILSS and total C-BCAM score (r = 0.439, P

The Ontario High Risk Breast Screening program follows women aged 30–69 at an increased risk of breast cancer, using a yearly mammography and breast MRI. The aim of this study is to determine the clinical outcomes for the enrolled women. Observational cohort study following 2081 participants in the high-risk screening program 2011–2017. The participants were divided into three subgroup according to their risk criteria: (a) known carriers of pathogenic variants (PV) in hereditary breast cancer genes. (b) Previous chest radiotherapy. (c) Estimated life time risk (ELR) ≥ 25%, calculated using the International Breast Cancer Intervention Study (IBIS) tool, with no known mutation or previous radiation. All Breast Cancer (BC) diagnosed during the follow-up time were recorded. 673 women carried PVs in hereditary breast cancer genes, 159 had a history of chest radiotherapy, and 1249 had an ELR ≥ 25%. The total cohort of screening years was 8126. Median age at BC diagnosis was 41 for the first group, 47 for the second group and 51 for the third. BC incidence rate was 18.2 for PV mutation carriers, 17.9 for the chest radiotherapy group and 6.2 for ELR ≥ 25%. Hazard ratio was similar for the first two groups, but significantly lower for the ELR ≥ 25% group. When stratifying by age, the incidence rate in the ELR ≥ 25% increased over time, until it became similar to that of the other subgroups after age 50. Our findings question the need to screen women with an elevated lifetime risk using the same screening practices used for women who are PV mutation carriers, or with a history of chest radiation, prior to the age of 50.

PURPOSE: Despite widespread promotion of breast and cervical cancer (BCC) screening, uptake remains low in rural communities. Barriers to healthcare, which often result in poorer health outcomes, differentially impact residents of rural communities. Effective interventions addressing the unique needs of rural women may target these barriers and increase BCC screening participation. Our objective is to review and assess the published literature on interventions to increase BCC screening in rural communities. METHODS: A systematic scoping review of PubMed/Medline was performed to identify BCC screening interventions conducted in rural settings. English language articles from peer-reviewed journals published from January 2006 to October 2019 were included if they reported results for BCC screening interventions in rural communities in the United States. RESULTS: We reviewed 228 articles and identified eight articles consistent with our inclusion criteria. Studies varied in sample population characteristics, geographic location, design, and mode of intervention delivery. Interventions included patient navigation strategies, educational outreach programs, peer counseling, and small media initiatives. Interventions focused on promoting uptake of initial or one-time screening rather than targeted repeat screening, and few studies detailed the cost-effectiveness of the interventions. CONCLUSION: This review may inform efforts to develop strategies to increase BCC screening among rural women. Additional cancer prevention and control research gaps in rural communities include the examination of the theoretical foundations, design, delivery, and cost-effectiveness of BCC screening interventions for rural communities. Future research might focus on methods to promote repeat BCC screening and effective translation of these interventions for other rural populations.

Ultrasound imaging modality is used prominently for breast cancer screening and diagnosis because of its safety, portability, ease of use and low cost. Over the years, computer-assisted algorithms have been used to aid the radiologists for interpreting the ultrasound images. The presence of speckle adversely affects the ultrasound image quality because of which accurate segmentation of tumors has become a challenging task. In the present work, various machine learning (ML) and deep learning (DL) based approaches designed for segmenting breast ultrasound images have been reviewed over the past two decades using a characterization approach in terms of (a) datasets used, (b) pre-processing methods, (c) augmentation methods, (d) segmentation methods and (e) evaluation metrics used for the segmentation algorithms along with their brainstorming diagrams. The review presents the achievements made till date in the design of ML and DL based segmentation methods applied to breast ultrasound images and also highlights the directions in which the future research could be carried out.

This paper examines the effectiveness of using personal health records (PHRs), which contains detailed health information to improve the use of recommended screening mammography among women at potential risk for breast cancer. It also explores the potential of PHR in reducing disparities in recommended mammography use experienced by minority and underserved women. The primary data used for this study were obtained from the 2015 Health Information National Trends Survey, and they were supplemented by the 2016 Area Health Resource Files. The study sample included women aged 40–75 years with no prior diagnosis of cancer. Because the use of PHRs as a key predictor of breast cancer screening may be endogenously determined, we used the instrumental variable (IV) approach to correct for estimation bias. We found a significant and positive association between the use of PHRs and recommended mammography use among women, with the likelihood of mammography screening increasing with more frequent use of PHRs. Furthermore, the effects of PHR use on mammography screening were found to be greater among Hispanic and Black women and those living in non-metropolitan areas compared with White women and those living in metropolitan areas, respectively. The use of PHRs for health information seeking can empower women at potential risk for breast cancer to participate in recommended screening mammography, particularly among those underserved and racial/ethnic minorities. Policymakers should consider developing policies and programs that can promote PHR use by women, especially medically underserved and minority women.

