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Iranian Journal of Public Health Feb 2024Approximately 2.3 million female breast cancer cases were identified globally in 2020, resulting in 685,000 fatalities among women. Serbia too experiences a high breast...
BACKGROUND
Approximately 2.3 million female breast cancer cases were identified globally in 2020, resulting in 685,000 fatalities among women. Serbia too experiences a high breast cancer burden. Effective reduction of breast cancer incidence and mortality necessitates strategic measures encompassing the implementation of cost-effective screening technology. However, various impediments to screening implementation persist. We aimed to estimate the impact of socioeconomic factors on breast cancer screening in Serbia.
METHODS
Data from the 2019 National Health Survey of the population of Serbia was. The research was a descriptive, cross-sectional analytical study by design, on a representative sample of the population of Serbia. Data from women aged 15+ yr were used to examine the demographic and socioeconomic factors associated with breast cancer screening inequalities.
RESULTS
In Serbia the age group of women who predominantly participated in organized breast cancer screening (39.5%) were the ones aged 65+ yr. Women with a secondary education were 2.1x more likely to undergo a screening exam voluntarily (57.5%), compared to women with a higher education background (26.6%). When considering marital and financial circumstances, married/unmarried women from an affluent financial category exhibited a notably higher frequency of self-initiating a mammography (73% and 48.5%) in comparison to those financially struggling (27.6%).
CONCLUSION
Strong support is imperative for countries to establish prevention and early detection programs for cancer.
PubMed: 38894841
DOI: 10.18502/ijph.v53i2.14923 -
Diagnostics (Basel, Switzerland) May 2024The evaluation of mammographic breast density, a critical indicator of breast cancer risk, is traditionally performed by radiologists via visual inspection of...
The evaluation of mammographic breast density, a critical indicator of breast cancer risk, is traditionally performed by radiologists via visual inspection of mammography images, utilizing the Breast Imaging-Reporting and Data System (BI-RADS) breast density categories. However, this method is subject to substantial interobserver variability, leading to inconsistencies and potential inaccuracies in density assessment and subsequent risk estimations. To address this, we present a deep learning-based automatic detection algorithm (DLAD) designed for the automated evaluation of breast density. Our multicentric, multi-reader study leverages a diverse dataset of 122 full-field digital mammography studies (488 images in CC and MLO projections) sourced from three institutions. We invited two experienced radiologists to conduct a retrospective analysis, establishing a ground truth for 72 mammography studies (BI-RADS class A: 18, BI-RADS class B: 43, BI-RADS class C: 7, BI-RADS class D: 4). The efficacy of the DLAD was then compared to the performance of five independent radiologists with varying levels of experience. The DLAD showed robust performance, achieving an accuracy of 0.819 (95% CI: 0.736-0.903), along with an F1 score of 0.798 (0.594-0.905), precision of 0.806 (0.596-0.896), recall of 0.830 (0.650-0.946), and a Cohen's Kappa (κ) of 0.708 (0.562-0.841). The algorithm achieved robust performance that matches and in four cases exceeds that of individual radiologists. The statistical analysis did not reveal a significant difference in accuracy between DLAD and the radiologists, underscoring the model's competitive diagnostic alignment with professional radiologist assessments. These results demonstrate that the deep learning-based automatic detection algorithm can enhance the accuracy and consistency of breast density assessments, offering a reliable tool for improving breast cancer screening outcomes.
PubMed: 38893643
DOI: 10.3390/diagnostics14111117 -
Diagnostics (Basel, Switzerland) May 2024The aim of this study was to compare the characteristics of breast microcalcification on digital mammography (DM) with the histological and molecular subtypes of breast...
The aim of this study was to compare the characteristics of breast microcalcification on digital mammography (DM) with the histological and molecular subtypes of breast cancer and to identify the predictive value of DM and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in assessing microcalcifications for radiologic-pathologic correlation. We relied on our prospectively maintained database of suspicious microcalcifications on DM, from which data were retrospectively collected between January 2020 and April 2023. We enrolled 158 patients, all of whom were subjected to biopsy. Additionally, 63 patients underwent breast DCE-MRI. Microcalcifications with a linear branched morphology were correlated with malignancies ( < 0.001), among which an association was highlighted between triple negatives (TNs) and segmental distribution ( < 0.001). Amorphous calcifications were correlated with atypical ductal hyperplasia (ADH) ( = 0.013), coarse heterogeneous ( < 0.001), and fine-pleomorphic ( = 0.008) with atypical lobular hyperplasia (ALH) and fine pleomorphic ( = 0.009) with flat epithelial atypia (FEA). Regarding DCE-MRI, no statistical significance was observed between non-mass lesions and ductal carcinoma in situ (DCIS). Concerning mass lesions, three were identified as DCIS and five as invasive ductal carcinoma (IDC). In conclusion, microcalcifications assessed in DM exhibit promising predictive characteristics concerning breast lesion subtypes, leading to a reduction in diagnostic times and further examination costs, thereby enhancing the clinical management of patients.
