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Sprague BL, Ichikawa L, Eavey J, Lowry KP, Rauscher GH, O’Meara ES, Miglioretti DL, Lee JM, Stout NK, Herschorn SD, Perry H, Weaver DL, Kerlikowske K, Wolfe S. Performance of Supplemental US Screening in Women with Dense Breasts and Varying Breast Cancer Risk: Results from the Breast Cancer Surveillance Consortium. Radiology 2024; 312:e232380. [PMID: 39105648 PMCID: PMC11366666 DOI: 10.1148/radiol.232380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 08/07/2024]
Abstract
Background It is unclear whether breast US screening outcomes for women with dense breasts vary with levels of breast cancer risk. Purpose To evaluate US screening outcomes for female patients with dense breasts and different estimated breast cancer risk levels. Materials and Methods This retrospective observational study used data from US screening examinations in female patients with heterogeneously or extremely dense breasts conducted from January 2014 to October 2020 at 24 radiology facilities within three Breast Cancer Surveillance Consortium (BCSC) registries. The primary outcomes were the cancer detection rate, false-positive biopsy recommendation rate, and positive predictive value of biopsies performed (PPV3). Risk classification of participants was performed using established BCSC risk prediction models of estimated 6-year advanced breast cancer risk and 5-year invasive breast cancer risk. Differences in high- versus low- or average-risk categories were assessed using a generalized linear model. Results In total, 34 791 US screening examinations from 26 489 female patients (mean age at screening, 53.9 years ± 9.0 [SD]) were included. The overall cancer detection rate per 1000 examinations was 2.0 (95% CI: 1.6, 2.4) and was higher in patients with high versus low or average risk of 6-year advanced breast cancer (5.5 [95% CI: 3.5, 8.6] vs 1.3 [95% CI: 1.0, 1.8], respectively; P = .003). The overall false-positive biopsy recommendation rate per 1000 examinations was 29.6 (95% CI: 22.6, 38.6) and was higher in patients with high versus low or average 6-year advanced breast cancer risk (37.0 [95% CI: 28.2, 48.4] vs 28.1 [95% CI: 20.9, 37.8], respectively; P = .04). The overall PPV3 was 6.9% (67 of 975; 95% CI: 5.3, 8.9) and was higher in patients with high versus low or average 6-year advanced cancer risk (15.0% [15 of 100; 95% CI: 9.9, 22.2] vs 4.9% [30 of 615; 95% CI: 3.3, 7.2]; P = .01). Similar patterns in outcomes were observed by 5-year invasive breast cancer risk. Conclusion The cancer detection rate and PPV3 of supplemental US screening increased with the estimated risk of advanced and invasive breast cancer. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Helbich and Kapetas in this issue.
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Affiliation(s)
- Brian L. Sprague
- From the Department of Surgery, Office of Health Promotion Research,
University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm
4425, Burlington, VT 05405 (B.L.S.); Department of Radiology, University of
Vermont Larner College of Medicine, Burlington, Vt (B.L.S., S.D.H., H.P.);
University of Vermont Cancer Center, University of Vermont Larner College of
Medicine, Burlington, Vt (B.L.S., S.D.H., H.P., D.L.W.); Kaiser Permanente
Washington Health Research Institute, Seattle, Wash (L.I., J.E., E.S.O.,
D.L.M.); Department of Radiology, University of Washington and Fred Hutchinson
Cancer Center, Seattle, Wash (K.P.L., J.M.L.); Division of Epidemiology and
Biostatistics, School of Public Health, University of Illinois at Chicago,
Chicago, Ill (G.H.R.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis, Davis, Calif (D.L.M.); Department of
Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care
Institute, Boston, Mass (N.K.S.); Department of Pathology & Laboratory
Medicine, University of Vermont Larner College of Medicine, Burlington, Vt
(D.L.W.); Departments of Medicine and Epidemiology and Biostatistics, University
of California San Francisco, San Francisco, Calif (K.K.); and Department of
Veterans Affairs, General Internal Medicine Section, University of California
San Francisco, San Francisco, Calif (K.K.)
| | - Laura Ichikawa
- From the Department of Surgery, Office of Health Promotion Research,
University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm
4425, Burlington, VT 05405 (B.L.S.); Department of Radiology, University of
Vermont Larner College of Medicine, Burlington, Vt (B.L.S., S.D.H., H.P.);
University of Vermont Cancer Center, University of Vermont Larner College of
Medicine, Burlington, Vt (B.L.S., S.D.H., H.P., D.L.W.); Kaiser Permanente
Washington Health Research Institute, Seattle, Wash (L.I., J.E., E.S.O.,
D.L.M.); Department of Radiology, University of Washington and Fred Hutchinson
Cancer Center, Seattle, Wash (K.P.L., J.M.L.); Division of Epidemiology and
Biostatistics, School of Public Health, University of Illinois at Chicago,
Chicago, Ill (G.H.R.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis, Davis, Calif (D.L.M.); Department of
Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care
Institute, Boston, Mass (N.K.S.); Department of Pathology & Laboratory
Medicine, University of Vermont Larner College of Medicine, Burlington, Vt
(D.L.W.); Departments of Medicine and Epidemiology and Biostatistics, University
of California San Francisco, San Francisco, Calif (K.K.); and Department of
Veterans Affairs, General Internal Medicine Section, University of California
San Francisco, San Francisco, Calif (K.K.)
| | - Joanna Eavey
- From the Department of Surgery, Office of Health Promotion Research,
University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm
4425, Burlington, VT 05405 (B.L.S.); Department of Radiology, University of
Vermont Larner College of Medicine, Burlington, Vt (B.L.S., S.D.H., H.P.);
University of Vermont Cancer Center, University of Vermont Larner College of
Medicine, Burlington, Vt (B.L.S., S.D.H., H.P., D.L.W.); Kaiser Permanente
Washington Health Research Institute, Seattle, Wash (L.I., J.E., E.S.O.,
D.L.M.); Department of Radiology, University of Washington and Fred Hutchinson
Cancer Center, Seattle, Wash (K.P.L., J.M.L.); Division of Epidemiology and
Biostatistics, School of Public Health, University of Illinois at Chicago,
Chicago, Ill (G.H.R.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis, Davis, Calif (D.L.M.); Department of
Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care
Institute, Boston, Mass (N.K.S.); Department of Pathology & Laboratory
Medicine, University of Vermont Larner College of Medicine, Burlington, Vt
(D.L.W.); Departments of Medicine and Epidemiology and Biostatistics, University
of California San Francisco, San Francisco, Calif (K.K.); and Department of
Veterans Affairs, General Internal Medicine Section, University of California
San Francisco, San Francisco, Calif (K.K.)
| | - Kathryn P. Lowry
- From the Department of Surgery, Office of Health Promotion Research,
University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm
4425, Burlington, VT 05405 (B.L.S.); Department of Radiology, University of
Vermont Larner College of Medicine, Burlington, Vt (B.L.S., S.D.H., H.P.);
University of Vermont Cancer Center, University of Vermont Larner College of
Medicine, Burlington, Vt (B.L.S., S.D.H., H.P., D.L.W.); Kaiser Permanente
Washington Health Research Institute, Seattle, Wash (L.I., J.E., E.S.O.,
D.L.M.); Department of Radiology, University of Washington and Fred Hutchinson
Cancer Center, Seattle, Wash (K.P.L., J.M.L.); Division of Epidemiology and
Biostatistics, School of Public Health, University of Illinois at Chicago,
Chicago, Ill (G.H.R.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis, Davis, Calif (D.L.M.); Department of
Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care
Institute, Boston, Mass (N.K.S.); Department of Pathology & Laboratory
Medicine, University of Vermont Larner College of Medicine, Burlington, Vt
(D.L.W.); Departments of Medicine and Epidemiology and Biostatistics, University
of California San Francisco, San Francisco, Calif (K.K.); and Department of
Veterans Affairs, General Internal Medicine Section, University of California
San Francisco, San Francisco, Calif (K.K.)
