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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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2
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Kothari P, Tseng JJ, Chalfant JS, Pittman SM, Hoyt AC, Larsen L, Sheth P, Yamashita M, Downey J, Ikeda DM. Breast Density Legislation Impact on Breast Cancer Screening and Risk Assessment. JOURNAL OF BREAST IMAGING 2022; 4:371-377. [PMID: 38416983 DOI: 10.1093/jbi/wbac034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To evaluate breast density notification legislation (BDNL) on breast imaging practice patterns, risk assessment, and supplemental screening. METHODS A 20-question anonymous web-based survey was administered to practicing Society of Breast Imaging radiologists in the U.S. between February and April 2021 regarding breast cancer risk assessment, supplemental screening, and density measurements. Results were compared between facilities with and without BDNL using the two-sided Fisher's exact test. RESULTS One hundred and ninety-seven radiologists from 41 U.S. states, with (187/197, 95%) or without (10/197, 5%) BDNL, responded. Fifty-seven percent (113/197) performed breast cancer risk assessment, and 93% (183/197) offered supplemental screening for women with dense breasts. Between facilities with or without BDNL, there was no significant difference in whether risk assessment was (P = 0.19) or was not performed (P = 0.20). There was no significant difference in supplemental screening types (P > 0.05) between BDNL and non-BDNL facilities. Thirty-five percent (69/197) of facilities offered no supplemental screening studies, and 25% (49/197) had no future plans to offer supplemental screening. A statistically significant greater proportion of non-BDNL facilities offered no supplemental screening (P < 0.03) and had no plans to offer supplemental screening compared to BDNL facilities (P < 0.02). CONCLUSION Facilities in BDNL states often offer supplemental screening compared to facilities in non-BDNL states. Compared to BDNL facilities, a statistically significant proportion of non-BDNL facilities had no supplemental screening nor plans for implementation. Our data suggest that upcoming federal BDNL will impact how supplemental screening is addressed in currently non-BDNL states.
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Affiliation(s)
- Pranay Kothari
- Scripps Health, Department of Radiology, San Diego, CA, USA
| | - Joseph J Tseng
- Stanford University School of Medicine, Department of Radiology, Stanford, CA, USA
| | - James S Chalfant
- David Geffen School of Medicine at University of California Los Angeles, Department of Radiological Sciences, Santa Monica, CA, USA
| | - Sarah M Pittman
- Stanford University School of Medicine, Department of Radiology, Stanford, CA, USA
| | - Anne C Hoyt
- David Geffen School of Medicine at University of California Los Angeles, Department of Radiological Sciences, Santa Monica, CA, USA
| | - Linda Larsen
- University of Southern California, Department of Radiology, Los Angeles, CA, USA
| | - Pulin Sheth
- University of Southern California, Department of Radiology, Los Angeles, CA, USA
| | - Mary Yamashita
- University of Southern California, Department of Radiology, Los Angeles, CA, USA
| | - John Downey
- Kaiser Permanente Medical Center, Department of Radiology, Walnut Creek, CA, USA
| | - Debra M Ikeda
- Stanford University School of Medicine, Department of Radiology, Stanford, CA, USA
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3
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Elezaby MA, Mao L, Burnside E, Zuley ML, Berg WA, Bhargavan-Chatfield M, Lee CS. Utilization and Cancer Yield of Probably Benign Assessment Category in the National Mammography Database: 2009 to 2018. J Am Coll Radiol 2022; 19:604-614. [DOI: 10.1016/j.jacr.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/21/2022] [Accepted: 01/30/2022] [Indexed: 10/18/2022]
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Pirikahu S, Lund H, Cadby G, Wylie E, Stone J. The impact of breast density notification on rescreening rates within a population-based mammographic screening program. Breast Cancer Res 2022; 24:5. [PMID: 35033155 PMCID: PMC8760641 DOI: 10.1186/s13058-021-01499-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High participation in mammographic screening is essential for its effectiveness to detect breast cancers early and thereby, improve breast cancer outcomes. Breast density is a strong predictor of breast cancer risk and significantly reduces the sensitivity of mammography to detect the disease. There are increasing mandates for routine breast density notification within mammographic screening programs. It is unknown if breast density notification impacts the likelihood of women returning to screening when next due (i.e. rescreening rates). This study investigates the association between breast density notification and rescreening rates using individual-level data from BreastScreen Western Australia (WA), a population-based mammographic screening program. METHODS We examined 981,705 screening events from 311,656 women aged 40+ who attended BreastScreen WA between 2008 and 2017. Mixed effect logistic regression was used to investigate the association between rescreening and breast density notification status. RESULTS Results were stratified by age (younger, targeted, older) and screening round (first, second, third+). Targeted women screening for the first time were more likely to return to screening if notified as having dense breasts (Percentunadjusted notified vs. not-notified: 57.8% vs. 56.1%; Padjusted = 0.016). Younger women were less likely to rescreen if notified, regardless of screening round (all P < 0.001). There was no association between notification and rescreening in older women (all P > 0.72). CONCLUSIONS Breast density notification does not deter women in the targeted age range from rescreening but could potentially deter younger women from rescreening. These results suggest that all breast density notification messaging should include information regarding the importance of regular mammographic screening to manage breast cancer risk, particularly for younger women. These results will directly inform BreastScreen programs in Australia as well as other population-based screening providers outside Australia who notify women about breast density or are considering implementing breast density notification.