Overseas, the importance for breast MRI screening for high-risk groups has been shown. However, the evidence among Japanese population was lacking. Therefore, we collaborated with the "Study on clinical and genetic characterization of hereditary breast and ovarian cancer and improvement in prognosis using genetic information in Japan" group, as part of the Comprehensive Research Project on the Promotion of Cancer Control, Health and Labour Sciences Research, and have been conducting the study entitled, "Study of the usefulness of MRI surveillance of BRCA1/2 mutation carriers" since 2014. In addition, we found that in the Japanese population also, the pathological and imaging characteristics differ between BRCA1 and BRCA2 mutation carriers, like in non-Japanese populations by the several reports. In high-risk females, risk categories such as BRCA1 or BRCA2 mutation carriers are very important. Furthermore, in the future, the optimal surveillance modalities and examination intervals would also vary according to the age, thinness of the breast (constitution), breast density (individual differences on mammography), etc.; this would be "personalized surveillance", and quality-assured MRI examination is of the essence. This review will present clinical trial data of prospective MRI surveillance in Japan, and summarize the current status of breast cancer screening in high-risk Japanese women.

Background Improving the quality of information and communication is a priority in organised breast cancer screening and an ethical duty. Programmes must offer the information each woman is looking for, promoting informed decision-making. This study aimed to develop and evaluate a web-based dynamic decision aid (DA). Methods A pragmatic randomised trial carried out in six regional organised screening programmes recruited women at the first invitation receiving DA or a web-based standard brochure (SB). The primary outcome was informed choice measured on knowledge, attitudes, and intentions. Follow-up period: 7–10 days. Secondary outcomes included participation rate, satisfaction, decisional conflict, and acceptability of DA. Results Two thousand one hundred and nineteen women were randomised and 1001 completed the study. Respectively, 43.9% and 36.9% in the DA and SB reached the informed choice. The DA gave a 13-point higher proportion of women aware about overdiagnosis compared to SB (38.3% versus 25.2%, p Conclusion DA increases informed choice. Complete information including the pros, cons, controversies, and overdiagnosis–overtreatment issues boost a woman’s knowledge without reducing the rate of actual screening participation. Clinical trial registration ClinicalTrials.gov number NCT 03097653.

Breast cancer is a commonly diagnosed malignancy and the second leading cause of cancer-related death among American women today. The literature suggests that African American Women (AAW) are more likely to die from the disease each year compared to their White counterparts. A biological basis for this disparity exists-early age of onset, more advanced stage of the disease, more aggressive histological changes, and worse survival. Even though mechanisms underlying these disparities are poorly understood, recent studies suggest that the poorer breast cancer outcome observed in AAW may, in part, result from underlying molecular factors. The present review was undertaken to investigate if AAW do, in fact, develop a more aggressive form of breast cancer compared to other racial groups based on molecular level differences and social determinants. This review also addresses health policy changes that may be implemented to aid in eliminating this disparity.

Objectives MRI is an integral part of breast cancer screening in high-risk patients. We investigated whether the application of the Kaiser score, a clinical decision-support tool, may be used to exclude malignancy in contrast-enhancing lesions classified as BI-RADS 4 on breast MRI screening exams. Methods This retrospective study included 183 consecutive, histologically proven, suspicious (MR BI-RADS 4) lesions detected within our local high-risk screening program. All lesions were evaluated according to the Kaiser score for breast MRI by three readers blinded to the final histopathological diagnosis. The Kaiser score ranges from 1 (lowest, cancer very unlikely) to 11 (highest, cancer very likely) and reflects increasing probabilities of malignancy, with scores greater than 4 requiring biopsy. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic accuracy. Results There were 142 benign and 41 malignant lesions, diagnosed in 159 patients (mean age, 43.6 years). Median Kaiser scores ranged between 2 and 5 in benign and 7 and 8 in malignant lesions. For all lesions, the Kaiser score’s accuracy, represented by the area under the curve (AUC), ranged between 86.5 and 90.2. The sensitivity of the Kaiser score was high, between 95.1 and 97.6% for all lesions, and was best in mass lesions. Application of the Kaiser score threshold for malignancy (≤ 4) could have potentially avoided 64 (45.1%) to 103 (72.5%) unnecessary biopsies in 142 benign lesions previously classified as BI-RADS 4. Conclusions The use of Kaiser score in high-risk MRI screening reliably excludes malignancy in more than 45% of contrast-enhancing lesions classified as BI-RADS 4. Key Points • The Kaiser score shows high diagnostic accuracy in identifying malignancy in contrast-enhancing lesions in patients undergoing high-risk screening for breast cancer. • The application of the Kaiser score may avoid > 45% of unnecessary breast biopsies in high-risk patients. • The Kaiser score aids decision-making in high-risk breast cancer MRI screening programs.