| | - Garth H. Rauscher
- From the Department of Surgery, Office of Health Promotion Research,
University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm
4425, Burlington, VT 05405 (B.L.S.); Department of Radiology, University of
Vermont Larner College of Medicine, Burlington, Vt (B.L.S., S.D.H., H.P.);
University of Vermont Cancer Center, University of Vermont Larner College of
Medicine, Burlington, Vt (B.L.S., S.D.H., H.P., D.L.W.); Kaiser Permanente
Washington Health Research Institute, Seattle, Wash (L.I., J.E., E.S.O.,
D.L.M.); Department of Radiology, University of Washington and Fred Hutchinson
Cancer Center, Seattle, Wash (K.P.L., J.M.L.); Division of Epidemiology and
Biostatistics, School of Public Health, University of Illinois at Chicago,
Chicago, Ill (G.H.R.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis, Davis, Calif (D.L.M.); Department of
Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care
Institute, Boston, Mass (N.K.S.); Department of Pathology & Laboratory
Medicine, University of Vermont Larner College of Medicine, Burlington, Vt
(D.L.W.); Departments of Medicine and Epidemiology and Biostatistics, University
of California San Francisco, San Francisco, Calif (K.K.); and Department of
Veterans Affairs, General Internal Medicine Section, University of California
San Francisco, San Francisco, Calif (K.K.)
| | - Ellen S. O’Meara
- From the Department of Surgery, Office of Health Promotion Research,
University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm
4425, Burlington, VT 05405 (B.L.S.); Department of Radiology, University of
Vermont Larner College of Medicine, Burlington, Vt (B.L.S., S.D.H., H.P.);
University of Vermont Cancer Center, University of Vermont Larner College of
Medicine, Burlington, Vt (B.L.S., S.D.H., H.P., D.L.W.); Kaiser Permanente
Washington Health Research Institute, Seattle, Wash (L.I., J.E., E.S.O.,
D.L.M.); Department of Radiology, University of Washington and Fred Hutchinson
Cancer Center, Seattle, Wash (K.P.L., J.M.L.); Division of Epidemiology and
Biostatistics, School of Public Health, University of Illinois at Chicago,
Chicago, Ill (G.H.R.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis, Davis, Calif (D.L.M.); Department of
Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care
Institute, Boston, Mass (N.K.S.); Department of Pathology & Laboratory
Medicine, University of Vermont Larner College of Medicine, Burlington, Vt
(D.L.W.); Departments of Medicine and Epidemiology and Biostatistics, University
of California San Francisco, San Francisco, Calif (K.K.); and Department of
Veterans Affairs, General Internal Medicine Section, University of California
San Francisco, San Francisco, Calif (K.K.)
| | - Diana L. Miglioretti
- From the Department of Surgery, Office of Health Promotion Research,
University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm
4425, Burlington, VT 05405 (B.L.S.); Department of Radiology, University of
Vermont Larner College of Medicine, Burlington, Vt (B.L.S., S.D.H., H.P.);
University of Vermont Cancer Center, University of Vermont Larner College of
Medicine, Burlington, Vt (B.L.S., S.D.H., H.P., D.L.W.); Kaiser Permanente
Washington Health Research Institute, Seattle, Wash (L.I., J.E., E.S.O.,
D.L.M.); Department of Radiology, University of Washington and Fred Hutchinson
Cancer Center, Seattle, Wash (K.P.L., J.M.L.); Division of Epidemiology and
Biostatistics, School of Public Health, University of Illinois at Chicago,
Chicago, Ill (G.H.R.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis, Davis, Calif (D.L.M.); Department of
Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care
Institute, Boston, Mass (N.K.S.); Department of Pathology & Laboratory
Medicine, University of Vermont Larner College of Medicine, Burlington, Vt
(D.L.W.); Departments of Medicine and Epidemiology and Biostatistics, University
of California San Francisco, San Francisco, Calif (K.K.); and Department of
Veterans Affairs, General Internal Medicine Section, University of California
San Francisco, San Francisco, Calif (K.K.)
| | - Janie M. Lee
- From the Department of Surgery, Office of Health Promotion Research,
University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm
4425, Burlington, VT 05405 (B.L.S.); Department of Radiology, University of
Vermont Larner College of Medicine, Burlington, Vt (B.L.S., S.D.H., H.P.);
University of Vermont Cancer Center, University of Vermont Larner College of
Medicine, Burlington, Vt (B.L.S., S.D.H., H.P., D.L.W.); Kaiser Permanente
Washington Health Research Institute, Seattle, Wash (L.I., J.E., E.S.O.,
D.L.M.); Department of Radiology, University of Washington and Fred Hutchinson
Cancer Center, Seattle, Wash (K.P.L., J.M.L.); Division of Epidemiology and
Biostatistics, School of Public Health, University of Illinois at Chicago,
Chicago, Ill (G.H.R.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis, Davis, Calif (D.L.M.); Department of
Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care
Institute, Boston, Mass (N.K.S.); Department of Pathology & Laboratory
Medicine, University of Vermont Larner College of Medicine, Burlington, Vt
(D.L.W.); Departments of Medicine and Epidemiology and Biostatistics, University
of California San Francisco, San Francisco, Calif (K.K.); and Department of
Veterans Affairs, General Internal Medicine Section, University of California
San Francisco, San Francisco, Calif (K.K.)
| | - Natasha K. Stout
- From the Department of Surgery, Office of Health Promotion Research,
University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm
4425, Burlington, VT 05405 (B.L.S.); Department of Radiology, University of
Vermont Larner College of Medicine, Burlington, Vt (B.L.S., S.D.H., H.P.);
University of Vermont Cancer Center, University of Vermont Larner College of
Medicine, Burlington, Vt (B.L.S., S.D.H., H.P., D.L.W.); Kaiser Permanente
Washington Health Research Institute, Seattle, Wash (L.I., J.E., E.S.O.,
D.L.M.); Department of Radiology, University of Washington and Fred Hutchinson
Cancer Center, Seattle, Wash (K.P.L., J.M.L.); Division of Epidemiology and
Biostatistics, School of Public Health, University of Illinois at Chicago,
Chicago, Ill (G.H.R.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis, Davis, Calif (D.L.M.); Department of
Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care
Institute, Boston, Mass (N.K.S.); Department of Pathology & Laboratory
Medicine, University of Vermont Larner College of Medicine, Burlington, Vt
(D.L.W.); Departments of Medicine and Epidemiology and Biostatistics, University
of California San Francisco, San Francisco, Calif (K.K.); and Department of
Veterans Affairs, General Internal Medicine Section, University of California
San Francisco, San Francisco, Calif (K.K.)
| | - Sally D. Herschorn
- From the Department of Surgery, Office of Health Promotion Research,
University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm
4425, Burlington, VT 05405 (B.L.S.); Department of Radiology, University of
Vermont Larner College of Medicine, Burlington, Vt (B.L.S., S.D.H., H.P.);
University of Vermont Cancer Center, University of Vermont Larner College of
Medicine, Burlington, Vt (B.L.S., S.D.H., H.P., D.L.W.); Kaiser Permanente
Washington Health Research Institute, Seattle, Wash (L.I., J.E., E.S.O.,
D.L.M.); Department of Radiology, University of Washington and Fred Hutchinson
Cancer Center, Seattle, Wash (K.P.L., J.M.L.); Division of Epidemiology and
Biostatistics, School of Public Health, University of Illinois at Chicago,
Chicago, Ill (G.H.R.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis, Davis, Calif (D.L.M.); Department of
Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care
Institute, Boston, Mass (N.K.S.); Department of Pathology & Laboratory
Medicine, University of Vermont Larner College of Medicine, Burlington, Vt
(D.L.W.); Departments of Medicine and Epidemiology and Biostatistics, University
of California San Francisco, San Francisco, Calif (K.K.); and Department of
Veterans Affairs, General Internal Medicine Section, University of California
San Francisco, San Francisco, Calif (K.K.)