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Affiliation(s)
- Sarah Pirikahu
- Genetic Epidemiology Group, School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, M431, Crawley, Perth, WA, 6009, Australia
| | - Helen Lund
- BreastScreen Western Australia, Women and Newborn Health Service, Perth, WA, Australia
| | - Gemma Cadby
- Genetic Epidemiology Group, School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, M431, Crawley, Perth, WA, 6009, Australia
| | - Elizabeth Wylie
- BreastScreen Western Australia, Women and Newborn Health Service, Perth, WA, Australia.,School of Medicine, The University of Western Australia, Perth, WA, Australia
| | - Jennifer Stone
- Genetic Epidemiology Group, School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, M431, Crawley, Perth, WA, 6009, Australia.
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5
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Huang S, Houssami N, Brennan M, Nickel B. The impact of mandatory mammographic breast density notification on supplemental screening practice in the United States: a systematic review. Breast Cancer Res Treat 2021; 187:11-30. [PMID: 33774734 DOI: 10.1007/s10549-021-06203-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/17/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Dense breast tissue is an independent risk factor for breast cancer and lowers the sensitivity of screening mammography. Supplemental screening with ultrasound or MRI improves breast cancer detection rate but has potential harms. Breast density notification (BDN) legislation has been introduced in the United States (US) and its impact on supplemental screening practice is unclear. This study systematically reviewed current evidence to explore the impact of BDN on supplemental screening practice in the US. METHODS Medline, PubMed, Embase, Cochrane and the Cinhal Library databases were searched (2009-August 2020). Studies were assessed for eligibility, data were extracted and summarised, and study quality was evaluated. RESULTS Evidence from the included studies (n = 14) predominantly showed that BDN legislation increased the overall utilisation of supplemental screening by 0.5-143%. This effect was amplified if the notification included a follow-up telephone call informing women about additional screening benefits, and if the state's law mandated insurance cover for supplemental screening. Likelihood of supplemental screening was also influenced by history of breast biopsy and family history of breast cancer, race, age, socioeconomic status, density category, and physician's specialty and region. Some studies reported increases in biopsy rate (up to 4%) and cancer detection rate (up to 11%) after implementation of BDN legislation. CONCLUSION BDN leads to increased use of supplemental screening. This has implications for women and the health system. These findings can help inform current and future screening programs, where breast density notification is currently implemented or being considered.
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Affiliation(s)
- Shuangqin Huang
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Nehmat Houssami
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Meagan Brennan
- School of Medicine Sydney, University of Notre Dame Australia, Oxford St, Darlinghurst, NSW, Australia.
