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Clinical Breast Cancer Apr 2022Supplemental screening with MRI or ultrasound increases cancer detection rate (CDR) in women with standard screening mammography. Whether it also reduces interval cancer... (Review)
Review
Supplemental screening with MRI or ultrasound increases cancer detection rate (CDR) in women with standard screening mammography. Whether it also reduces interval cancer rate (ICR) is unclear. This study reviewed the evidence evaluating the effect of supplemental imaging on ICR in women undergoing screening mammography. This systematic review included studies that reported both CDR and ICR in women undergoing screening mammography alone compared to those undergoing screening mammography with supplemental imaging. Five studies (3 randomized trials) were eligible. These reported on 142,153 women undergoing mammography screening alone or mammography with supplemental imaging (3 ultrasound and 2 MRI studies). Two studies included a general screening population and 3 included special populations (young, high genetic risk and/or dense breasts). The incremental CDR for supplemental MRI was 14.2 to 16.5/1000 screens and for ultrasound was 0 to 4.4/1000 screens. Effect on ICR was variable but evidence of a reduced ICR was more consistent for studies using supplemental MRI (ICR 0.3 to 0.8 per 1000 screens) than those using ultrasound (ICR 0.49 to 1.9 per 1000 screens). The higher CDR and lower ICR with supplemental screening were associated with higher recall and biopsy rates particularly with supplemental MRI (9.5%-15.9%, up to 69/1000 screens). Cancers detected with supplemental imaging modalities were generally smaller and earlier stage. Mammography with supplemental MRI or ultrasound increases detection of cancers (versus mammography only) in some sub-groups but also increases recall and biopsy rates and may have a relatively modest effect in reducing ICR.
Topics: Breast Neoplasms; Early Detection of Cancer; Female; Humans; Male; Mammography; Mass Screening; Ultrasonography
PubMed: 34756834
DOI: 10.1016/j.clbc.2021.09.011 -
Radiography (London, England : 1995) Aug 2023Mammography screening programs have been implemented in European countries as prevention tools aimed at reducing breast cancer mortality through early detection in... (Review)
Review
INTRODUCTION
Mammography screening programs have been implemented in European countries as prevention tools aimed at reducing breast cancer mortality through early detection in asymptomatic women. Nordic countries (Denmark, Finland, Iceland, Norway, Sweden, the Faroe Islands, and Greenland) demonstrated high participation rates; however, breast cancer mortality could be limited by further optimizing screening. This review aimed to explore factors that affect women's participation in mammography screening in Nordic countries.
METHOD
A systematic review of segregated mixed research synthesis using a deductive approach was conducted. The following databases and platforms were searched to identify relevant studies: CINAHL with Full Text (EBSCOHost), MEDLINE (EBSCOHost), PsycInfo (ProQuest), Scopus (Elsevier) and Web of Science Core Collection (SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, and ESCI). The Critical Appraisal Skills Program was used for quality assessment. The Health Promotion Model was applied to integrate findings from qualitative and qualitative research. All methodological steps followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
RESULTS
The final selection (16 articles) included studies from three Nordic countries: Denmark (four quantitative studies), Norway (one qualitative and four quantitative studies), and Sweden (three qualitative and seven quantitative studies). Sixty-three factors were identified as barriers, facilitators, or factors with no influence.
CONCLUSION
A substantial number of obtained factors, spread across a wide spectrum, describe (non-)participation in mammography screening as a versatile phenomenon.
IMPLICATIONS FOR PRACTICE
The findings of this review could benefit the mammography staff and providers regarding possible interventions aimed at improving screening participation rates.