| | - Hannah Perry
- From the Department of Surgery, Office of Health Promotion Research,
University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm
4425, Burlington, VT 05405 (B.L.S.); Department of Radiology, University of
Vermont Larner College of Medicine, Burlington, Vt (B.L.S., S.D.H., H.P.);
University of Vermont Cancer Center, University of Vermont Larner College of
Medicine, Burlington, Vt (B.L.S., S.D.H., H.P., D.L.W.); Kaiser Permanente
Washington Health Research Institute, Seattle, Wash (L.I., J.E., E.S.O.,
D.L.M.); Department of Radiology, University of Washington and Fred Hutchinson
Cancer Center, Seattle, Wash (K.P.L., J.M.L.); Division of Epidemiology and
Biostatistics, School of Public Health, University of Illinois at Chicago,
Chicago, Ill (G.H.R.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis, Davis, Calif (D.L.M.); Department of
Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care
Institute, Boston, Mass (N.K.S.); Department of Pathology & Laboratory
Medicine, University of Vermont Larner College of Medicine, Burlington, Vt
(D.L.W.); Departments of Medicine and Epidemiology and Biostatistics, University
of California San Francisco, San Francisco, Calif (K.K.); and Department of
Veterans Affairs, General Internal Medicine Section, University of California
San Francisco, San Francisco, Calif (K.K.)
| | - Donald L. Weaver
- From the Department of Surgery, Office of Health Promotion Research,
University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm
4425, Burlington, VT 05405 (B.L.S.); Department of Radiology, University of
Vermont Larner College of Medicine, Burlington, Vt (B.L.S., S.D.H., H.P.);
University of Vermont Cancer Center, University of Vermont Larner College of
Medicine, Burlington, Vt (B.L.S., S.D.H., H.P., D.L.W.); Kaiser Permanente
Washington Health Research Institute, Seattle, Wash (L.I., J.E., E.S.O.,
D.L.M.); Department of Radiology, University of Washington and Fred Hutchinson
Cancer Center, Seattle, Wash (K.P.L., J.M.L.); Division of Epidemiology and
Biostatistics, School of Public Health, University of Illinois at Chicago,
Chicago, Ill (G.H.R.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis, Davis, Calif (D.L.M.); Department of
Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care
Institute, Boston, Mass (N.K.S.); Department of Pathology & Laboratory
Medicine, University of Vermont Larner College of Medicine, Burlington, Vt
(D.L.W.); Departments of Medicine and Epidemiology and Biostatistics, University
of California San Francisco, San Francisco, Calif (K.K.); and Department of
Veterans Affairs, General Internal Medicine Section, University of California
San Francisco, San Francisco, Calif (K.K.)
| | - Karla Kerlikowske
- From the Department of Surgery, Office of Health Promotion Research,
University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm
4425, Burlington, VT 05405 (B.L.S.); Department of Radiology, University of
Vermont Larner College of Medicine, Burlington, Vt (B.L.S., S.D.H., H.P.);
University of Vermont Cancer Center, University of Vermont Larner College of
Medicine, Burlington, Vt (B.L.S., S.D.H., H.P., D.L.W.); Kaiser Permanente
Washington Health Research Institute, Seattle, Wash (L.I., J.E., E.S.O.,
D.L.M.); Department of Radiology, University of Washington and Fred Hutchinson
Cancer Center, Seattle, Wash (K.P.L., J.M.L.); Division of Epidemiology and
Biostatistics, School of Public Health, University of Illinois at Chicago,
Chicago, Ill (G.H.R.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis, Davis, Calif (D.L.M.); Department of
Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care
Institute, Boston, Mass (N.K.S.); Department of Pathology & Laboratory
Medicine, University of Vermont Larner College of Medicine, Burlington, Vt
(D.L.W.); Departments of Medicine and Epidemiology and Biostatistics, University
of California San Francisco, San Francisco, Calif (K.K.); and Department of
Veterans Affairs, General Internal Medicine Section, University of California
San Francisco, San Francisco, Calif (K.K.)
| | - Shannyn Wolfe
- From the Department of Surgery, Office of Health Promotion Research,
University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm
4425, Burlington, VT 05405 (B.L.S.); Department of Radiology, University of
Vermont Larner College of Medicine, Burlington, Vt (B.L.S., S.D.H., H.P.);
University of Vermont Cancer Center, University of Vermont Larner College of
Medicine, Burlington, Vt (B.L.S., S.D.H., H.P., D.L.W.); Kaiser Permanente
Washington Health Research Institute, Seattle, Wash (L.I., J.E., E.S.O.,
D.L.M.); Department of Radiology, University of Washington and Fred Hutchinson
Cancer Center, Seattle, Wash (K.P.L., J.M.L.); Division of Epidemiology and
Biostatistics, School of Public Health, University of Illinois at Chicago,
Chicago, Ill (G.H.R.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis, Davis, Calif (D.L.M.); Department of
Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care
Institute, Boston, Mass (N.K.S.); Department of Pathology & Laboratory
Medicine, University of Vermont Larner College of Medicine, Burlington, Vt
(D.L.W.); Departments of Medicine and Epidemiology and Biostatistics, University
of California San Francisco, San Francisco, Calif (K.K.); and Department of
Veterans Affairs, General Internal Medicine Section, University of California
San Francisco, San Francisco, Calif (K.K.)
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Lee Argov EJ, Rodriguez CB, Agovino M, Schmitt KM, Desperito E, Karr AG, Wei Y, Terry MB, Tehranifar P. Screening mammography frequency following dense breast notification among a predominantly Hispanic/Latina screening cohort. Cancer Causes Control 2024; 35:1133-1142. [PMID: 38607569 DOI: 10.1007/s10552-024-01871-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/11/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE Nationally legislated dense breast notification (DBN) informs women of their breast density (BD) and the impact of BD on breast cancer risk and detection, but consequences for screening participation are unclear. We evaluated the association of DBN in New York State (NYS) with subsequent screening mammography in a largely Hispanic/Latina cohort. METHODS Women aged 40-60 were surveyed in their preferred language (33% English, 67% Spanish) during screening mammography from 2016 to 2018. We used clinical BD classification from mammography records from 2013 (NYS DBN enactment) through enrollment (baseline) to create a 6-category variable capturing prior and new DBN receipt (sent only after clinically dense mammograms). We used this variable to compare the number of subsequent mammograms (0, 1, ≥ 2) from 10 to 30 months after baseline using ordinal logistic regression. RESULTS In a sample of 728 women (78% foreign-born, 72% Hispanic, 46% high school education or less), first-time screeners and women who received DBN for the first time after prior non-dense mammograms had significantly fewer screening mammograms within 30 months of baseline (Odds Ratios range: 0.33 (95% Confidence Interval (CI) 0.12-0.85) to 0.38 (95% CI 0.17-0.82)) compared to women with prior mammography but no DBN. There were no differences in subsequent mammogram frequency between women with multiple DBN and those who never received DBN. Findings were consistent across age, language, health literacy, and education groups. CONCLUSION Women receiving their first DBN after previous non-dense mammograms have lower mammography participation within 2.5 years. DBN has limited influence on screening participation of first-time screeners and those with persistent dense mammograms.
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Affiliation(s)
- Erica J Lee Argov
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168Th St., New York, NY, 10032, USA
| | - Carmen B Rodriguez
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168Th St., New York, NY, 10032, USA
| | - Mariangela Agovino
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168Th St., New York, NY, 10032, USA
| | - Karen M Schmitt
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
- Division of Academics, Columbia University School of Nursing, New York, NY, USA
| | - Elise Desperito
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Anita G Karr
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168Th St., New York, NY, 10032, USA
| | - Ying Wei
- Department of Biostatistics, Columbia University Mailman School of Public Health, 722 W 168Th St., New York, NY, USA
| | - Mary Beth Terry
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168Th St., New York, NY, 10032, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Parisa Tehranifar
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168Th St., New York, NY, 10032, USA.
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA.
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Kim E, Lewin AA. Breast Density: Where Are We Now? Radiol Clin North Am 2024; 62:593-605. [PMID: 38777536 DOI: 10.1016/j.rcl.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Breast density refers to the amount of fibroglandular tissue relative to fat on mammography and is determined either qualitatively through visual assessment or quantitatively. It is a heritable and dynamic trait associated with age, race/ethnicity, body mass index, and hormonal factors. Increased breast density has important clinical implications including the potential to mask malignancy and as an independent risk factor for the development of breast cancer. Breast density has been incorporated into breast cancer risk models. Given the impact of dense breasts on the interpretation of mammography, supplemental screening may be indicated.
