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The Canadian Journal of Cardiology Dec 2023Recent studies have shown that breast arterial calcification (BAC) detected on screening mammography is linked to cardiovascular diseases via medial calcification.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Recent studies have shown that breast arterial calcification (BAC) detected on screening mammography is linked to cardiovascular diseases via medial calcification. However, its effect on cardiovascular outcomes remains unclear. Therefore, we conducted a meta-analysis to determine the effect of BAC on cardiovascular outcomes in patients.
METHODS
Three electronic databases (Pubmed, Embase, and Scopus) were searched on May 1, 2022, for studies examining the relationship between BAC and cardiovascular outcomes including cardiac death, acute myocardial infarction, ischemic heart disease, stroke, peripheral artery disease, and heart failure. A random-effects meta-analysis model was used to summarise the studies.
RESULTS
A total of 5 longitudinal studies were included with a combined cohort of 87,865 patients. Significantly, the pooled risk ratio (RR) of the association between BAC and cardiac death was 2.06 (P < 0.00001). BAC was associated with a significantly increased risk of developing other cardiovascular diseases, such as ischemic/hemorrhagic stroke (RR 1.51; P = 0.003), ischemic stroke (RR 1.82; P < 0.00001), peripheral vascular disease (RR 1.24; P = 0.003), and heart failure (RR 1.84; P < 0.00001). There was no significant relationship for developing myocardial infarction or for total cardiovascular diseases.
CONCLUSIONS
Our findings suggest that BAC was associated with an increased risk of cardiovascular mortality, and certain cardiovascular outcomes. There is thus a potential to use BAC as a sex-specific cardiovascular risk assessment tool. Furthermore, there is a need for more widespread reporting of BAC to better understand the pathophysiologic mechanisms behind its correlation with cardiovascular disease and to apply it in clinical practice.
Topics: Female; Male; Humans; Cardiovascular Diseases; Breast; Mammography; Breast Neoplasms; Risk Factors; Early Detection of Cancer; Breast Diseases; Myocardial Infarction; Heart Failure; Death
PubMed: 37506765
DOI: 10.1016/j.cjca.2023.07.024 -
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 -
In Vivo (Athens, Greece) 2023COVID-19 has dramatically impacted non-pandemic-related care, including preventive medicine. Our objective was to quantify the alterations in the volume of screening... (Review)
Review
BACKGROUND/AIM
COVID-19 has dramatically impacted non-pandemic-related care, including preventive medicine. Our objective was to quantify the alterations in the volume of screening tests for breast and cervical cancer during the COVID-19 era compared to pre-pandemic levels. Secondarily, we discussed the causes responsible for this change, presented suggestions for screening optimization and conducted a targeted search of the relevant literature for worsening of future mortality due to screening setback.
MATERIALS AND METHODS
We systematically searched Pubmed, Google Scholar and Epistemonikos for articles in English or Greek, published from March 11th, 2020, until September 14th, 2022, that illustrated quantitative variations of mammograms or Pap/HPV tests. Preprint articles, editorials and speeches were excluded. Quality of included studies was assessed via the JBI critical appraisal checklist for studies reporting prevalence data. The evidence was narratively synthesized.
RESULTS
A total of 56 articles were included, being either observational studies or reports from cancer registries. Large reductions were universally identified, peaked during the first wave but partially persisted after easing of the restrictions.
CONCLUSION
Our systematic review provides an updated record of the variations in screening volume and approaches screening neglect from a multidimensional perspective answering why it happened and how we could achieve recovery. A strong awareness campaign is proposed, in conjunction with triaging citizens more likely to benefit from screening. Cervical self-sampling is emphasized in the literature. Various studies displayed a potential increase in cancer mortality in the future based on predictive statistical models.
Topics: Female; Humans; Uterine Cervical Neoplasms; Early Detection of Cancer; Pandemics; COVID-19; Mammography
PubMed: 37369493
DOI: 10.21873/invivo.13230 -
Cancer Causes & Control : CCC Nov 2023It may be important for women to have mammograms at different points in time to track changes in breast density, as fluctuations in breast density can affect breast... (Review)
Review
PURPOSE
It may be important for women to have mammograms at different points in time to track changes in breast density, as fluctuations in breast density can affect breast cancer risk. This systematic review aimed to assess methods used to relate repeated mammographic images to breast cancer risk.