PubMed: 38893590
DOI: 10.3390/diagnostics14111063 -
Journal of Clinical Medicine Jun 2024Breast cancer (BC) is one of the leading causes of mortality worldwide. There are observed disparities in patients with disability as compared to those without... (Review)
Review
Breast cancer (BC) is one of the leading causes of mortality worldwide. There are observed disparities in patients with disability as compared to those without disability, which leads to poor BC screening attendance, thereby worsening disease management. Aim: The aim of this systematic review is to investigate if there are disparities in screening rates in women with disability as compared to those without disability, as well as the different factors that pose barriers to patients with disability for enrolment in BC screening programs. : Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically reviewed published articles between 2008 and 2023, which assessed different factors that contributed to poor attendance in BC screening programs held across different countries. Detailed study characteristics were obtained, and methodological quality assessment was performed on the individual studies included in this review. : A total of fifty-three articles were identified as eligible studies based on the pre-defined inclusion and exclusion criteria. These included 7,252,913 patients diagnosed with BC (913,902 patients with disability/6,339,011 patients without disability). The results revealed there are demographic, clinical, financial, and service-related barriers that contributed to lower screening rates in disabled patients as compared to non-disabled. Patient age is the most common factor, with the highest effect observed for 80 years (vs. 30-44 years) [odds ratio (OR) = 13.93 (95% confidence interval (CI) = 8.27-23.47), < 0.0001], followed by race/ethnicity for Hispanic (vs. non-Hispanic white) [OR = 9.5 (95%CI = 1.0-91.9), < 0.05]. Additionally, patients with multiple disabilities had the highest rate of dropouts [OR = 27.4 (95%CI = 21.5-33.3)]. Other factors like education, income, marital status, and insurance coverage were essential barriers in screening programs. This study presents a holistic view of all barriers to poor BC screening attendance in disabled patients, thereby exacerbating health inequalities. A standardized approach to overcome the identified barriers and the need for a tailored guideline, especially for disability groups, is inevitable.
PubMed: 38892994
DOI: 10.3390/jcm13113283 -
Journal of Clinical Medicine May 2024: Both diabetes mellitus (DM) and gynaecological and colorectal cancers are highly prevalent diseases. Furthermore, the presence of DM constitutes a risk factor and poor...
: Both diabetes mellitus (DM) and gynaecological and colorectal cancers are highly prevalent diseases. Furthermore, the presence of DM constitutes a risk factor and poor prognostic indicator for these types of cancer. This study is based on the European Health Interview Surveys in Spain (EHISS) of 2014 and 2020. It aimed to determine the trends in adherence to screening tests for gynaecological cancers (breast and cervical) and colorectal cancer, compare adherence levels between populations with and without diabetes, and identify predictors of adherence in the population with diabetes. : An epidemiological case-control study based on the EHISS data of 2014 and 2020 was conducted. The characteristics of participants who underwent screening tests were analysed based on the presence or absence of DM, and predictors of adherence to these preventive activities were identified. : A total of 1852 participants with reported DM and 1852 controls without DM, adjusted for age and sex, were included. A higher adherence to mammography was observed in women without diabetes compared to those with diabetes, although statistical significance was not reached (72.9% vs. 68.6%, = 0.068). Similarly, higher Pap smear adherence was observed in the population without diabetes in the age group between 60 and 69 years compared to the population with diabetes (54.0% vs. 45.8%, = 0.016). Pap smear adherence among women with diabetes was significantly higher in the EHISS of 2020 (52.0% in 2014 vs. 61.0% in 2020, = 0.010), as was the case for faecal occult blood testing (13.8% in 2014 vs. 33.8% in 2020, < 0.001), but it was not significant for mammography (70.4% in 2014 vs. 66.8% in 2020, = 0.301). Overall, the predictors of adherence to screening tests were older age, history of cancer and higher education level. : Adherence levels to cancer screening tests were lower in the population with diabetes compared to those without diabetes, although an improvement in Pap smear and faecal occult blood test adherence was observed in 2020 compared to 2014. Understanding predictors is important to improve adherence rates in the population with diabetes.
