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Journal of Clinical Epidemiology Apr 2024Film mammography has been replaced by digital mammography in breast screening programs globally. This led to a small increase in the rate of detection, but whether the...
Systematic review and meta-analysis of prognostic characteristics for breast cancers in populations with digital vs film mammography indicate the transition may have increased both early detection and overdiagnosis.
OBJECTIVES
Film mammography has been replaced by digital mammography in breast screening programs globally. This led to a small increase in the rate of detection, but whether the detection of clinically important cancers increased is uncertain. We aimed to assess the impact on tumor characteristics of screen-detected and interval breast cancers.
STUDY DESIGN AND SETTING
We searched seven databases from inception to October 08, 2023, for publications comparing film and digital mammography within the same population of asymptomatic women at population (average) risk of breast cancer. We recorded reported tumor characteristics and assessed risk of bias using the Risk Of Bias In Non-randomised Studies - of Interventions tool. We synthesized results using meta-analyses of random effects.
RESULTS
Eighteen studies were included in the analysis from 8 countries, including 11,592,225 screening examinations (8,117,781 film; 3,474,444 digital). There were no differences in tumor size, morphology, grade, node status, receptor status, or stage in the pooled differences for screen-detected and interval invasive cancer tumor characteristics. There were statistically significant increases in screen-detected ductal carcinoma in situ (DCIS) across all grades: 0.05 (0.00-0.11), 0.14 (0.05-0.22), and 0.19 (0.05-0.33) per 1000 screens for low, intermediate, and high-grade DCIS, respectively. There were similar (non-statistically significant) increases in screen-detected invasive cancer across all grades.
CONCLUSION
The increased detection of all grades of DCIS and invasive cancer may indicate both increased early detection of more aggressive disease and increased overdiagnosis.
PubMed: 38570078
DOI: 10.1016/j.jclinepi.2024.111339 -
Psycho-oncology Apr 2024(i) To systematically identify constructs and outcome measures used to assess the emotional and mood impact of false positive breast screening test results; (ii) to... (Review)
Review
OBJECTIVE
(i) To systematically identify constructs and outcome measures used to assess the emotional and mood impact of false positive breast screening test results; (ii) to appraise the reporting clarity and rationale for selecting constructs and outcome measures.
METHODS
Databases (MEDLINE, CINAHL, PsycINFO) were systematically searched from 1970. Studies using standardised and non-standardised outcome measures to evaluate the emotion or mood impact of false positive breast screening test results were eligible. A 15-item coding scheme was devised to appraise articles on clarity and rationale for selected constructs and measures.
RESULTS
Forty-seven articles were identified. The most investigated constructs were general anxiety and depression and disease-specific anxiety and worry. Twenty-two standardised general outcome questionnaire measures and three standardised disease-specific outcome questionnaire measures were identified. Twenty articles used non-standardised scales/items. Reporting of constructs and outcome measures was generally clear, but rationales for their selection were lacking. Anxiety was typically justified, but justification for depression was almost always absent. Practical and psychometric justification for selecting outcome measures was lacking, and theoretical rationale was absent.
CONCLUSIONS
Heterogeneity in constructs and measures, coupled with unclear rationale for these, impedes a thorough understanding of why there are emotional effects of false positive screening test results. This may explain the repeated practice of investigating less relevant outcomes such as depression. There is need to develop a consensual conceptual model of and standardised approach to measuring emotional impact from cancer screening test results, to address heterogeneity and other known issues of interpreting an inconsistent evidence base.
Topics: Humans; Emotions; Anxiety; Affect; Anxiety Disorders; Surveys and Questionnaires
PubMed: 38549216
DOI: 10.1002/pon.6334 -
Breast (Edinburgh, Scotland) Apr 2024High breast density is an independent risk factor for breast cancer and decreases the sensitivity of mammography. This systematic review synthesizes the evidence on the... (Review)
Review
BACKGROUND
High breast density is an independent risk factor for breast cancer and decreases the sensitivity of mammography. This systematic review synthesizes the evidence on the impact of breast density (BD) information and/or notification on women's psychosocial outcomes among women from racial and ethnic minority groups.
METHODS
A systematic search was performed in March 2023, and the articles were identified using CINHAL, Embase, Medline, and PsychInfo databases. The search strategy combined the terms "breast", "density", "notification" and synonyms. The authors specifically kept the search terms broad and did not include terms related to race and ethnicity. Full-text articles were reviewed for analysis by race, ethnicity and primary language of participants. Two authors evaluated the eligibility of studies with verification from the study team, extracted and crosschecked data, and assessed the risk of bias.