METHODS
The databases including Medline (Ovid) 1946-, Embase.com 1947-, CINAHL Plus 1937-, Scopus 1823-, Cochrane Library (including CENTRAL), and Clinicaltrials.gov were searched through October 2021. Eligibility criteria included published articles in English describing the relationship of change in mammographic features with risk of breast cancer. Risk of bias was assessed using the Quality in Prognostic Studies tool.
RESULTS
Twenty articles were included. The Breast Imaging Reporting and Data System and Cumulus were most commonly used for classifying mammographic density and automated assessment was used on more recent digital mammograms. Time between mammograms varied from 1 year to a median of 4.1, and only nine of the studies used more than two mammograms. Several studies showed that adding change of density or mammographic features improved model performance. Variation in risk of bias of studies was highest in prognostic factor measurement and study confounding.
CONCLUSION
This review provided an updated overview and revealed research gaps in assessment of the use of texture features, risk prediction, and AUC. We provide recommendations for future studies using repeated measure methods for mammogram images to improve risk classification and risk prediction for women to tailor screening and prevention strategies to level of risk.
Topics: Female; Humans; Breast Density; Breast Neoplasms; Mammography; Breast; Risk; Risk Factors
PubMed: 37340148
DOI: 10.1007/s10552-023-01739-2 -
Ontario Health Technology Assessment... 2023The current standard treatment for nonpalpable breast tumours is surgical excision; however, it is nearly impossible to locate these small masses during surgery....
BACKGROUND
The current standard treatment for nonpalpable breast tumours is surgical excision; however, it is nearly impossible to locate these small masses during surgery. Therefore, a marker must be implanted into the abnormal tissue under mammography or ultrasound guidance prior to surgery to guide the surgeon to the location of the tumour. Two techniques to localize nonpalpable breast tumours are currently used in Ontario: wire-guided localization and radioactive seed localization.However, these techniques have some limitations. New wire-free, nonradioactive technologies that address these limitations are now available. We conducted a health technology assessment of wire-free, nonradioactive localization techniques available in Canada that are used to localize nonpalpable breast tumours for surgical excision. This report includes an evaluation of the effectiveness, safety, and budget impact of publicly funding these techniques, as well as an evaluation of patient preferences and values.
METHODS
We performed a systematic literature search of the clinical evidence. We assessed the risk of bias of each included study using the ROBINS-I tool and the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We performed a systematic economic literature search, and we analyzed the budget impact of publicly funding wire-free, nonradioactive localization techniques to guide surgical excision of nonpalpable breast tumours in Ontario. We did not conduct a primary economic evaluation because of the limited data available to use as model inputs. To contextualize the potential value of wire-free, nonradioactive localization techniques, we spoke with people who had undergone a localization procedure for the surgical excision of a nonpalpable breast tumour.
RESULTS
We included 16 studies in the clinical evidence review, of which 15 were comparative studies and one was a single-arm study. The results of our analysis of the comparative studies suggest that the re-excision rate for the wire-guided, nonradioactive devices included in this review is either lower or not different from the rate for conventional localization methods (GRADE: Moderate/Low). We found no difference in postoperative complications or operation time between the new and the conventional techniques (GRADE: Moderate). In a feasibility study of a newly developed magnetic seed device in Ontario, no patient required re-excision (GRADE: not assessed). Our economic evidence review identified two costing studies that found that wire-free, nonradioactive localization techniques were more expensive than wire-guided and radioactive seed localization. We were unable to identify any published cost-effectiveness evidence for wire-free, nonradioactive localization techniques. The annual budget impact of publicly funding wire-free, nonradioactive localization techniques in Ontario over the next 5 years ranges from an additional $0.51 million in year 1 to an additional $2.61 million in year 5, for a total 5-year budget impact of $7.73 million. The people we spoke with who had undergone a localization procedure reported valuing surgical interventions that are clinically effective, timely, and patient centred. They responded positively to the potential public funding of wire-free, nonradioactive localization techniques and felt that equitable access should be a requirement of implementation.
CONCLUSIONS
The wire-free, nonradioactive localization techniques included in this review are effective and safe methods for the localization of nonpalpable breast tumours and are reasonable alternatives to wire-guided and radioactive seed localization. We estimate that publicly funding wire-free, nonradioactive localization techniques in Ontario would result in an additional cost of $7.73 million over the next 5 years. Broad access to wire-free, nonradioactive localization techniques may have a positive impact on patients undergoing surgical excision for a nonpalpable breast tumour. People with lived experience of a localization procedure value surgical interventions that are clinically effective, timely, and patient centred. They also value equitable access to surgical care.