PubMed: 38892758
DOI: 10.3390/jcm13113047 -
Medical Care Jun 2024The Medicare Annual Wellness Visit (AWV)-a prevention-focused annual check-up-has been available to beneficiaries with Part B coverage since 2011. The objective of this...
OBJECTIVE
The Medicare Annual Wellness Visit (AWV)-a prevention-focused annual check-up-has been available to beneficiaries with Part B coverage since 2011. The objective of this study was to estimate the effect of Medicare AWVs on breast cancer screening and diagnosis.
DATA SOURCES AND STUDY SETTING
The National Cancer Institute's Surveillance, Epidemiology, and End Results cancer registry data linked to Medicare claims (SEER-Medicare), HRSA's Area Health Resources Files, the FDA's Mammography Facilities database, and CMS "Mapping Medicare Disparities" utilization data from 2013 to 2015.
STUDY DESIGN
Using an instrumental variables approach, we estimated the effect of AWV utilization on breast cancer screening and diagnosis, using county Welcome to Medicare Visit (WMV) rates as the instrument.
DATA COLLECTION/EXTRACTION METHODS
66,088 person-year observations from 49,769 unique female beneficiaries.
PRINCIPAL FINDINGS
For every 1-percentage point increase in county WMV rate, the probability of AWV increased by 1.7 percentage points. Having an AWV was associated with a 22.4-percentage point increase in the probability of receiving a screening mammogram within 6 months (P<0.001). There was no statistically significant increase in the probability of breast cancer diagnosis (overall or early stage) within 6 months of an AWV. Findings were robust to multiple model specifications.
CONCLUSIONS
Performing routine cancer screening is an evidence-based practice for diagnosing earlier-stage, more treatable cancers. The Medicare Annual Wellness Visit effectively increases breast cancer screening and may lead to more timely screening. Continued investment in Annual Wellness Visits supports breast cancer screening completion by women who are most likely to benefit, thus reducing the risk of overscreening and overdiagnosis.
PubMed: 38889206
DOI: 10.1097/MLR.0000000000002023 -
Radiology Jun 2024
Topics: Humans; Female; Breast Neoplasms; Ultrasonography, Mammary; Early Detection of Cancer; Mammography; Mass Screening; Breast
PubMed: 38888483
DOI: 10.1148/radiol.241074 -
Radiology Jun 2024Women with dense breasts benefit from supplemental cancer screening with US, but US has low specificity. (Comparative Study)
Comparative Study
BACKGROUND
Women with dense breasts benefit from supplemental cancer screening with US, but US has low specificity.
PURPOSE
To evaluate the performance of breast US tomography (UST) combined with full-field digital mammography (FFDM) compared with FFDM alone for breast cancer screening in women with dense breasts.
MATERIALS AND METHODS
This retrospective multireader multicase study included women with dense breasts who underwent FFDM and UST at 10 centers between August 2017 and October 2019 as part of a prospective case collection registry. All patients in the registry with cancer were included; patients with benign biopsy or negative follow-up imaging findings were randomly selected for inclusion. Thirty-two Mammography Quality Standards Act-qualified radiologists independently evaluated FFDM followed immediately by FFDM plus UST for suspicious findings and assigned a Breast Imaging Reporting and Data System (BI-RADS) category. The superiority of FFDM plus UST versus FFDM alone for cancer detection (assessed with area under the receiver operating characteristic curve [AUC]), BI-RADS 4 sensitivity, and BI-RADS 3 sensitivity and specificity were evaluated using the two-sided significance level of α = .05. Noninferiority of BI-RADS 4 specificity was evaluated at the one-sided significance level of α = .025 with a -10% margin.