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Affiliation(s)
- Eric Kim
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Alana A Lewin
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA; New York University Grossman School of Medicine, New York University Langone Health, Laura and Isaac Perlmutter Cancer Center, 160 East 34th Street 3rd Floor, New York, NY 10016, USA.
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4
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Hruska CB, Gray LR, Jenkins SM, Block EA, Hunt KN, Conners AL, Zingula SN, O'Connor MK, Rhodes DJ. A Survey of Patient Experience During Molecular Breast Imaging. J Nucl Med Technol 2024; 52:107-114. [PMID: 38839120 DOI: 10.2967/jnmt.123.266856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/09/2023] [Indexed: 06/07/2024] Open
Abstract
Molecular breast imaging (MBI) is one of several options available to patients seeking supplemental screening due to mammographically dense breasts. Patient experience during MBI may influence willingness to undergo the test but has yet to be formally assessed. We aimed to assess patient comfort level during MBI, to compare MBI comfort with mammography comfort, to identify factors associated with MBI discomfort, and to evaluate patients' willingness to return for future MBI. Methods: A 10-question survey was sent by e-mail to patients undergoing MBI between August and December 2022 to obtain quantitative assessments and qualitative opinions about MBI. Results: Of 561 invited patients, 209 (37%) completed the survey and provided study consent. Their average age was 60.1 y (range, 40-81 y). Of the 209 responders, 202 (97%) were presenting for screening MBI, 195 (94%) had dense breasts, and 46 (22%) had a personal history of breast cancer. The average rating of MBI comfort was 2.9 (SD, 1.5; median, 3.0) on a 7-point scale (1 indicating extremely comfortable and 7 indicating extremely uncomfortable). The rating distribution was as follows: 140 (67%) comfortable (rating, 1-3); 24 (12%) neither comfortable nor uncomfortable (rating, 4); and 45 (22%) uncomfortable (rating, 5 or 6). No responders gave a 7 rating. The most frequently mentioned sources of discomfort included breast compression (n = 16), back or neck discomfort (n = 14), and maintaining position during the examination (n = 14). MBI comfort was associated with responder age (74% ≥55 y old were comfortable, versus 53% <55 y old [P = 0.003]) and history of MBI (71% with prior MBI were comfortable, versus 61% having a first MBI [P = 0.006]). Of 208 responders with a prior mammogram, 148 (71%) said MBI is more comfortable than mammography (a significant majority [P < 0.001]). Of 202 responders to the question of whether they were willing to return for a future MBI, 196 (97%) were willing. A notable factor in positive patient experience was interaction with the MBI nuclear medicine technologist. Conclusion: Most responders thought MBI to be a comfortable examination and more comfortable than mammography. Patient experience during MBI may be improved by ensuring back support and soliciting patient feedback at the time of positioning and throughout the examination. Methods under study to reduce imaging time may be most important for improving patient experience.
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Affiliation(s)
| | - Lacey R Gray
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Sarah M Jenkins
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Emily A Block
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Katie N Hunt
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Deborah J Rhodes
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut; and
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
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5
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Isautier JMJ, Wang S, Houssami N, McCaffery K, Brennan ME, Li T, Nickel B. The impact of breast density notification on psychosocial outcomes in racial and ethnic minorities: A systematic review. Breast 2024; 74:103693. [PMID: 38430905 PMCID: PMC10918326 DOI: 10.1016/j.breast.2024.103693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
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.
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Affiliation(s)
- J M J Isautier
- The University of Sydney, Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, New South Wales Australia; Wiser Healthcare, School of Public Health, The University of Sydney, New South Wales, Australia
| | - S Wang
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - N Houssami
- Wiser Healthcare, School of Public Health, The University of Sydney, New South Wales, Australia; The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - K McCaffery
- The University of Sydney, Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, New South Wales Australia; Wiser Healthcare, School of Public Health, The University of Sydney, New South Wales, Australia
| | - M E Brennan
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Sydney, Australia; National School of Medicine, University of Notre Dame Australia, Sydney, Australia
| | - T Li
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - B Nickel
- The University of Sydney, Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, New South Wales Australia; Wiser Healthcare, School of Public Health, The University of Sydney, New South Wales, Australia.
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6
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Best R, Wilkinson LS, Oliver-Williams C, Tolani F, Yates J. Should we share breast density information during breast cancer screening in the United Kingdom? an integrative review. Br J Radiol 2023; 96:20230122. [PMID: 37751169 PMCID: PMC10646652 DOI: 10.1259/bjr.20230122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/25/2023] [Accepted: 08/24/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE Dense breasts are an established risk factor for breast cancer and also reduce the sensitivity of mammograms. There is increasing public concern around breast density in the UK, with calls for this information to be shared at breast cancer screening. METHODS We searched the PubMed database, Cochrane Library and grey literature, using broad search terms in October 2022. Two reviewers extracted data and assessed the risk of bias of each included study. The results were narratively synthesised by five research questions: desire for information, communication formats, psychological impact, knowledge impact and behaviour change. RESULTS We identified 19 studies: three Randomised Controlled Trials (RCTs), three cohort studies, nine cross-sectional studies, one qualitative interview study, one mixed methods study and two 2021 systematic reviews. Nine studies were based in the United States of America (USA), five in Australia, two in the UK and one in Croatia. One systematic review included 14 USA studies, and the other 27 USA studies, 1 Australian and 1 Canadian. The overall GRADE evidence quality rating for each research question was very low to low.Generally, participants wanted to receive breast density information. Conversations with healthcare professionals were more valued and effective than letters. Breast density awareness after notification varied greatly between studies.Breast density information either did not impact frequency of mammography screening or increased the intentions of participants to return for routine screening as well as intention to access, and uptake of, supplementary screening. People from ethnic minority groups or of lower socioeconomic status (SES) had greater confusion following notification, and, along with those without healthcare insurance, were less likely to access supplementary screening. CONCLUSION Breast density specific research in the UK, including different communities, is needed before the UK considers sharing breast density information at screening. There are also practical considerations around implementation and recording, which need to be addressed. ADVANCES IN KNOWLEDGE Currently, sharing breast density information at breast cancer screening in the UK may not be beneficial to participants and could widen inequalities. UK specific research is needed, and measurement, communication and future testing implications need to be carefully considered.
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Affiliation(s)
- Rebecca Best
- NHS England Screening Quality Assurance Service, Health Education England, England, United Kingdom
| | | | - Clare Oliver-Williams
- NHS England Screening Quality Assurance Service, Health Education England, England, United Kingdom
| | - Foyeke Tolani
- Public Health Department, Bedford Borough Council, Bedford, United Kingdom
| | - Jan Yates
- NHS England Screening Quality Assurance Service, Health Education England, England, United Kingdom
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7
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McCarthy AM, Fernandez Perez C, Beidas RS, Bekelman JE, Blumenthal D, Mack E, Bauer AM, Ehsan S, Conant EF, Wheeler BC, Guerra CE, Nunes LW, Gabriel P, Doucette A, Wileyto EP, Buttenheim AM, Asch DA, Rendle KA, Shelton RC, Fayanju OM, Ware S, Plag M, Hyland S, Gionta T, Shulman LN, Schnoll R. Protocol for a pragmatic stepped wedge cluster randomized clinical trial testing behavioral economic implementation strategies to increase supplemental breast MRI screening among patients with extremely dense breasts. Implement Sci 2023; 18:65. [PMID: 38001506 PMCID: PMC10668465 DOI: 10.1186/s13012-023-01323-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Increased breast density augments breast cancer risk and reduces mammography sensitivity. Supplemental breast MRI screening can significantly increase cancer detection among women with dense breasts. However, few women undergo this exam, and screening is consistently lower among racially minoritized populations. Implementation strategies informed by behavioral economics ("nudges") can promote evidence-based practices by improving clinician decision-making under conditions of uncertainty. Nudges directed toward clinicians and patients may facilitate the implementation of supplemental breast MRI. METHODS Approximately 1600 patients identified as having extremely dense breasts after non-actionable mammograms, along with about 1100 clinicians involved with their care at 32 primary care or OB/GYN clinics across a racially diverse academically based health system, will be enrolled. A 2 × 2 randomized pragmatic trial will test nudges to patients, clinicians, both, or neither to promote supplemental breast MRI screening. Before implementation, rapid cycle approaches informed by clinician and patient experiences and behavioral economics and health equity frameworks guided nudge design. Clinicians will be clustered into clinic groups based on existing administrative departments and care patterns, and these clinic groups will be randomized to have the nudge activated at different times per a stepped wedge design. Clinicians will receive nudges integrated into the routine mammographic report or sent through electronic health record (EHR) in-basket messaging once their clinic group (i.e., wedge) is randomized to receive the intervention. Independently, patients will be randomized to receive text message nudges or not. The primary outcome will be defined as ordering or scheduling supplemental breast MRI. Secondary outcomes include MRI completion, cancer detection rates, and false-positive rates. Patient sociodemographic information and clinic-level variables will be examined as moderators of nudge effectiveness. Qualitative interviews conducted at the trial's conclusion will examine barriers and facilitators to implementation. DISCUSSION This study will add to the growing literature on the effectiveness of behavioral economics-informed implementation strategies to promote evidence-based interventions. The design will facilitate testing the relative effects of nudges to patients and clinicians and the effects of moderators of nudge effectiveness, including key indicators of health disparities. The results may inform the introduction of low-cost, scalable implementation strategies to promote early breast cancer detection. TRIAL REGISTRATION ClinicalTrials.gov NCT05787249. Registered on March 28, 2023.