Topics: Humans; Female; Technology Assessment, Biomedical; Postoperative Complications; Cost-Benefit Analysis; Ontario; Breast Neoplasms
PubMed: 37284228
DOI: No ID Found -
Radiology Jun 2023Background There is considerable interest in the potential use of artificial intelligence (AI) systems in mammographic screening. However, it is essential to critically... (Meta-Analysis)
Meta-Analysis
Background There is considerable interest in the potential use of artificial intelligence (AI) systems in mammographic screening. However, it is essential to critically evaluate the performance of AI before it can become a modality used for independent mammographic interpretation. Purpose To evaluate the reported standalone performances of AI for interpretation of digital mammography and digital breast tomosynthesis (DBT). Materials and Methods A systematic search was conducted in PubMed, Google Scholar, Embase (Ovid), and Web of Science databases for studies published from January 2017 to June 2022. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) values were reviewed. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 and Comparative (QUADAS-2 and QUADAS-C, respectively). A random effects meta-analysis and meta-regression analysis were performed for overall studies and for different study types (reader studies vs historic cohort studies) and imaging techniques (digital mammography vs DBT). Results In total, 16 studies that include 1 108 328 examinations in 497 091 women were analyzed (six reader studies, seven historic cohort studies on digital mammography, and four studies on DBT). Pooled AUCs were significantly higher for standalone AI than radiologists in the six reader studies on digital mammography (0.87 vs 0.81, = .002), but not for historic cohort studies (0.89 vs 0.96, = .152). Four studies on DBT showed significantly higher AUCs in AI compared with radiologists (0.90 vs 0.79, < .001). Higher sensitivity and lower specificity were seen for standalone AI compared with radiologists. Conclusion Standalone AI for screening digital mammography performed as well as or better than radiologists. Compared with digital mammography, there is an insufficient number of studies to assess the performance of AI systems in the interpretation of DBT screening examinations. © RSNA, 2023 See also the editorial by Scaranelo in this issue.
Topics: Female; Humans; Artificial Intelligence; Breast Neoplasms; Early Detection of Cancer; Mammography; Breast; Retrospective Studies
PubMed: 37219445
DOI: 10.1148/radiol.222639 -
Clinical Breast Cancer Jul 2023Breast cancer screening performance of supplemental imaging modalities by breast density and breast cancer risk has not been widely studied, and the optimal choice of... (Meta-Analysis)
Meta-Analysis
Breast cancer screening performance of supplemental imaging modalities by breast density and breast cancer risk has not been widely studied, and the optimal choice of modality for women with dense breasts remains unclear in clinical practice and guidelines. This systematic review aimed to assess breast cancer screening performance of supplemental imaging modalities for women with dense breasts, by breast cancer risk. Systematic reviews (SRs) in 2000 to 2021, and primary studies in 2019 to 2021, on outcomes of supplemental screening modalities (digital breast tomography [DBT], MRI (full/abbreviated protocol), contrast enhanced mammography (CEM), ultrasound (hand-held [HHUS]/automated [ABUS]) in women with dense breasts (BI-RADS C&D) were identified. None of the SRs analyzed outcomes by cancer risk. Meta-analysis of the primary studies was not feasible due to lack of studies (MRI, CEM, DBT) or methodological heterogeneity (ultrasound); therefore, findings were summarized narratively. For average risk, a single MRI trial reported a superior screening performance (higher cancer detection rate [CDR] and lower interval cancer rate [ICR]) compared to HHUS, ABUS and DBT. For intermediate risk, ultrasound was the only modality assessed, but accuracy estimates ranged widely. For mixed risk, a single CEM study reported the highest CDR, but included a high proportion of women with intermediate risk. This systematic review does not allow a complete comparison of supplemental screening modalities for dense breast populations by breast cancer risk. However, the data suggest that MRI and CEM might generally offer superior screening performance versus other modalities. Further studies of screening modalities are urgently required.