RESULTS
Of 1784 articles, 32 articles published from 2003 to 2023 were included. Thirty-one studies were conducted in the United States and one in Australia, with 28 quantitative and four qualitative methodologies. The overall results in terms of breast density awareness, knowledge, communication with healthcare professionals, screening intentions and supplemental screening practice were heterogenous across studies. Barriers to understanding BD notifications and intentions/access to supplemental screening among racial and ethnic minorities included socioeconomic factors, language, health literacy and medical mistrust.
CONCLUSIONS
A one-size approach to inform women about their BD may further disadvantage racial and ethnic minority women. BD notification and accompanying information should be tailored and translated to ensure readability and understandability by all women.
Topics: Female; Humans; United States; Breast Density; Breast Neoplasms; Ethnicity; Ethnic and Racial Minorities; Trust; Minority Groups
PubMed: 38430905
DOI: 10.1016/j.breast.2024.103693 -
BMC Women's Health Feb 2024Breast density has consistently been shown to be an independent risk factor for breast cancer in Western populations; however, few studies have evaluated this topic in... (Meta-Analysis)
Meta-Analysis
PURPOSE
Breast density has consistently been shown to be an independent risk factor for breast cancer in Western populations; however, few studies have evaluated this topic in Chinese women and there is not yet a unified view. This study investigated the association between mammographic density (MD) and breast cancer risk in Chinese women.
METHODS
The PubMed, Cochrane Library, Embase, and Wanfang databases were systematically searched in June 2023 to include all studies on the association between MD and breast cancer risk in Chinese women. A total of 13,977 breast cancer cases from 14 studies were chosen, including 10 case-control/cross-sectional studies, and 4 case-only studies. For case-control/cross-sectional studies, the odds ratios (ORs) of MD were combined using random effects models, and for case-only studies, relative odds ratios (RORs) were combinations of premenopausal versus postmenopausal breast cancer cases.
RESULTS
Women with BI-RADS density category II-IV in case-control/cross-sectional studies had a 0.93-fold (95% confidence interval [CI] 0.55, 1.57), 1.08-fold (95% CI 0.40, 2.94), and 1.24-fold (95% CI 0.42, 3.69) higher risk compared to women with the lowest density category. Combined RORs for premenopausal versus postmenopausal women in case-only studies were 3.84 (95% CI 2.92, 5.05), 22.65 (95% CI 7.21, 71.13), and 42.06 (95% CI 4.22, 419.52), respectively, for BI-RADS density category II-IV versus I.
CONCLUSIONS
For Chinese women, breast cancer risk is weakly associated with MD; however, breast cancer risk is more strongly correlated with mammographic density in premenopausal women than postmenopausal women. Further research on the factors influencing MD in premenopausal women may provide meaningful insights into breast cancer prevention in China.
Topics: Female; Humans; Breast Neoplasms; Breast Density; Mammography; Cross-Sectional Studies; Breast; Risk Factors
PubMed: 38378562
DOI: 10.1186/s12905-024-02960-0 -
Frontiers in Public Health 2024This scoping review aims to highlight key social determinants of health associated with breast cancer screening behavior in United States women aged ≥40 years old,...
INTRODUCTION
This scoping review aims to highlight key social determinants of health associated with breast cancer screening behavior in United States women aged ≥40 years old, identify public and private databases with SDOH data at city, state, and national levels, and share lessons learned from United States based observational studies in addressing SDOH in underserved women influencing breast cancer screening behaviors.
METHODS
The Arksey and O'Malley York methodology was used as guidance for this review: (1) identifying research questions; (2) searching for relevant studies; (3) selecting studies relevant to the research questions; (4) charting the data; and (5) collating, summarizing, and reporting results.
RESULTS
The 72 included studies were published between 2013 and 2023. Among the various SDOH identified, those related to socioeconomic status ( = 96) exhibited the highest frequency. The Health Care Access and Quality category was reported in the highest number of studies ( = 44; 61%), showing its statistical significance in relation to access to mammography. Insurance status was the most reported sub-categorical factor of Health Care Access and Quality.
DISCUSSION
Results may inform future evidence-based interventions aiming to address the underlying factors contributing to low screening rates for breast cancer in the United States.
Topics: Humans; Female; United States; Adult; Breast Neoplasms; Social Determinants of Health; Early Detection of Cancer; Mammography; Health Inequities
PubMed: 38375339
DOI: 10.3389/fpubh.2024.1354717 -
BMC Women's Health Feb 2024The incidence of breast cancer among Chinese women has gradually increased in recent years. This study aims to analyze the situation of breast cancer screening programs... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The incidence of breast cancer among Chinese women has gradually increased in recent years. This study aims to analyze the situation of breast cancer screening programs in China and compare the cancer detection rates (CDRs), early-stage cancer detection rates (ECDRs), and the proportions of early-stage cancer among different programs.