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Affiliation(s)
- Anne Marie McCarthy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA.
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA.
| | | | - Rinad S Beidas
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Justin E Bekelman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Daniel Blumenthal
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Interdisciplinary Research On Nicotine Addiction, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth Mack
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anna-Marika Bauer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Interdisciplinary Research On Nicotine Addiction, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah Ehsan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily F Conant
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Carmen E Guerra
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Linda W Nunes
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter Gabriel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Abigail Doucette
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - E Paul Wileyto
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA
- Center for Interdisciplinary Research On Nicotine Addiction, University of Pennsylvania, Philadelphia, PA, USA
| | - Alison M Buttenheim
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - David A Asch
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Katharine A Rendle
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA
| | - Rachel C Shelton
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Oluwadamilola M Fayanju
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Sue Ware
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Interdisciplinary Research On Nicotine Addiction, University of Pennsylvania, Philadelphia, PA, USA
| | - Martina Plag
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Steven Hyland
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tracy Gionta
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lawrence N Shulman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Robert Schnoll
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
- Center for Interdisciplinary Research On Nicotine Addiction, University of Pennsylvania, Philadelphia, PA, USA
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8
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Nickel B, Ormiston‐Smith N, Hammerton L, Cvejic E, Vardon P, Mcinally Z, Legerton P, Baker K, Isautier J, Larsen E, Giles M, Brennan ME, McCaffery KJ, Houssami N. Psychosocial outcomes and health service use after notifying women participating in population breast screening when they have dense breasts: a BreastScreen Queensland randomised controlled trial. Med J Aust 2023; 219:423-428. [PMID: 37751916 PMCID: PMC10952548 DOI: 10.5694/mja2.52117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/23/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Robust evidence regarding the benefits and harms of notifying Australian women when routine breast screening identifies that they have dense breasts is needed for informing future mammography population screening practice and policy. OBJECTIVES To assess the psychosocial and health services use effects of notifying women participating in population-based breast cancer screening that they have dense breasts; to examine whether the mode of communicating this information about its implications (print, online formats) influences these effects. METHODS AND ANALYSIS The study population comprises women aged 40 years or older who attend BreastScreen Queensland Sunshine Coast services for mammographic screening and are found to have dense breasts (BI-RADS density C or D). The randomised controlled trial includes three arms (952 women each): standard BreastScreen care (no notification of breast density; control arm); notification of dense breasts in screening results letter and print health literacy-sensitive information (intervention arm 1) or a link or QR code to online video-based health literacy-sensitive information (intervention arm 2). Baseline demographic data will be obtained from BreastScreen Queensland. Outcomes data will be collected in questionnaires at baseline and eight weeks, twelve months, and 27 months after breast screening. Primary outcomes will be psychological outcomes and health service use; secondary outcomes will be supplemental screening outcomes, cancer worry, perceived breast cancer risk, knowledge about breast density, future mammographic screening intentions, and acceptability of notification about dense breasts. ETHICS APPROVAL Gold Coast Hospital and Health Service Ethics Committee (HREC/2023/QGC/89770); Sunshine Coast Hospital and Health Service Research Governance and Development (SSA/2023/QSC/89770). DISSEMINATION OF FINDINGS Findings will be reported in peer-reviewed journals and at national and international conferences. They will also be reported to BreastScreen Queensland, BreastScreen Australia, Cancer Australia, and other bodies involved in cancer care and screening, including patient and support organisations. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12623000001695p (prospective: 9 January 2023).
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Affiliation(s)
- Brooke Nickel
- School of Public Healththe University of SydneySydneyNSW
| | | | - Lisa Hammerton
- Sunshine Coast Service, BreastScreen QueenslandNambourQLD
| | - Erin Cvejic
- School of Public Healththe University of SydneySydneyNSW
| | - Paul Vardon
- Cancer Screening Unit, Queensland Department of HealthBrisbaneQLD
| | - Zoe Mcinally
- Cancer Screening Unit, Queensland Department of HealthBrisbaneQLD
| | - Paula Legerton
- Cancer Screening Unit, Queensland Department of HealthBrisbaneQLD
| | - Karen Baker
- Cancer Screening Unit, Queensland Department of HealthBrisbaneQLD
| | | | - Emma Larsen
- Sunshine Coast Service, BreastScreen QueenslandNambourQLD
| | | | - Meagan E Brennan
- School of Public Healththe University of SydneySydneyNSW
- The University of Notre Dame AustraliaSydneyNSW
| | | | - Nehmat Houssami
- School of Public Healththe University of SydneySydneyNSW
- The Daffodil Centre, the University of Sydney and Cancer Council NSWSydneyNSW
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9
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Kerlikowske K, Bissell MCS, Sprague BL, Tice JA, Tossas KY, Bowles EJA, Ho TQH, Keegan THM, Miglioretti DL. Impact of BMI on Prevalence of Dense Breasts by Race and Ethnicity. Cancer Epidemiol Biomarkers Prev 2023; 32:1524-1530. [PMID: 37284771 PMCID: PMC10701641 DOI: 10.1158/1055-9965.epi-23-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/18/2023] [Accepted: 04/25/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Density notification laws require notifying women of dense breasts with dense breast prevalence varying by race/ethnicity. We evaluated whether differences in body mass index (BMI) account for differences in dense breasts prevalence by race/ethnicity. METHODS Prevalence of dense breasts (heterogeneously or extremely dense) according to Breast Imaging Reporting and Data System and obesity (BMI > 30 kg/m2) were estimated from 2,667,207 mammography examinations among 866,033 women in the Breast Cancer Surveillance Consortium (BCSC) from January 2005 through April 2021. Prevalence ratios (PR) for dense breasts relative to overall prevalence by race/ethnicity were estimated by standardizing race/ethnicity prevalence in the BCSC to the 2020 U.S. population, and adjusting for age, menopausal status, and BMI using logistic regression. RESULTS Dense breasts were most prevalent among Asian women (66.0%) followed by non-Hispanic/Latina (NH) White (45.5%), Hispanic/Latina (45.3%), and NH Black (37.0%) women. Obesity was most prevalent in Black women (58.4%) followed by Hispanic/Latina (39.3%), NH White (30.6%), and Asian (8.5%) women. The adjusted prevalence of dense breasts was 19% higher [PR = 1.19; 95% confidence interval (CI), 1.19-1.20] in Asian women, 8% higher (PR = 1.08; 95% CI, 1.07-1.08) in Black women, the same in Hispanic/Latina women (PR = 1.00; 95% CI, 0.99-1.01), and 4% lower (PR = 0.96; 95% CI, 0.96-0.97) in NH White women relative to the overall prevalence. CONCLUSIONS Clinically important differences in breast density prevalence are present across racial/ethnic groups after accounting for age, menopausal status, and BMI. IMPACT If breast density is the sole criterion used to notify women of dense breasts and discuss supplemental screening it may result in implementing inequitable screening strategies across racial/ethnic groups. See related In the Spotlight, p. 1479.