Topics: Female; Humans; Breast; Breast Density; Breast Neoplasms; Early Detection of Cancer; Mammography; Mass Screening; Ultrasonography, Mammary
PubMed: 37202338
DOI: 10.1016/j.clbc.2023.04.003 -
International Journal of Molecular... May 2023Breast cancer continues to be the leading cause of death in women worldwide. Mammography, which is the current gold standard technique used to diagnose it, presents... (Meta-Analysis)
Meta-Analysis Review
Breast cancer continues to be the leading cause of death in women worldwide. Mammography, which is the current gold standard technique used to diagnose it, presents strong limitations in early ages where breast cancer is much more aggressive and fatal. MiRNAs present in numerous body fluids might represent a new line of research in breast cancer biomarkers, especially oncomiRNAs, known to play an important role in the suppression and development of neoplasms. The aim of this systematic review and meta-analysis was to evaluate dysregulated miRNA biomarkers and their diagnostic accuracy in breast cancer. Two independent researchers reviewed the included studies according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A protocol for this review was registered in PROSPERO with the registration number "CRD42021256338". Observational case-control-based studies analyzing concentrations of microRNAs which have been published within the last 10 years were selected, and the concentrations of miRNAs in women with breast cancer and healthy controls were analyzed. Random-effects meta-analyses of miR-155 were performed on the studies which provided enough data to calculate diagnostic odds ratios. We determined that 34 microRNAs were substantially dysregulated and could be considered biomarkers of breast cancer. Individually, miR-155 provided better diagnostic results than mammography on average. However, when several miRNAs are used to screen, forming a panel, sensitivity and specificity rates improve, and they can be associated with classic biomarkers such us CA-125 or CEA. Based on the results of our meta-analysis, miR-155 might be a promising diagnostic biomarker for this patient population.
Topics: Humans; Female; MicroRNAs; Biomarkers, Tumor; Breast Neoplasms; Breast; Sensitivity and Specificity
PubMed: 37175974
DOI: 10.3390/ijms24098270 -
Frontiers in Oncology 2023Various natural language processing (NLP) algorithms have been applied in the literature to analyze radiology reports pertaining to the diagnosis and subsequent care of...
Various natural language processing (NLP) algorithms have been applied in the literature to analyze radiology reports pertaining to the diagnosis and subsequent care of cancer patients. Applications of this technology include cohort selection for clinical trials, population of large-scale data registries, and quality improvement in radiology workflows including mammography screening. This scoping review is the first to examine such applications in the specific context of breast cancer. Out of 210 identified articles initially, 44 met our inclusion criteria for this review. Extracted data elements included both clinical and technical details of studies that developed or evaluated NLP algorithms applied to free-text radiology reports of breast cancer. Our review illustrates an emphasis on applications in diagnostic and screening processes over treatment or therapeutic applications and describes growth in deep learning and transfer learning approaches in recent years, although rule-based approaches continue to be useful. Furthermore, we observe increased efforts in code and software sharing but not with data sharing.
PubMed: 37124523
DOI: 10.3389/fonc.2023.1160167 -
Clinical Breast Cancer Jun 2023Breast cancer is a global health problem with a high rate of incidence and annual death. The protection motivation model (PMT) is a health psychology theory that has... (Review)
Review
Breast cancer is a global health problem with a high rate of incidence and annual death. The protection motivation model (PMT) is a health psychology theory that has been introduced to motivate health behaviors using coping appraisal and threat appraisal. We aimed to systematically review the applicability of PMT to predict and improve the knowledge and intention (the patient's intent to undergo breast cancer screening with self/clinical breast exam or mammography) for protective behaviors among women. A systematic search was performed in May 2022 in electronic databases to investigate the role of PMT in the prediction of protection behaviors in addition to improving the knowledge about the prevention of breast cancer using specific keywords. The relevant studies were then included for data extraction. Seventeen articles including 7 interventional and 10 prediction studies were selected for data assessment. Findings demonstrated that PMT could be used to predict the rate of knowledge and intention about breast cancer risk among women. It was also shown that PMT could be considered as a framework for the prevention of breast cancer by changing the behaviors of individuals by training the participants. Fear arousal, response efficacy, and response cost were found as the main determinants of knowledge and intention rate. PMT can provide a useful framework to evaluate the factors associated with women's intentions about breast cancer. Periodical educational programs should be implemented to improve protection behaviors by increasing the intention of women to regular self-examination.
Topics: Humans; Female; Motivation; Breast Neoplasms; Health Knowledge, Attitudes, Practice; Self Efficacy; Intention
PubMed: 37045635
DOI: 10.1016/j.clbc.2023.02.013