METHODS
We conducted a systematic review and meta-analysis of studies in multiple literature databases. Studies that were published between January 1, 2010 and June 30, 2023 were retrieved. A random effects model was employed to pool the single group rate, and subgroup analyses were carried out based on screening model, time, process, age, population, and follow-up method.
RESULTS
A total of 35 studies, including 47 databases, satisfied the inclusion criteria. Compared with opportunistic screening, the CDR (1.32‰, 95% CI: 1.10‰-1.56‰) and the ECDR (0.82‰, 95% CI: 0.66‰-0.99‰) were lower for population screening, but the proportion of early-stage breast cancer (80.17%, 95% CI: 71.40%-87.83%) was higher. In subgroup analysis, the CDR of population screening was higher in the urban group (2.28‰, 95% CI: 1.70‰-2.94‰), in the breast ultrasonography (BUS) in parallel with mammography (MAM) group (3.29‰, 95% CI: 2.48‰-4.21‰), and in the second screening follow-up group (2.47‰, 95% CI: 1.64‰-3.47‰), and the proportion of early-stage breast cancer was 85.70% (95% CI: 68.73%-97.29%), 88.18% (95% CI: 84.53%-91.46%), and 90.05% (95% CI: 84.07%-94.95%), respectively.
CONCLUSION
There were significant differences between opportunistic and population screening programs. The results of these population screening studies were influenced by the screening process, age, population, and follow-up method. In the future, China should carry out more high-quality and systematic population-based screening programs to improve screening coverage and service.
Topics: Female; Humans; Breast Neoplasms; Early Detection of Cancer; Mammography; China; Ultrasonography, Mammary; Mass Screening
PubMed: 38321439
DOI: 10.1186/s12905-024-02924-4 -
Current Problems in Cancer Feb 2024In Southeast Asia, breast cancer is the most prevalent cancer among women and ranks as the second leading cause of cancer-related deaths. This systematic review and... (Meta-Analysis)
Meta-Analysis Review
In Southeast Asia, breast cancer is the most prevalent cancer among women and ranks as the second leading cause of cancer-related deaths. This systematic review and meta-analysis, encompassing 27 observational cohort studies with a minimum one-year follow-up period, aimed to examine temporal trends in breast cancer survival rates. Among the subset of five out of eleven Southeast Asian nations with available data, our analysis revealed pooled survival rates of 88.8 % at 1 year, 73.8 % at 3 years, 70.8 % at 5 years, and 49.3 % at 10 years for breast cancer patients. The mean age at diagnosis was 50.77±10.07 years, with 52.81 % of patients presenting with positive lymph nodes. Notably, stages I and II remained predominant even five years post-diagnosis. Although an overall amelioration in survival rates transpired over the preceding four decades, a noticeable exception pertained to the 3-year rate, demonstrating limited improvement. These findings underscore the pressing need for enhanced research efforts, particularly in countries within the region that lack survival data, to enable accurate estimations. Furthermore, our review also emphasizes the crucial need for future comprehensive, well-designed studies to delve into the factors behind survival rate disparities in Southeast Asia and the younger age at diagnosis compared to other regions.
Topics: Humans; Female; Adult; Middle Aged; Breast Neoplasms; Survival Rate; Southeast Asian People; Cohort Studies; Asian People; Observational Studies as Topic
PubMed: 38309146
DOI: 10.1016/j.currproblcancer.2024.101062 -
BMJ Health & Care Informatics Feb 2024Breast cancer is the most common disease in women. Recently, explainable artificial intelligence (XAI) approaches have been dedicated to investigate breast cancer. An... (Review)
Review
BACKGROUND
Breast cancer is the most common disease in women. Recently, explainable artificial intelligence (XAI) approaches have been dedicated to investigate breast cancer. An overwhelming study has been done on XAI for breast cancer. Therefore, this study aims to review an XAI for breast cancer diagnosis from mammography and ultrasound (US) images. We investigated how XAI methods for breast cancer diagnosis have been evaluated, the existing ethical challenges, research gaps, the XAI used and the relation between the accuracy and explainability of algorithms.
METHODS
In this work, Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and diagram were used. Peer-reviewed articles and conference proceedings from PubMed, IEEE Explore, ScienceDirect, Scopus and Google Scholar databases were searched. There is no stated date limit to filter the papers. The papers were searched on 19 September 2023, using various combinations of the search terms 'breast cancer', 'explainable', 'interpretable', 'machine learning', 'artificial intelligence' and 'XAI'. Rayyan online platform detected duplicates, inclusion and exclusion of papers.
RESULTS
This study identified 14 primary studies employing XAI for breast cancer diagnosis from mammography and US images. Out of the selected 14 studies, only 1 research evaluated humans' confidence in using the XAI system-additionally, 92.86% of identified papers identified dataset and dataset-related issues as research gaps and future direction. The result showed that further research and evaluation are needed to determine the most effective XAI method for breast cancer.