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Affiliation(s)
- Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA, USA
| | - Michael C. S. Bissell
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA
| | - Brian L. Sprague
- Departments of Surgery and Radiology, Office of Health Promotion Research, Larner College of Medicine at the University of Vermont and University of Vermont Cancer Center, Burlington, VT, USA
| | - Jeffrey A. Tice
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Katherine Y. Tossas
- Department of Health Behavior and Policy, School of Medicine, and Massey Cancer Center, Virginia Commonwealth University, Richmond VA, USA
| | - Erin J. A. Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Thao-Quyen H. Ho
- Department of Training and Scientific Research, University Medical Center, Ho Chi Minh city, Vietnam
- Breast Imaging Unit, Diagnostic Imaging Center, Tam Anh General Hospital, Ho Chi Minh City, Vietnam
| | - Theresa H. M. Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Diana L. Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
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10
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Balasubramaniam S, Velmurugan Y, Jaganathan D, Dhanasekaran S. A Modified LeNet CNN for Breast Cancer Diagnosis in Ultrasound Images. Diagnostics (Basel) 2023; 13:2746. [PMID: 37685284 PMCID: PMC10486538 DOI: 10.3390/diagnostics13172746] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 09/10/2023] Open
Abstract
Convolutional neural networks (CNNs) have been extensively utilized in medical image processing to automatically extract meaningful features and classify various medical conditions, enabling faster and more accurate diagnoses. In this paper, LeNet, a classic CNN architecture, has been successfully applied to breast cancer data analysis. It demonstrates its ability to extract discriminative features and classify malignant and benign tumors with high accuracy, thereby supporting early detection and diagnosis of breast cancer. LeNet with corrected Rectified Linear Unit (ReLU), a modification of the traditional ReLU activation function, has been found to improve the performance of LeNet in breast cancer data analysis tasks via addressing the "dying ReLU" problem and enhancing the discriminative power of the extracted features. This has led to more accurate, reliable breast cancer detection and diagnosis and improved patient outcomes. Batch normalization improves the performance and training stability of small and shallow CNN architecture like LeNet. It helps to mitigate the effects of internal covariate shift, which refers to the change in the distribution of network activations during training. This classifier will lessen the overfitting problem and reduce the running time. The designed classifier is evaluated against the benchmarking deep learning models, proving that this has produced a higher recognition rate. The accuracy of the breast image recognition rate is 89.91%. This model will achieve better performance in segmentation, feature extraction, classification, and breast cancer tumor detection.
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Affiliation(s)
| | - Yuvarajan Velmurugan
- Computer Science and Engineering, Sona College of Technology, Salem 636005, India; (Y.V.); (D.J.)
| | - Dhayanithi Jaganathan
- Computer Science and Engineering, Sona College of Technology, Salem 636005, India; (Y.V.); (D.J.)
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11
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Sprague BL, Ichikawa L, Eavey J, Lowry KP, Rauscher G, O’Meara ES, Miglioretti DL, Chen S, Lee JM, Stout NK, Mandelblatt JS, Alsheik N, Herschorn SD, Perry H, Weaver DL, Kerlikowske K. Breast cancer risk characteristics of women undergoing whole-breast ultrasound screening versus mammography alone. Cancer 2023; 129:2456-2468. [PMID: 37303202 PMCID: PMC10506533 DOI: 10.1002/cncr.34768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 02/06/2023] [Accepted: 02/24/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND There are no consensus guidelines for supplemental breast cancer screening with whole-breast ultrasound. However, criteria for women at high risk of mammography screening failures (interval invasive cancer or advanced cancer) have been identified. Mammography screening failure risk was evaluated among women undergoing supplemental ultrasound screening in clinical practice compared with women undergoing mammography alone. METHODS A total of 38,166 screening ultrasounds and 825,360 screening mammograms without supplemental screening were identified during 2014-2020 within three Breast Cancer Surveillance Consortium (BCSC) registries. Risk of interval invasive cancer and advanced cancer were determined using BCSC prediction models. High interval invasive breast cancer risk was defined as heterogeneously dense breasts and BCSC 5-year breast cancer risk ≥2.5% or extremely dense breasts and BCSC 5-year breast cancer risk ≥1.67%. Intermediate/high advanced cancer risk was defined as BCSC 6-year advanced breast cancer risk ≥0.38%. RESULTS A total of 95.3% of 38,166 ultrasounds were among women with heterogeneously or extremely dense breasts, compared with 41.8% of 825,360 screening mammograms without supplemental screening (p < .0001). Among women with dense breasts, high interval invasive breast cancer risk was prevalent in 23.7% of screening ultrasounds compared with 18.5% of screening mammograms without supplemental imaging (adjusted odds ratio, 1.35; 95% CI, 1.30-1.39); intermediate/high advanced cancer risk was prevalent in 32.0% of screening ultrasounds versus 30.5% of screening mammograms without supplemental screening (adjusted odds ratio, 0.91; 95% CI, 0.89-0.94). CONCLUSIONS Ultrasound screening was highly targeted to women with dense breasts, but only a modest proportion were at high mammography screening failure risk. A clinically significant proportion of women undergoing mammography screening alone were at high mammography screening failure risk.
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Affiliation(s)
- Brian L. Sprague
- Office of Health Promotion Research, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT
- Department of Radiology, University of Vermont Larner College of Medicine, Burlington, VT
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT
| | - Laura Ichikawa
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, Washington
| | - Joanna Eavey
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, Washington
| | - Kathryn P. Lowry
- Department of Radiology, University of Washington and Seattle Cancer Care Alliance, Seattle, WA
| | - Garth Rauscher
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Ellen S. O’Meara
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, Washington
| | - Diana L. Miglioretti
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, Washington
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA
| | - Shuai Chen
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA
| | - Janie M. Lee
- Department of Radiology, University of Washington and Seattle Cancer Care Alliance, Seattle, WA
| | - Natasha K. Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Jeanne S. Mandelblatt
- Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, DC, USA
| | - Nila Alsheik
- Advocate Caldwell Breast Center, Advocate Lutheran General Hospital, 1700 Luther Lane, Park Ridge, IL
| | - Sally D. Herschorn
- Department of Radiology, University of Vermont Larner College of Medicine, Burlington, VT
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT
| | - Hannah Perry
- Department of Radiology, University of Vermont Larner College of Medicine, Burlington, VT
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT
| | - Donald L. Weaver
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT
- Department of Pathology & Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, VT
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA
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12
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Smith KA, Hunt KN, Rauch GM, Fowler AM. Molecular Breast Imaging in the Screening Setting. JOURNAL OF BREAST IMAGING 2023; 5:240-247. [PMID: 38416886 DOI: 10.1093/jbi/wbad011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Indexed: 03/01/2024]
Abstract
Early detection of breast cancer through screening mammography saves lives. However, the sensitivity of mammography for breast cancer detection is reduced in women with dense breast tissue. Imaging modalities for supplemental breast cancer screening include MRI, whole breast US, contrast-enhanced mammography, and molecular breast imaging (MBI). Molecular breast imaging with 99mTc-sestamibi is a functional imaging test to identify metabolically active areas in the breast with positioning analogous to mammography. Since 2011, there have been six large, published studies of screening MBI as a supplement to mammography involving over 6000 women from four different institutions. A multicenter, prospective clinical trial of 3000 women comparing breast cancer detection using screening digital breast tomosynthesis alone or in combination with MBI recently completed enrollment. This review focuses on the current evidence of MBI use for supplemental breast cancer screening, the strengths and limitations of MBI, and recent technological advances.