Topics: Female; Humans; Mammography; Breast Neoplasms; Scandinavian and Nordic Countries; Qualitative Research; Norway
PubMed: 37421878
DOI: 10.1016/j.radi.2023.06.010 -
Scientific Reports May 2020We proposed to compare the accuracy and effectiveness of digital breast tomosynthesis (DBT), plus digital or synthetic mammography, with digital mammography alone in... (Meta-Analysis)
Meta-Analysis
We proposed to compare the accuracy and effectiveness of digital breast tomosynthesis (DBT), plus digital or synthetic mammography, with digital mammography alone in women attending population-based breast cancer screenings. We performed a systematic review and included controlled studies comparing DBT with digital mammography for breast cancer screening. Search strategies were applied to the MEDLINE, Embase, LILACS, and CENTRAL databases. With moderate quality of evidence, in 1,000 screens, DBT plus digital mammography increased the overall and invasive breast cancer rates by 3 and 2 (RR 1.36, 95% CI 1.18 to 1.58 and RR 1.51, 95% CI 1.27 to 1.79, respectively). DBT plus synthetic mammography increased both overall and invasive breast cancer rates by 2 (RR 1.38, 95% CI 1.24 to 1.54 and RR 1.37, 95% CI 1.22 to 1.55, respectively). DBT did not improve recall, false positive and false negative rates. However due to heterogeneity the quality of evidence was low. For women attending population-based breast cancer screenings, DBT increases rates of overall and invasive breast cancer. There is no evidence with high or moderate quality showing that DBT compared with digital mammography decreases recall rates, as well as false positive and false negative rates.
Topics: Breast Neoplasms; Early Detection of Cancer; Female; Humans; Mammography; Mass Screening; Publication Bias; Reproducibility of Results; Sensitivity and Specificity
PubMed: 32409756
DOI: 10.1038/s41598-020-64802-x -
Cancer Epidemiology, Biomarkers &... May 2012Obesity is associated with increased colon cancer mortality and lower rates of mammography and Pap testing. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Obesity is associated with increased colon cancer mortality and lower rates of mammography and Pap testing.
METHODS
We conducted a systematic review to determine whether obesity is associated with lower rates of colon cancer screening. We searched the PubMed, CINAHL, and Cochrane Library databases. Two investigators reviewed citations, abstracts, and articles independently. Two investigators abstracted study information sequentially and evaluated quality independently using standardized forms. We included all studies in our qualitative syntheses. We used random effects meta-analyses to combine those studies providing screening results by the following body mass index (BMI) categories: Normal, 18.5-24.9 kg/m(2) (reference); overweight, 25-29.9 kg/m(2); class I obesity, 30-34.9 kg/m(2); class II obesity, 35-39.9 kg/m(2); and class III obesity, ≥ 40 kg/m(2).
RESULTS
Of 5,543 citations, we included 23 articles. Almost all studies were cross-sectional and ascertained BMI and screening through self-report. BMI was not associated with colon cancer screening overall. The subgroup of obese white women reported lower rates of colon cancer screening compared with those with a normal BMI with combined ORs (95% CI) of 0.87 (0.82-0.93), 0.80 (0.65-0.99), and 0.73 (0.58-0.94) for class I, II, and III obesity, respectively. Results were similar among white men with class II obesity.
CONCLUSIONS
Overall, BMI was not associated with colon cancer screening. Obese white men and women may be less likely to undergo colon cancer screening compared with those with a normal BMI.
IMPACT
Further investigation of this disparity may reduce the risk of obesity-related colon cancer death.
Topics: Body Mass Index; Colonic Neoplasms; Early Detection of Cancer; Female; Humans; Male; Mass Screening; Obesity; Sex Factors; United States; White People
PubMed: 22492832
DOI: 10.1158/1055-9965.EPI-11-0826 -
Preventive Medicine Dec 2015To assess the inequalities in adherence to breast and cervical cancer screening according to educational level. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To assess the inequalities in adherence to breast and cervical cancer screening according to educational level.
METHODS
A systematic review was carried out between 2000 and 2013 by querying an electronic database using specific keywords. Studies published in English reporting an estimation of the association between level of education and adherence to breast and/or cervical cancer screening were included in the study. Two different meta-analyses were carried out for adherence to breast and cervical cancer screening, respectively: women with the highest level of education and women with the lowest level of education were compared. The level of heterogeneity was investigated and subgroup analyses were carried out.