- Westmead Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Brooke Nickel
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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6
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Marsh MW, Benefield TS, Lee S, Pritchard M, Earnhardt K, Agans R, Henderson LM. Availability Versus Utilization of Supplemental Breast Cancer Screening Post Passage of Breast Density Legislation. J Womens Health (Larchmt) 2020; 30:579-586. [PMID: 32960137 DOI: 10.1089/jwh.2020.8528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Despite the lack of evidence that supplemental screening in women with dense breasts reduces breast cancer mortality, 38 states have passed breast density legislation, with some including recommendations for supplemental screening. The objective of this study is to compare the availability versus use of supplemental breast cancer screening modalities and determine factors driving use of supplemental screening in rural versus urban settings. Methods: A 50-item mailed survey using the Tailored Design Method was sent to American College of Radiology mammography-accredited facilities in North Carolina in 2017. Respondents included 94 facilities (48 rural and 46 urban locations). Survey questions focused on breast cancer and supplemental screening services, breast density, risk factors/assessment, and facility demographics. Results: The survey response rate was 60.3% (94/156). Among the 94 respondents, 64.0% (n = 60) reported availability of any type of supplemental screening (digital breast tomosynthesis [DBT], ultrasound, or magnetic resonance imaging [MRI]). In facilities where supplemental screening modalities were available, the most commonly utilized supplemental screening modality was DBT (96.4%), compared with ultrasound (35.7%) and MRI (46.7%). Facilities reported using supplemental screening based on patient breast density (48.3%), referring physician recommendation (63.3%), reading radiologist recommendation (63.3%), breast cancer risk factors (48.3%), and patient request (40.0%). Urban facilities were more likely than rural facilities to base supplemental screening on breast cancer risk factors (62.5% vs. 32.1%; p-value = 0.019), referring physician (75.0% vs. 50.0%; p-value = 0.045), and reading radiologist (78.1% vs. 46.4%; p-value = 0.011). Conclusion: In our study, supplemental screening modalities were widely available, with facilities more likely to use DBT for supplemental screening compared to other modalities.
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Affiliation(s)
- Mary W Marsh
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thad S Benefield
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sheila Lee
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael Pritchard
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katie Earnhardt
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Robert Agans
- Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Louise M Henderson
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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7
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Seitzman RL, Pushkin J, Berg WA. Radiologic Technologist and Radiologist Knowledge Gaps about Breast Density Revealed by an Online Continuing Education Course. JOURNAL OF BREAST IMAGING 2020; 2:315-329. [PMID: 38424967 DOI: 10.1093/jbi/wbaa039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE We sought to identify provider knowledge gaps and their predictors, as revealed by a breast density continuing education course marketed to the radiology community. METHODS The course, continually available online during the study period of November 2, 2016 and December 31, 2018, includes demographics collection; a monograph on breast density, breast cancer risk, and screening; and a post-test. Four post-test questions were modified during the study period, resulting in different sample sizes pre- and postmodification. Multiple logistic regression was used to identify predictors of knowledge gaps (defined as > 25% of responses incorrect). RESULTS Of 1649 analyzable registrants, 1363 (82.7%) were radiologic technologists, 226 (13.7%) were physicians, and 60 (3.6%) were other nonphysicians; over 90% of physicians and over 90% of technologists/nonphysicians specialized in radiology. Sixteen of 49 physicians (32.7%) and 80/233 (34.3%) technologists/nonphysicians mistakenly thought the Gail model should be used to determine "high-risk" status for recommending MRI or genetic testing. Ninety-nine of 226 (43.8%) physicians and 682/1423 (47.9%) technologists/nonphysicians misunderstood the inverse relationship between increasing age and lifetime breast cancer risk. Fifty-two of 166 (31.3%) physicians and 549/1151 (47.7%) technologists/nonphysicians were unaware that MRI should be recommended for women with a family history of BRCA1/BRCA2 mutations. Tomosynthesis effectiveness was overestimated, with 18/60 (30.0%) physicians and 95/272 (34.9%) technologists/nonphysicians believing sensitivity nearly equaled MRI. Knowledge gaps were more common in technologists/nonphysicians. CONCLUSIONS Important knowledge gaps about breast density, breast cancer risk assessment, and screening exist among radiologic technologists and radiologists. Continued education efforts may improve appropriate breast cancer screening recommendations.