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Affiliation(s)
| | - Katie N Hunt
- Mayo Clinic, Department of Radiology, Rochester, MN, USA
| | - Gaiane M Rauch
- The University of Texas MD Anderson Cancer Center, Department of Breast Imaging, Houston, TX, USA
- The University of Texas MD Anderson Cancer Center, Department of Abdominal Imaging, Houston, TX, USA
| | - Amy M Fowler
- University of Wisconsin School of Medicine and Public Health, Department of Radiology, Madison, WI, USA
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Department of Medical Physics, Madison, WI, USA
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13
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Edmonds CE, O'Brien SR, Conant EF. Mammographic Breast Density: Current Assessment Methods, Clinical Implications, and Future Directions. Semin Ultrasound CT MR 2023; 44:35-45. [PMID: 36792272 DOI: 10.1053/j.sult.2022.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mammographic breast density is widely accepted as an independent risk factor for the development of breast cancer. In addition, because dense breast tissue may mask breast malignancies, breast density is inversely related to the sensitivity of screening mammography. Given the risks associated with breast density, as well as ongoing efforts to stratify individual risk and personalize breast cancer screening and prevention, numerous studies have sought to better understand the factors that impact breast density, and to develop and implement reproducible, quantitative methods to assess mammographic density. Breast density assessments have been incorporated into risk assessment models to improve risk stratification. Recently, novel techniques for analyzing mammographic parenchymal complexity, or texture, have been explored as potential means of refining mammographic tissue-based risk assessment beyond breast density.
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Affiliation(s)
- Christine E Edmonds
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA.
| | - Sophia R O'Brien
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Emily F Conant
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
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14
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Pandya T, Liu Z, Dolan H, Hersch J, Brennan M, Houssami N, Nickel B. Australian Women's Responses to Breast Density Information: A Content Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1596. [PMID: 36674351 PMCID: PMC9861812 DOI: 10.3390/ijerph20021596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 06/17/2023]
Abstract
Breast density (BD) is an independent risk factor for breast cancer and reduces mammographic sensitivity. This study explored women's responses and intentions if notified that they had dense breasts. METHODS Content analysis was used to assess responses from a written questionnaire undertaken in conjunction with focus groups on BD involving 78 Australian women aged 40-74. RESULTS Half the women reported that they would feel a little anxious if notified they had dense breasts, while 29.5% would not feel anxious. The most common theme (29.5%) related to anxiety was the psychosocial impact of the possibility of developing cancer, and women believed that being better informed could help with anxiety (26.9%). When asked what they would do if notified of having dense breasts, the most common response was to consult their doctor for information/advice (38.5%), followed by considering supplemental screening (23%). Consequently, when asked directly, 65.4% were interested in undergoing supplemental screening, while others (10.3%) said they "wouldn't worry about it too much". DISCUSSION These findings have important implications for health systems with population-based breast screening programs that are currently considering widespread BD notification in terms of the impact on women, health services and primary care.
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Affiliation(s)
- Tanvi Pandya
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Zixuan Liu
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Hankiz Dolan
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Jolyn Hersch
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Meagan Brennan
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2145, Australia
- The National School of Medicine, The University of Notre Dame Australia, Sydney, NSW 2007, Australia
| | - Nehmat Houssami
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, NSW 2006, Australia
| | - Brooke Nickel
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
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15
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Madani M, Behzadi MM, Nabavi S. The Role of Deep Learning in Advancing Breast Cancer Detection Using Different Imaging Modalities: A Systematic Review. Cancers (Basel) 2022; 14:5334. [PMID: 36358753 PMCID: PMC9655692 DOI: 10.3390/cancers14215334] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 12/02/2022] Open
Abstract
Breast cancer is among the most common and fatal diseases for women, and no permanent treatment has been discovered. Thus, early detection is a crucial step to control and cure breast cancer that can save the lives of millions of women. For example, in 2020, more than 65% of breast cancer patients were diagnosed in an early stage of cancer, from which all survived. Although early detection is the most effective approach for cancer treatment, breast cancer screening conducted by radiologists is very expensive and time-consuming. More importantly, conventional methods of analyzing breast cancer images suffer from high false-detection rates. Different breast cancer imaging modalities are used to extract and analyze the key features affecting the diagnosis and treatment of breast cancer. These imaging modalities can be divided into subgroups such as mammograms, ultrasound, magnetic resonance imaging, histopathological images, or any combination of them. Radiologists or pathologists analyze images produced by these methods manually, which leads to an increase in the risk of wrong decisions for cancer detection. Thus, the utilization of new automatic methods to analyze all kinds of breast screening images to assist radiologists to interpret images is required. Recently, artificial intelligence (AI) has been widely utilized to automatically improve the early detection and treatment of different types of cancer, specifically breast cancer, thereby enhancing the survival chance of patients. Advances in AI algorithms, such as deep learning, and the availability of datasets obtained from various imaging modalities have opened an opportunity to surpass the limitations of current breast cancer analysis methods. In this article, we first review breast cancer imaging modalities, and their strengths and limitations. Then, we explore and summarize the most recent studies that employed AI in breast cancer detection using various breast imaging modalities. In addition, we report available datasets on the breast-cancer imaging modalities which are important in developing AI-based algorithms and training deep learning models. In conclusion, this review paper tries to provide a comprehensive resource to help researchers working in breast cancer imaging analysis.
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Affiliation(s)
- Mohammad Madani
- Department of Mechanical Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Computer Science and Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Mohammad Mahdi Behzadi
- Department of Mechanical Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Computer Science and Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Sheida Nabavi
- Department of Computer Science and Engineering, University of Connecticut, Storrs, CT 06269, USA
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16
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Chalfant JS, Hoyt AC. Breast Density: Current Knowledge, Assessment Methods, and Clinical Implications. JOURNAL OF BREAST IMAGING 2022; 4:357-370. [PMID: 38416979 DOI: 10.1093/jbi/wbac028] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Indexed: 03/01/2024]
Abstract
Breast density is an accepted independent risk factor for the future development of breast cancer, and greater breast density has the potential to mask malignancies on mammography, thus lowering the sensitivity of screening mammography. The risk associated with dense breast tissue has been shown to be modifiable with changes in breast density. Numerous studies have sought to identify factors that influence breast density, including age, genetic, racial/ethnic, prepubertal, adolescent, lifestyle, environmental, hormonal, and reproductive history factors. Qualitative, semiquantitative, and quantitative methods of breast density assessment have been developed, but to date there is no consensus assessment method or reference standard for breast density. Breast density has been incorporated into breast cancer risk models, and there is growing consciousness of the clinical implications of dense breast tissue in both the medical community and public arena. Efforts to improve breast cancer screening sensitivity for women with dense breasts have led to increased attention to supplemental screening methods in recent years, prompting the American College of Radiology to publish Appropriateness Criteria for supplemental screening based on breast density.
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Affiliation(s)
- James S Chalfant
- David Geffen School of Medicine at University of California, Los Angeles, Department of Radiological Sciences, Santa Monica, CA, USA
| | - Anne C Hoyt
- David Geffen School of Medicine at University of California, Los Angeles, Department of Radiological Sciences, Santa Monica, CA, USA
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17
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Elezaby MA. Impact of a Deep Learning Model for Predicting Mammographic Breast Density in Routine Clinical Practice: A Methodologic Framework for Clinical Testing of Artificial Intelligence Tools. J Am Coll Radiol 2022; 19:1031-1033. [PMID: 35690078 DOI: 10.1016/j.jacr.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Mai A Elezaby
- Associate Section Chief, Breast Imaging and Intervention Section, Associate Program Director, Breast Imaging Fellowship, and Associate Program Director, Diagnostic Radiology Residency, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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18
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Dolan H, McCaffery K, Houssami N, Cvejic E, Brennan M, Hersch J, Dorrington M, Verde A, Vaccaro L, Nickel B. Australian Women's Intentions and Psychological Outcomes Related to Breast Density Notification and Information: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2216784. [PMID: 35708691 PMCID: PMC9204548 DOI: 10.1001/jamanetworkopen.2022.16784] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Whether the benefits of notifying women about breast density outweigh the potential harms to inform current and future mammogram screening practice remains unknown. OBJECTIVE To assess the effect of mammographic breast density notification and information provision on women's intention to seek supplemental screening and psychological outcomes. DESIGN, SETTING, AND PARTICIPANTS A 3-arm online randomized clinical trial was conducted from August 10 to 31, 2021. Data analysis was conducted from September 1 to October 20, 2021. Participants included Australian residents identifying as female, aged between 40 and 74 years, with no history of breast cancer who were residing in jurisdictions without existing breast density notification with screening mammograms. INTERVENTIONS Women were randomized to receive 1 of the following hypothetical breast screening test result letters: screening mammogram result letter without breast density messaging (control), screening mammogram result letter with breast density messaging and an existing density information letter taken from a screening service in Australia (intervention 1), and screening mammogram result letter with breast density messaging and a health literacy-sensitive version of the letter adapted for people with lower health literacy (intervention 2). MAIN OUTCOMES AND MEASURES Primary outcomes were intention to seek supplemental screening; feeling anxious (uneasy, worried, or nervous), informed, or confused; and having breast cancer worry. RESULTS A total of 1420 Australian women were randomized and included in the final analysis. The largest group consisted of 603 women aged 60 to 74 years (42.5%). Compared with the control cohort (n = 480), women who received density notification via intervention 1 (n = 470) and intervention 2 (n = 470) reported a significantly higher intention to seek supplemental screening (0.8% vs 15.6% and 14.2%; P < .001) and feeling anxious (14.2% vs 49.4% and 48.5%; P < .001), confusion (7.8% vs 24.0% and 23.6%; P < .001), and worry about breast cancer (quite/very worried: 6.9% vs 17.2% and 15.5%; P < .001). There were no statistically significant differences in these outcomes between the 2 intervention groups. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, breast density notification and information integrated with screening mammogram results increased women's intention to seek supplemental screening and made women feel anxious, confused, or worried about breast cancer. These findings have relevance and implications for mammogram screening services and policy makers considering whether and, if so, how best to implement widespread notification of breast density as part of mammography screening. TRIAL REGISTRATION ACTRN12621000253808.