BACKGROUND: Cancer screening is chiefly performed by primary care providers (PCPs) who rely on organizational screening guidelines. These guidelines provide evidence-based recommendations; however, they are often without unanimity leading to divergent screening recommendations. OBJECTIVE: Due to the high incidence of breast cancer, the availability of screening methods, and the presence of multiple incongruent guideline recommendations, we sought to understand breast cancer screening practices in Wisconsin to identify patterns that would allow us to improve evidence-based screening adherence. METHODS: A 46-question survey on breast cancer screening beliefs and practices for average-risk women was sent to healthcare providers in Wisconsin in 2018, who provided cancer screening services to women. Providers included physicians, nurse practitioners (NPs), physician assistants (PAs), and midwives. RESULTS: A total of 295 people responded to the survey, for a response rate of 28.6%. Most respondents were physicians (64.1%), followed by NPs (25.7%), PAs (5.3%), and midwives (1.5%). Of physicians, most practiced family medicine (65.3%), followed by internal medicine (25.3%) and gynecology (9.4%). The United States Preventive Services Task Force (USPSTF) was reported as being “very influential” for 60.5% of providers, followed by the American Cancer Society at 46.8%. For patients 40–49 years old, 75.6% of providers performed clinical breast exams and 58.5% recommended self-breast exams; these numbers increased for women 50+ years old to 78.7% and 61.2%, respectively. Mammography was more likely to be recommended annually for women aged 40–49 rather than biennially by non-physician clinicians compared to physicians (p

BACKGROUND: Mammography is limited when analyzing dense breasts for 2 reasons: (1) breast density masks underlying cancers and (2) breast density is an independent risk factor for cancer. We undertook this study to assess whether there is a racial/ethnic difference in supplemental image ordering for women with dense breasts. METHODS: We conducted a retrospective, observational cohort study of women aged 50–75 from an academic medical center who had completed a screening mammogram between 2014 and 2016 that was read as BI-RADS 1 with heterogeneously or extremely dense breasts or BI-RADS 2 with extremely dense breasts. Data were abstracted on type, timing and frequency of supplemental imaging tests ordered within two years of an initial screening mammogram. Patient characteristics (age, race/ethnicity, insurance, and comorbidities) were also abstracted. We used bivariate and multivariate logistic regression to assess for differences in supplemental imaging ordered by race/ethnicity. RESULTS: Three hundred twenty-six women met inclusion criteria. Mean age was 58 years: 25% were non-Hispanic white, 30% were non-Hispanic black, 27% were Hispanic, 6% were Asian and 14% unknown. Seventy-nine (24%) women were ordered a supplemental breast ultrasound after the initial screening mammogram. Non-Hispanic black and Hispanic women were less likely to have supplemental imaging ordered compared to non-Hispanic white women (15% and 10%, respectively, vs. 45%, p < 0.0001). After controlling for patient age, ordering physician specialty, insurance, BI-RADS score, breast density, and family history of breast cancer, non-Hispanic black and Hispanic women remained less likely to be ordered supplemental imaging (OR 0.38 [95% CI 0.17–0.85] and OR 0.24 [95% CI 0.10–0.61], respectively, p < 0.0001). CONCLUSION: Minority women with dense breasts are less likely to be ordered supplemental breast imaging. Further research should investigate physician and patient behaviors to determine barriers in supplemental imaging. Understanding these differences may help reduce disparities in breast cancer care and mortality.

The Asian Society of Mastology (ASOMA) was established with an attempt to bring together experts in the field of breast surgery, radiation oncology, medical oncology, radiology, pathology, and breast care nursing to update and improve care for the patients with various breast diseases in developing countries. The ASOMA-proposed “Standards of Care for Breast Cancer Patients” has been developed with an attempt to identify obstacles and provide possible solutions to improve quality of care for breast cancer patients. Besides these recommendations for cancer care, issues related to common benign breast diseases, viz. non-lactation mastitis, granulomatous mastitis, high-risk lesions, and issues related to triple assessment, were also deliberated.

PURPOSE OF THE REVIEW: This article outlines considerations for individuals interested in developing and implementing breast cancer risk models and has relevance for individuals developing risk-models with the goal of implementing them into health systems. RECENT FINDINGS: There has been increased focus on developing risk models for clinical use—often with less attention model implementation. Epidemiologists developing risk-models must think through model outcomes including stakeholder needs, time horizons, terminology and reference groups and clarity on what actionable steps are for health systems, providers and patients following its implementation. SUMMARY: Model performance needs to be evaluated relative to complexity of the model to be implemented–not just from the risk-prediction perspective, but also from the burden on patients, providers and systems for the amount and frequency of required data collection and with clear actionable steps to be taken with the information collected.