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Affiliation(s)
- Robin L Seitzman
- Seitzman Consulting, San Diego, CA
- DenseBreast-info, Inc., Deer Park, NY
| | | | - Wendie A Berg
- DenseBreast-info, Inc., Deer Park, NY
- University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Department of Radiology, Pittsburgh, PA
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8
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Aminawung JA, Hoag JR, Kyanko KA, Xu X, Richman IB, Busch SH, Gross CP. Breast cancer supplemental screening: Women's knowledge and utilization in the era of dense breast legislation. Cancer Med 2020; 9:5662-5671. [PMID: 32537899 PMCID: PMC7402830 DOI: 10.1002/cam4.3218] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 05/07/2020] [Accepted: 05/24/2020] [Indexed: 01/24/2023] Open
Abstract
Background Given the growth in dense breast notification (DBN) legislation in the United States, we examined the association between different types of DBN laws and supplemental screening behaviors among women. Methods We surveyed in March–April 2018 a nationally representative sample of women aged 40‐59 years who received a routine screening mammogram in the past 18 months. Survey items included the following topics regarding supplemental screening: discussing risks or benefits with a provider, knowledge about the risk of false positives, and utilization. We grouped women by state DBN into non‐DBN, generic DBN (mentions breast density but not supplemental screening), DBN that mentions supplemental screening (DBN‐SS), and DBN with mandated insurance coverage for supplemental screening (DBN‐coverage), and estimated adjusted predicted probabilities for supplemental screening behaviors. Results Of 1641 women surveyed, 21.3% resided in non‐DBN, 41.2% in generic DBN, 25.8% in DBN‐SS, and 12.5% in DBN‐coverage states. Overall, 23.0% of respondents had discussed supplemental screening with a provider, 11.3% of whom discussed the risks, and 49.5% discussed the benefits. In adjusted analysis, women living in DBN‐coverage states were more likely to discuss supplemental screening (27.5%) than women in non‐DBN states (13.6%); pairwise contrast 13.8% (95% CI, 2.1% to 25.6%; P = .01). They were also more likely to have received supplemental screening for increased breast density (19.3%) compared to women living in non‐DBN (9.9%); contrast 9.4% (95% CI, 1.6% to 17.3%; P = .01), Generic DBN (7.3%); difference 12.0% (95% CI, 4.6% to 19.4%; P =< .001), and DBN‐SS (8.8%); contrast 10.5% (95% CI, 2.6% to 18.5%; P < .01) states. Conclusions Women in DBN‐coverage states were more likely to discuss supplemental screening with their providers, and to undergo supplemental screening, compared to women in states with other types of DBN laws, or without DBN laws.
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Affiliation(s)
- Jenerius A Aminawung
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA.,Department of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jessica R Hoag
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA
| | - Kelly A Kyanko
- Department of Population Health, New York University School of Medicine, New York City, NY, USA
| | - Xiao Xu
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Ilana B Richman
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA.,Department of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Susan H Busch
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA.,Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Cary P Gross
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA.,Department of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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9
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Screening Breast Ultrasound: Update After 10 Years of Breast Density Notification Laws. AJR Am J Roentgenol 2020; 214:1424-1435. [DOI: 10.2214/ajr.19.22275] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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10
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Chough DM, Berg WA, Bandos AI, Rathfon GY, Hakim CM, Lu AH, Gizienski TA, Ganott MA, Gur D. A Prospective Study of Automated Breast Ultrasound Screening of Women with Dense Breasts in a Digital Breast Tomosynthesis-based Practice. JOURNAL OF BREAST IMAGING 2020; 2:125-133. [PMID: 38424893 DOI: 10.1093/jbi/wbaa006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To assess prospectively the interpretative performance of automated breast ultrasound (ABUS) as a supplemental screening after digital breast tomosynthesis (DBT) or as a standalone screening of women with dense breast tissue. METHODS Under an IRB-approved protocol (written consent required), women with dense breasts prospectively underwent concurrent baseline DBT and ABUS screening. Examinations were independently evaluated, in opposite order, by two of seven Mammography Quality Standards Act-qualified radiologists, with the primary radiologist arbitrating disagreements and making clinical management recommendations. We report results for 1111 screening examinations (598 first year and 513 second year) for which all diagnostic workups are complete. Imaging was also retrospectively reviewed for all cancers. Statistical assessments used a 0.05 significance level and accounted for correlation between participants' examinations. RESULTS Of 1111 women screened, primary radiologists initially "recalled" based on DBT alone (6.6%, 73/1111, CI: 5.2%-8.2%), of which 20 were biopsied, yielding 6/8 total cancers. Automated breast ultrasound increased recalls overall to 14.4% (160/1111, CI: 12.4%-16.6%), with 27 total biopsies, yielding 1 additional cancer. Double reading of DBT alone increased the recall rate to 10.7% (119/1111), with 21 biopsies, with no improvement in cancer detection. Double reading ABUS increased the recall rate to 15.2% (169/1111, CI: 13.2%-17.5%) of women, of whom 22 were biopsied, yielding the detection of 7 cancers, including one seen only on double reading ABUS. Inter-radiologist agreement was similar for recall recommendations from DBT (κ = 0.24, CI: 0.14-0.34) and ABUS (κ = 0.23, CI: 0.15-0.32). Integrated assessments from both readers resulted in a recall rate of 15.1% (168/1111, CI: 13.1%-17.4%). CONCLUSION Supplemental or standalone ABUS screening detected cancers not seen on DBT, but substantially increased noncancer recall rates.