RESULTS
Of 1231 identified articles, 10 cross-sectional studies were included in the analysis. The meta-analyses showed that women with the highest level of education were more likely to have both screenings with an overall OR=1.61 (95% CI 1.36-1.91; I(2)=71%) for mammography and OR=1.96 (95% CI 1.79-2.16; I(2)=0%) for Pap test, respectively. Stratified meta-analysis for breast cancer screening included only studies that reported guidelines with target age of population ≥50 years and showed a reduction in the level of heterogeneity and an increase of 36% in the adherence (95% CI 1.19-1.55; I(2)=0%).
CONCLUSIONS
This study confirms and reinforces evidence of inequalities in breast and cervical cancer screening adherence according to educational level.
Topics: Adult; Breast Neoplasms; Early Detection of Cancer; Educational Status; Female; Guideline Adherence; Humans; Mammography; Mass Screening; Middle Aged; Papanicolaou Test; Patient Acceptance of Health Care; Uterine Cervical Neoplasms
PubMed: 26408405
DOI: 10.1016/j.ypmed.2015.09.011 -
Gland Surgery Oct 2023Cone-beam breast computed tomography (CBBCT) is a new breast imaging technique, however, CBBCT is not yet widely used, and its future application will depend on its...
Diagnostic accuracy of cone-beam breast computed tomography and head-to-head comparison of digital mammography, magnetic resonance imaging and cone-beam breast computed tomography for breast cancer: a systematic review and meta-analysis.
BACKGROUND
Cone-beam breast computed tomography (CBBCT) is a new breast imaging technique, however, CBBCT is not yet widely used, and its future application will depend on its diagnostic potential and application value. Therefore, it is of great clinical significance to systematically review and analyze the diagnostic accuracy of CBBCT for breast cancer detection in existing studies and compare it with other traditional imaging methods for the diagnosis of breast lesions.
METHODS
We searched PubMed, Embase, Web of Science, and Chinese databases until August 2022 for relevant papers. Studies evaluating the diagnostic accuracy of CBBCT in women with suspected breast cancer were included. Each study's quality was evaluated using the Quality Assessment of Diagnostic Performance Studies-2 (QUADAS-2) instrument.
RESULTS
Eighteen studies with a total of 1,792 patients were included in the analysis. The overall pooled sensitivity and specificity of CBBCT in diagnosing breast cancer were 0.95 [95% confidence interval (CI): 0.91-0.97] and 0.72 (95% CI: 0.62-0.80), respectively. The area under the curve (AUC) for CBBCT was 0.92 (95% CI: 0.90-0.94). In a head-to-head comparison of CBBCT and digital mammography (DM), eight trials with 992 patients were included in the study, and the AUCs for CBBCT and DM were 0.94 (95% CI: 0.92-0.96) and 0.83 (95% CI: 0.80-0.83), respectively. In a head-to-head comparison of CBBCT and magnetic resonance imaging (MRI), four trials with 203 patients were included in the analysis; the AUC for CBBCT and MRI were 0.88 (95% CI: 0.85-0.91) and 0.96 (95% CI: 0.94-0.97), respectively.
CONCLUSIONS
This meta-analysis of CBBCT test accuracy indicated encouraging diagnostic performance. In the summary of head-to-head comparative studies, there is a tendency for CBBCT to have greater diagnostic accuracy than DM, although its diagnostic performance is marginally inferior to that of MRI. However, the meta-analysis results were derived from studies with limited sample sizes. There is a need for more extensive research in this setting.
PubMed: 38021193
DOI: 10.21037/gs-23-153 -
Journal of Medical Screening Dec 2021Mammography screening is generally accepted in women aged 50-69, but the balance between benefits and harms remains controversial in other age groups. This study...
Benefits and harms of breast cancer mammography screening for women at average risk of breast cancer: A systematic review for the European Commission Initiative on Breast Cancer.
OBJECTIVES
Mammography screening is generally accepted in women aged 50-69, but the balance between benefits and harms remains controversial in other age groups. This study systematically reviews these effects to inform the European Breast Cancer Guidelines.