CONCLUSION
XAI is not conceded to increase users' and doctors' trust in the system. For the real-world application, effective and systematic evaluation of its trustworthiness in this scenario is lacking.
PROSPERO REGISTRATION NUMBER
CRD42023458665.
Topics: Female; Humans; Breast Neoplasms; Artificial Intelligence; Mammography; Machine Learning; Algorithms
PubMed: 38307616
DOI: 10.1136/bmjhci-2023-100954 -
European Journal of Radiology Feb 2024To compare the diagnostic performance of cone-beam breast computed tomography (CBBCT) and mammography (MG) in primary breast cancer. (Meta-Analysis)
Meta-Analysis
INTRODUCTION
To compare the diagnostic performance of cone-beam breast computed tomography (CBBCT) and mammography (MG) in primary breast cancer.
METHODS
PubMed, Embase, Web of Science, China National Knowledge Infrastructure, WanFang DATA, and China Science and Technology Journal databases were searched comprehensively from inception to March 2023. Sensitivity and specificity were calculated using bivariate random-effects models, and a summary receiver operating characteristic (SROC) curve was constructed. Bivariate I statistics and meta-regression analyses were also performed. The differences in diagnostic performance between CBBCT and MG were analysed using Z-test statistics. Clinical utility was explored using Fagan's nomogram, and quality assessment was conducted utilising the Quality Assessment of Diagnostic Accuracy Studies-2 checklist.
RESULTS
The summary sensitivity and specificity for CBBCT in diagnosing primary breast cancer were 0.92 (95 % CI: 0.87-0.94) and 0.79 (95 % CI: 0.71-0.85), respectively, and the area under the curve (AUC) of the SROC was 0.93 (95 % CI: 0.90-0.95). For MG, the summary sensitivity and specificity were 0.77 (95 % CI: 0.69-0.83) and 0.75 (95 % CI: 0.66-0.82), respectively, with an AUC of 0.83 (95 % CI: 0.80-0.86). The Z-test revealed that the summary sensitivity of CBBCT was significantly higher than that of MG (P < 0.001). Additionally, the summary AUC of CBBCT was significantly higher than that of MG (P < 0.001).
CONCLUSION
The diagnostic performance of CBBCT for primary breast cancer was better than that of MG. However, the results of both the CBBCT and MG are based on studies with small sample sizes. Further studies with larger sample sizes and more comprehensive designs are required to address this issue.
Topics: Humans; Female; Breast Neoplasms; Reproducibility of Results; Breast; Mammography; Cone-Beam Computed Tomography
PubMed: 38211395
DOI: 10.1016/j.ejrad.2024.111292 -
Radiography (London, England : 1995) Jan 2024A positive experience in mammography is essential for increasing patient attendance and reattendance at these examinations, whether conducted for diagnostic or screening... (Review)
Review
INTRODUCTION
A positive experience in mammography is essential for increasing patient attendance and reattendance at these examinations, whether conducted for diagnostic or screening purposes. Mammograms indeed facilitate early disease detection, enhance the potential for cure, and consequently reduce breast cancer mortality. The main objective of this review was to identify and map the strategies aiming to improve the patient experience in diagnostic and screening mammography.
METHODS
This scoping review was performed following the JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Searches were performed through databases of MEDLINE, Embase.com, CINAHL, APA PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, ProQuest Dissertation and Theses, and three clinical trial registries. This review considered studies evaluating the effect of interventions, occurring within the mammography department, on the patient experience.
RESULTS
The literature search yielded 8113 citations of which 60, matching the inclusion criteria, were included. The strategies were classified into eight categories. The most represented one was breast compression and positioning, followed by relaxation techniques and analgesic care, communication and information, screening equipment, examination procedures, patient-related factors, physical environment, and finally staff characteristics. The studied outcomes related to patient experience were mainly pain, anxiety, comfort, and satisfaction. Other types of outcomes were also considered in the studies such as image quality, technical parameters, or radiation dose. Most studies were conducted by radiographers, on female patients, and none mentioned the inclusion of male or transgender patients.
CONCLUSION
This review outlined a diversity of strategies to improve patient experience, although technique-based interventions were predominant. Further research is warranted, notably on psychological strategies, and on men and transgender people.
IMPLICATIONS FOR PRACTICE
This scoping review provides guidance to healthcare providers and services for better patient/client-centered care.
Topics: Female; Humans; Breast Neoplasms; Early Detection of Cancer; Mammography; Pain; Patient Satisfaction
PubMed: 38141428
DOI: 10.1016/j.radi.2023.11.016