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Affiliation(s)
- Denise M Chough
- University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Department of Radiology, Pittsburgh, PA
| | - Wendie A Berg
- University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Department of Radiology, Pittsburgh, PA
| | - Andriy I Bandos
- University of Pittsburgh, Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA
| | | | - Christiane M Hakim
- University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Department of Radiology, Pittsburgh, PA
| | - Amy H Lu
- University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Department of Radiology, Pittsburgh, PA
| | - Terri-Ann Gizienski
- University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Department of Radiology, Pittsburgh, PA
| | - Marie A Ganott
- University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Department of Radiology, Pittsburgh, PA
| | - David Gur
- University of Pittsburgh School of Medicine, Department of Radiology, Radiology Imaging Research, Pittsburgh, PA
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11
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Nyante SJ, Marsh MW, Benefield T, Earnhardt K, Lee SS, Henderson LM. Supplemental Breast Imaging Utilization After Breast Density Legislation in North Carolina. J Am Coll Radiol 2020; 17:6-14. [PMID: 31271735 PMCID: PMC6938553 DOI: 10.1016/j.jacr.2019.05.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Breast density notification laws are increasingly common but little is known of how they affect supplemental screening use. The aim of this study was to investigate supplemental screening before and after density notification in North Carolina, where notification has been required since 2014. METHODS Breast screening data from Carolina Mammography Registry participants aged 40 to 79 years with no personal histories of breast cancer or breast implants were evaluated. Supplemental screening was defined as a nondiagnostic digital breast tomosynthesis (DBT), whole-breast ultrasound, or breast MRI performed within 3 months of negative or benign results on screening mammography (2-D or DBT). Supplemental screening before (2012-2013) and after (2014-2016) the notification law was compared using logistic regression. RESULTS During the study period, 78,967 women underwent 145,279 index screening mammographic examinations. Supplemental screening use was similar before and after the notification law, regardless of breast density (dense breasts: adjusted odds ratio [aOR], 1.01; 95% confidence interval [CI], 0.58-1.75; nondense breasts: aOR, 0.63; 95% CI, 0.38-1.04). Although there was no change in supplemental screening, new use of any screening DBT from 2014 to 2016 was greater for women with dense breasts (versus nondense breasts; aOR, 1.15; 95% CI, 1.08-1.23). CONCLUSIONS Data suggest that supplemental screening use in North Carolina did not change after enactment of a breast density notification law, though the increase in new use of any screening DBT was greater for women with dense breasts. The short-term lack of change in supplemental screening should be considered as additional notification laws are developed.