METHODS
We searched PubMed, EMBASE and Cochrane Library for randomised clinical trials (RCTs) or systematic reviews of observational studies in the absence of RCTs comparing invitation to mammography screening to no invitation in women at average breast cancer (BC) risk. We extracted data for mortality, BC stage, mastectomy rate, chemotherapy provision, overdiagnosis and false-positive-related adverse effects. We performed a pooled analysis of relative risks, applying an inverse-variance random-effects model for three age groups (<50, 50-69 and 70-74). GRADE (Grading of Recommendations Assessment, Development and Evaluation) was used to assess the certainty of evidence.
RESULTS
We identified 10 RCTs including 616,641 women aged 38-75. Mammography reduced BC mortality in women aged 50-69 (relative risk (RR) 0.77, 95%CI (confidence interval) 0.66-0.90, ) and 70-74 (RR 0.77, 95%CI 0.54-1.09, ), with smaller reductions in under 50s (RR 0.88, 95%CI 0.76-1.02, ). Mammography reduced stage IIA+ in women 50-69 (RR 0.80, 95%CI 0.64-1.00, ) but resulted in an overdiagnosis probability of 23% (95%CI 18-27%) and 17% (95%CI 15-20%) in under 50s and 50-69, respectively (). Mammography was associated with 2.9% increased risk of invasive procedures with benign outcomes ().
CONCLUSIONS
For women 50-69, high certainty evidence that mammography screening reduces BC mortality risk would support policymakers formulating strong recommendations. In other age groups, where the net balance of effects is less clear, conditional recommendations will be more likely, together with shared decision-making.
Topics: Breast; Breast Neoplasms; Early Detection of Cancer; Female; Humans; Mammography; Mastectomy
PubMed: 33632023
DOI: 10.1177/0969141321993866 -
American Journal of Preventive Medicine Jun 2021The U.S. is the only industrialized country in the world with no national policy mandating paid sick leave for workers. This study systematically reviews and quantifies... (Meta-Analysis)
Meta-Analysis Review
CONTEXT
The U.S. is the only industrialized country in the world with no national policy mandating paid sick leave for workers. This study systematically reviews and quantifies the impact of paid sick leave on the use of healthcare services among employed adults.
EVIDENCE ACQUISITION
Articles published from January 2000 to February 2020 were located in MEDLINE/PubMed, SCOPUS, ScienceDirect, and Embase from March/April 2020. Key search terms included paid sick leave and health care utilization. Articles were assessed for methodologic quality, and qualitative and quantitative data were extracted. From the quantitative data, pooled OR, distribution, and heterogeneity statistics were calculated when possible.
EVIDENCE SYNTHESIS
A total of 12 manuscripts met the criteria for systematic review, and 8 of them had statistics required for meta-analysis. Individuals with paid sick leave had 1.57 (95% CI=1.50, 1.63; p<0.001) odds of having an influenza vaccination, 1.54 (95% CI=1.48, 1.60; p<0.001) odds of having a mammogram, 1.33 (95% CI=1.25, 1.41; p<0.001) odds of seeing a doctor, and 1.29 (95% CI=1.18, 1.39; p<0.001) odds of getting a Pap test compared with individuals without paid sick leave. However, the I was relatively high with a significant p-value for most of the services, indicating potential heterogeneity.
CONCLUSIONS
Paid sick leave is likely to be an effective way to increase the use of primary and preventive healthcare services in the U.S. Further studies should be carried out to track outcomes over a longer period and to compare the effect of the number of paid sick days in relation to healthcare utilization.
Topics: Adult; Humans; Mammography; Patient Acceptance of Health Care; Preventive Health Services; Salaries and Fringe Benefits; Sick Leave
PubMed: 33785275
DOI: 10.1016/j.amepre.2021.01.009 -
Journal of the National Cancer Institute Jun 2021Our objective was to perform a systematic review and meta-analysis comparing the breast cancer detection rate (CDR), invasive CDR, recall rate, and positive predictive... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Our objective was to perform a systematic review and meta-analysis comparing the breast cancer detection rate (CDR), invasive CDR, recall rate, and positive predictive value 1 (PPV1) of digital mammography (DM) alone, combined digital breast tomosynthesis (DBT) and DM, combined DBT and synthetic 2-dimensional mammography (S2D), and DBT alone.