RESULTS
Among 140 women (mean age, 56 years ±10 [SD]; 36 with cancer, 104 without), FFDM plus UST achieved superior performance compared with FFDM alone (AUC, 0.60 [95% CI: 0.51, 0.69] vs 0.54 [95% CI: 0.45, 0.64]; = .03). For FFDM plus UST versus FFDM alone, BI-RADS 4 mean sensitivity was superior (37% [428 of 1152] vs 30% [343 of 1152]; = .03) and BI-RADS 4 mean specificity was noninferior (82% [2741 of 3328] vs 88% [2916 of 3328]; = .004). For FFDM plus UST versus FFDM, no difference in BI-RADS 3 mean sensitivity was observed (40% [461 of 1152] vs 33% [385 of 1152]; = .08), but BI-RADS 3 mean specificity was superior (75% [2491 of 3328] vs 69% [2299 of 3328]; = .04).
CONCLUSION
In women with dense breasts, FFDM plus UST improved cancer detection by radiologists versus FFDM alone. Clinical trial registration nos. NCT03257839 and NCT04260620 Published under a CC BY 4.0 license. See also the editorial by Mann in this issue.
Topics: Humans; Female; Breast Neoplasms; Mammography; Middle Aged; Retrospective Studies; Breast Density; Sensitivity and Specificity; Aged; Ultrasonography, Mammary; Adult; Breast; Early Detection of Cancer
PubMed: 38888480
DOI: 10.1148/radiol.231680 -
Scientific Reports Jun 2024While precision medicine applications of radiomics analysis are promising, differences in image acquisition can cause "batch effects" that reduce reproducibility and...
While precision medicine applications of radiomics analysis are promising, differences in image acquisition can cause "batch effects" that reduce reproducibility and affect downstream predictive analyses. Harmonization methods such as ComBat have been developed to correct these effects, but evaluation methods for quantifying batch effects are inconsistent. In this study, we propose the use of the multivariate statistical test PERMANOVA and the Robust Effect Size Index (RESI) to better quantify and characterize batch effects in radiomics data. We evaluate these methods in both simulated and real radiomics features extracted from full-field digital mammography (FFDM) data. PERMANOVA demonstrated higher power than standard univariate statistical testing, and RESI was able to interpretably quantify the effect size of site at extremely large sample sizes. These methods show promise as more powerful and interpretable methods for the detection and quantification of batch effects in radiomics studies.
Topics: Humans; Mammography; Female; Multivariate Analysis; Breast Neoplasms; Reproducibility of Results; Image Processing, Computer-Assisted; Radiomics
PubMed: 38886407
DOI: 10.1038/s41598-024-64208-z -
Journal of Clinical Epidemiology Jun 2024Observational cohort studies are used to evaluate the effectiveness of screening mammography in women offered screening. Because screening mammography has no effect on...
OBJECTIVE
Observational cohort studies are used to evaluate the effectiveness of screening mammography in women offered screening. Because screening mammography has no effect on causes of death other than breast cancer, cohort studies should show reductions in the risk of breast cancer death substantially greater than possible reductions in the risk of all cause death. We assessed the risk of breast cancer death and of all-cause (or of non-breast cancer) death associated with screening mammography attendance reported in cohort studies.
STUDY DESIGN AND SETTING
Cohort studies published from 2002 to 2022 on women invited to screening mammography were searched in PubMed, Web of Sciences, Scopus and in review articles. Random effect meta-analyses were performed using relative risks of death between women who attended screening compared to women who did not attend screening.
RESULTS
Eighteen cohort studies were identified, nine that reported relative risks of breast cancer death only, five that reported relative risks of all cause death only, and four that reported relative risks for both breast cancer death and all cause death. The latter four cohort studies reported 12 to 76 times more all-cause deaths than breast cancer deaths. The random-effect summary relative risk for breast cancer mortality in screening attenders vs. nonattenders was 0.55 (95% CI: 0.50-0.60) in 13 cohort studies. The summary relative risk for all-cause mortality was 0.54 (0.50-0.58) in 10 cohort studies. In the four cohort studies that evaluated both outcomes, the summary relative risks were 0.63 (0.43-0.83) for breast cancer mortality and of 0.54 (0.44-0.64) for all-cause mortality.
CONCLUSION
The similar relative reductions in breast- and all-cause (or non-breast cancer) mortality indicates that screening mammography attendance is an indicator of characteristics associated with a lower risk of dying from any cause, including from breast cancer, which observational studies have falsely interpreted as a screening effect.
PubMed: 38878837
DOI: 10.1016/j.jclinepi.2024.111426