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Affiliation(s)
- Sarah J Nyante
- Department of Radiology and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Mary W Marsh
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Thad Benefield
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathryn Earnhardt
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sheila S Lee
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Louise M Henderson
- Department of Radiology and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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12
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Lee JM, Arao RF, Sprague BL, Kerlikowske K, Lehman CD, Smith RA, Henderson LM, Rauscher GH, Miglioretti DL. Performance of Screening Ultrasonography as an Adjunct to Screening Mammography in Women Across the Spectrum of Breast Cancer Risk. JAMA Intern Med 2019; 179:658-667. [PMID: 30882843 PMCID: PMC6503561 DOI: 10.1001/jamainternmed.2018.8372] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Whole-breast ultrasonography has been advocated to supplement screening mammography to improve outcomes in women with dense breasts. OBJECTIVE To determine the performance of screening mammography plus screening ultrasonography compared with screening mammography alone in community practice. DESIGN, SETTING, AND PARTICIPANTS Observational cohort study. Two Breast Cancer Surveillance Consortium registries provided prospectively collected data on screening mammography with vs without same-day breast ultrasonography from January 1, 2000, to December 31, 2013. The dates of analysis were March 2014 to December 2018. A total of 6081 screening mammography plus same-day screening ultrasonography examinations in 3386 women were propensity score matched 1:5 to 30 062 screening mammograms without screening ultrasonography in 15 176 women from a sample of 113 293 mammograms. Exclusion criteria included a personal history of breast cancer and self-reported breast symptoms. EXPOSURES Screening mammography with vs without screening ultrasonography. MAIN OUTCOMES AND MEASURES Cancer detection rate and rates of interval cancer, false-positive biopsy recommendation, short-interval follow-up, and positive predictive value of biopsy recommendation were estimated and compared using log binomial regression. RESULTS Screening mammography with vs without ultrasonography examinations was performed more often in women with dense breasts (74.3% [n = 4317 of 5810] vs 35.9% [n = 39 928 of 111 306] in the overall sample), in women who were younger than 50 years (49.7% [n = 3022 of 6081] vs 31.7% [n = 16 897 of 112 462]), and in women with a family history of breast cancer (42.9% [n = 2595 of 6055] vs 15.0% [n = 16 897 of 112 462]). While 21.4% (n = 1154 of 5392) of screening ultrasonography examinations were performed in women with high or very high (≥2.50%) Breast Cancer Surveillance Consortium 5-year risk scores, 53.6% (n = 2889 of 5392) had low or average (<1.67%) risk. Comparing mammography plus ultrasonography with mammography alone, the cancer detection rate was similar at 5.4 vs 5.5 per 1000 screens (adjusted relative risk [RR], 1.14; 95% CI, 0.76-1.68), as were interval cancer rates at 1.5 vs 1.9 per 1000 screens (RR, 0.67; 95% CI, 0.33-1.37). The false-positive biopsy rates were significantly higher at 52.0 vs 22.2 per 1000 screens (RR, 2.23; 95% CI, 1.93-2.58), as was short-interval follow-up at 3.9% vs 1.1% (RR, 3.10; 95% CI, 2.60-3.70). The positive predictive value of biopsy recommendation was significantly lower at 9.5% vs 21.4% (RR, 0.50; 95% CI, 0.35-0.71). CONCLUSIONS AND RELEVANCE In a relatively young population of women at low, intermediate, and high breast cancer risk, these results suggest that the benefits of supplemental ultrasonography screening may not outweigh associated harms.
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Affiliation(s)
- Janie M Lee
- Department of Radiology, University of Washington, Seattle
| | - Robert F Arao
- Kaiser Permanente Washington Health Research Institute, Seattle.,Department of Psychiatry and Behavioral Science, University of Washington, Seattle
| | - Brian L Sprague
- Office of Health Promotion Research, Department of Surgery, College of Medicine, University of Vermont, Burlington
| | - Karla Kerlikowske
- General Internal Medicine Section, Department of Medicine, Department of Veterans Affairs, San Francisco, California.,Department of Epidemiology and Biostatistics, Department of Veterans Affairs, San Francisco, California.,University of California, San Francisco
| | - Constance D Lehman
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Robert A Smith
- Cancer Control Department, American Cancer Society, Atlanta, Georgia
| | - Louise M Henderson
- Department of Radiology, The University of North Carolina at Chapel Hill
| | - Garth H Rauscher
- Department of Epidemiology, School of Public Health, University of Illinois at Chicago
| | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, Seattle.,Department of Public Health Sciences, School of Medicine, University of California, Davis
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13