METHODS
MEDLINE and Embase were searched until April 2020 to identify comparative design studies reporting on patients undergoing routine breast cancer screening. Random effects model proportional meta-analyses estimated CDR, invasive CDR, recall rate, and PPV1. Meta-regression modeling was used to compare imaging modalities. All statistical tests were 2-sided.
RESULTS
Forty-two studies reporting on 2 606 296 patients (13 003 breast cancer cases) were included. CDR was highest in combined DBT and DM (6.36 per 1000 screened, 95% confidence interval [CI] = 5.62 to 7.14, P < .001), and combined DBT and S2D (7.40 per 1000 screened, 95% CI = 6.49 to 8.37, P < .001) compared with DM alone (4.68 per 1000 screened, 95% CI = 4.28 to 5.11). Invasive CDR was highest in combined DBT and DM (4.53 per 1000 screened, 95% CI = 3.97 to 5.12, P = .003) and combined DBT and S2D (5.68 per 1000 screened, 95% CI = 4.43 to 7.09, P < .001) compared with DM alone (3.42 per 1000 screened, 95% CI = 3.02 to 3.83). Recall rate was lowest in combined DBT and S2D (42.3 per 1000 screened, 95% CI = 37.4 to 60.4, P<.001). PPV1 was highest in combined DBT and DM (10.0%, 95% CI = 8.0% to 12.0%, P = .004), and combined DBT and S2D (16.0%, 95% CI = 10.0% to 23.0%, P < .001), whereas no difference was detected for DBT alone (7.0%, 95% CI = 6.0% to 8.0%, P = .75) compared with DM alone (7.0%, 95.0% CI = 5.0% to 8.0%).
CONCLUSIONS
Our findings provide evidence on key performance metrics for DM, DBT alone, combined DBT and DM, and combined DBT and S2D, which may inform optimal application of these modalities for breast cancer screening.
Topics: Breast; Breast Neoplasms; Early Detection of Cancer; Female; Humans; Mammography; Mass Screening; Predictive Value of Tests; Retrospective Studies
PubMed: 33372954
DOI: 10.1093/jnci/djaa205 -
BMJ Open Feb 2023To systematically identify interventions that increase the use of mammography screening in women living in low-income and middle-income countries (LMICs).
OBJECTIVE
To systematically identify interventions that increase the use of mammography screening in women living in low-income and middle-income countries (LMICs).
DESIGN
Systematic review.
DATA SOURCES
MEDLINE, Embase, Global Health, CINAHL, PsycINFO, Web of Science, Cochrane Central Register of Controlled Trials, Google Scholar and African regional databases.
ELIGIBILITY CRITERIA
Studies conducted in LMICs, published between 1 January 1990 and 30 June 2021, in the English language. Studies whose population included asymptomatic women eligible for mammography screening. Studies with a reported outcome of using mammography by either self-report or medical records. No restrictions were set on the study design.
DATA EXTRACTION AND SYNTHESIS
Screening, data extraction and risk-of-bias assessment were conducted by two independent reviewers. A narrative synthesis of the included studies was conducted.
RESULTS
Five studies met the inclusion criteria consisting of two randomised controlled trials, one quasi-experiment and two cross-sectional studies. All included studies employed client-oriented intervention strategies including one-on-one education, group education, mass and small media, reducing client out-of-pocket costs, reducing structural barriers, client reminders and engagement of community health workers (CHWs). Most studies used multicomponent interventions, resulting in increases in the rate of use of mammography than those that employed a single strategy.
CONCLUSION
Mass and small media, group education, reduction of economic and structural barriers, client reminders and engagement of CHWs can increase use of mammography among women in LMICs. Promoting the adoption of these interventions should be considered, especially the multicomponent interventions, which were significantly effective relative to a single strategy in increasing use of mammography.
PROSPERO REGISTRATION NUMBER
CRD42021269556.
Topics: Female; Humans; Developing Countries; Cross-Sectional Studies; Mammography; Self Report
PubMed: 36750281
DOI: 10.1136/bmjopen-2022-066928