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Affiliation(s)
- Hankiz Dolan
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Nehmat Houssami
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Erin Cvejic
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Meagan Brennan
- University of Notre Dame Australia, School of Medicine Sydney, Sydney, Australia
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Sydney, Australia
| | - Jolyn Hersch
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Angela Verde
- Breast Cancer Network Australia, Melbourne, Australia
| | - Lisa Vaccaro
- Health Consumers New South Wales, Sydney, Australia
- Discipline of Behavioural and Social Sciences in Health, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Brooke Nickel
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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19
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Ryser MD, Lange J, Inoue LYT, O'Meara ES, Gard C, Miglioretti DL, Bulliard JL, Brouwer AF, Hwang ES, Etzioni RB. Estimation of Breast Cancer Overdiagnosis in a U.S. Breast Screening Cohort. Ann Intern Med 2022; 175:471-478. [PMID: 35226520 PMCID: PMC9359467 DOI: 10.7326/m21-3577] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Mammography screening can lead to overdiagnosis-that is, screen-detected breast cancer that would not have caused symptoms or signs in the remaining lifetime. There is no consensus about the frequency of breast cancer overdiagnosis. OBJECTIVE To estimate the rate of breast cancer overdiagnosis in contemporary mammography practice accounting for the detection of nonprogressive cancer. DESIGN Bayesian inference of the natural history of breast cancer using individual screening and diagnosis records, allowing for nonprogressive preclinical cancer. Combination of fitted natural history model with life-table data to predict the rate of overdiagnosis among screen-detected cancer under biennial screening. SETTING Breast Cancer Surveillance Consortium (BCSC) facilities. PARTICIPANTS Women aged 50 to 74 years at first mammography screen between 2000 and 2018. MEASUREMENTS Screening mammograms and screen-detected or interval breast cancer. RESULTS The cohort included 35 986 women, 82 677 mammograms, and 718 breast cancer diagnoses. Among all preclinical cancer cases, 4.5% (95% uncertainty interval [UI], 0.1% to 14.8%) were estimated to be nonprogressive. In a program of biennial screening from age 50 to 74 years, 15.4% (UI, 9.4% to 26.5%) of screen-detected cancer cases were estimated to be overdiagnosed, with 6.1% (UI, 0.2% to 20.1%) due to detecting indolent preclinical cancer and 9.3% (UI, 5.5% to 13.5%) due to detecting progressive preclinical cancer in women who would have died of an unrelated cause before clinical diagnosis. LIMITATIONS Exclusion of women with first mammography screen outside BCSC. CONCLUSION On the basis of an authoritative U.S. population data set, the analysis projected that among biennially screened women aged 50 to 74 years, about 1 in 7 cases of screen-detected cancer is overdiagnosed. This information clarifies the risk for breast cancer overdiagnosis in contemporary screening practice and should facilitate shared and informed decision making about mammography screening. PRIMARY FUNDING SOURCE National Cancer Institute.
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Affiliation(s)
- Marc D Ryser
- Department of Population Health Sciences, Duke University Medical Center, and Department of Mathematics, Duke University, Durham, North Carolina (M.D.R.)
| | - Jane Lange
- Center for Early Detection Advanced Research, Knight Cancer Institute, Oregon Health Sciences University, Portland, Oregon (J.L.)
| | - Lurdes Y T Inoue
- Department of Biostatistics, University of Washington, Seattle, Washington (L.Y.I.)
| | - Ellen S O'Meara
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (E.S.O.)
| | - Charlotte Gard
- Department of Economics, Applied Statistics, and International Business, New Mexico State University, Las Cruces, New Mexico (C.G.)
| | - Diana L Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, Davis, California, and Kaiser Permanente Washington Health Research Institute, Seattle, Washington (D.L.M.)
| | - Jean-Luc Bulliard
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland (J.B.)
| | - Andrew F Brouwer
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan (A.F.B.)
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina (E.S.H.)
| | - Ruth B Etzioni
- Program in Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, Washington (R.B.E.)
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20
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Differential detection by breast density for digital breast tomosynthesis versus digital mammography population screening: a systematic review and meta-analysis. Br J Cancer 2022; 127:116-125. [PMID: 35352019 PMCID: PMC9276736 DOI: 10.1038/s41416-022-01790-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 02/27/2022] [Accepted: 03/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background We examined whether digital breast tomosynthesis (DBT) detects differentially in high- or low-density screens. Methods We searched six databases (2009–2020) for studies comparing DBT and digital mammography (DM), and reporting cancer detection rate (CDR) and/or recall rate by breast density. Meta-analysis was performed to pool incremental CDR and recall rate for DBT (versus DM) for high- and low-density (dichotomised based on BI-RADS) and within-study differences in incremental estimates between high- and low-density. Screening settings (European/US) were compared. Results Pooled within-study difference in incremental CDR for high- versus low-density was 1.0/1000 screens (95% CI: 0.3, 1.6; p = 0.003). Estimates were not significantly different in US (0.6/1000; 95% CI: 0.0, 1.3; p = 0.05) and European (1.9/1000; 95% CI: 0.3, 3.5; p = 0.02) settings (p for subgroup difference = 0.15). For incremental recall rate, within-study differences between density subgroups differed by setting (p < 0.001). Pooled incremental recall was less in high- versus low-density screens (−0.9%; 95% CI: −1.4%, −0.4%; p < 0.001) in US screening, and greater (0.8%; 95% CI: 0.3%, 1.3%; p = 0.001) in European screening. Conclusions DBT has differential incremental cancer detection and recall by breast density. Although incremental CDR is greater in high-density, a substantial proportion of additional cancers is likely to be detected in low-density screens. Our findings may assist screening programmes considering DBT for density-tailored screening.
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21
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The Conundrum of Breast Density; Guidance for Healthcare Providers. Best Pract Res Clin Obstet Gynaecol 2022; 83:24-35. [DOI: 10.1016/j.bpobgyn.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/24/2022] [Accepted: 01/31/2022] [Indexed: 11/18/2022]
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22
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Nickel B, Houssami N. Improving Breast Density Communication: Does the Provision of Complex Health Information Online Work? J Womens Health (Larchmt) 2021; 30:1527-1528. [PMID: 34520271 DOI: 10.1089/jwh.2021.0388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Brooke Nickel
- Wiser Healthcare and Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Health Literacy Lab, Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nehmat Houssami
- Wiser Healthcare and Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
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23
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Bovbjerg ML. Current Resources for Evidence-Based Practice, September 2021. J Obstet Gynecol Neonatal Nurs 2021; 50:642-654. [PMID: 34437841 DOI: 10.1016/j.jogn.2021.08.095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes an assessment of safety of birth centers in the United States and commentaries on reviews focused on aspirin prophylaxis in pregnancy and the new gestational weight gain evidence summary from the United States Preventive Services Task Force.
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