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Use of Contrast-Enhanced MRI in Management of Discordant Core Biopsy Results. AJR Am J Roentgenol 2019; 212:1157-1165. [PMID: 30835519 DOI: 10.2214/ajr.18.20157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE. Evaluating concordance between core biopsy results and imaging findings is an integral component of breast intervention. Pathologic results deemed benign discordant reflect concern that a malignancy may have been incorrectly sampled. Standard of care currently is surgical excision, although a large percentage of these lesions will be benign at final pathologic analysis. The purpose of this study was to determine whether inclusion of contrast-enhanced MRI would optimize patient care. MATERIALS AND METHODS. Forty-five patients with 46 lesions were identified who underwent contrast-enhanced MRI after receiving discordant ultrasound or stereotactic biopsy results between 2012 and mid 2018. These findings were classified BI-RADS category 4 at diagnostic imaging. Disease-positive was defined as all malignancies and borderline lesions. RESULTS. Fourteen patients had suspicious MRI findings; 31 patients did not. Negative or benign MRI findings were validated by stability at imaging follow-up of at least 1 year in 27 patients (28 lesions) and at least 6 months in four patients. Eight of the total of 46 discordant lesions were ultimately malignant, a rate of 17.3%, an expected result for BI-RADS 4 lesions. Sensitivity, specificity, positive predictive value, and negative predictive value of MRI calculated in the group of 41 patients (42 lesions) with documented stability for at least 1 year were 100%, 93.3%, 85.7%, and 100%. The false-negative rate of MRI was 0%; the false-positive rate was 2 of 30 (6.7%). CONCLUSION. In the management of discordant benign core biopsy results, contrast-enhanced MRI facilitated successful triage of patients to surgery; 31 of the original 45 patients (68.9%) avoided surgery.
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14
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Characteristics of State Policies Impact Health Care Delivery: An Analysis of Mammographic Dense Breast Notification and Insurance Legislation. Med Care 2019; 56:798-804. [PMID: 30036236 DOI: 10.1097/mlr.0000000000000967] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Increased breast tissue density may mask cancer and thus decrease the diagnostic sensitivity of mammography. A patient group advocacy led to the implementation of laws to increase the awareness of breast tissue density and to improve access to supplemental imaging in many states. Given limited evidence about best practices, variation exists in several characteristics of adopted policies. OBJECTIVE To identify which characteristics of state-level policies with regard to dense breast tissue were associated with increased use of downstream breast ultrasound. RESEARCH DESIGN This was a retrospective series of monthly cross-sections of screening mammography procedures before and after implementation of laws. SUBJECTS A sample of 13,481,554 screening mammography procedures extracted from the MarketScan Research database performed between 2007 and 2014 on privately insured women aged 40-64 years that resided in a state that had implemented relevant legislation during that period. MEASURES The outcome was an indicator of whether breast ultrasound imaging followed a screening mammography procedure within 30 days. The main independent variables were policy characteristics indicators. RESULTS Notification of patients about issues surrounding increased breast density was associated with increased follow-up by ultrasound by 1.02 percentage points (P=0.016). Some policy characteristics such as the explicit suggestion of supplemental imaging or mandated coverage of supplemental imaging by health insurance augmented that effect. Other policy characteristics moderated the effect. CONCLUSIONS The heterogeneous effect of state legislation with regard to dense breast tissue on screening mammography follow-up by ultrasound may be explained by specific and unique characteristics of the approaches taken by a variety of states.
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15
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Mainiero MB, Parikh JR. Recognizing and Overcoming Burnout in Breast Imaging. JOURNAL OF BREAST IMAGING 2019; 1:60-63. [PMID: 38424870 DOI: 10.1093/jbi/wby003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Burnout is a psychological syndrome created by chronic job stress, and it is typified by emotional exhaustion, depersonalization, and feelings of decreased personal accomplishment. In physicians, burnout occurs at alarming rates, and it is on the rise. High burnout rates are ubiquitous in radiology across multiple subspecialties. We know of no study specifically examining burnout among breast imaging radiologists, but given the rates across multiple specialties in radiology, we must assume that a significant portion of breast imaging radiologists also experience burnout. As breast imaging increases in volume and complexity, we must find new ways of practicing that help achieve a healthy work environment.
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Affiliation(s)
- Martha B Mainiero
- Alpert Medical School Brown University, Department of Radiology, Providence, RI
| | - Jay R Parikh
- University of Texas MD Anderson Cancer Center, Department of Radiology, Houston, TX
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16
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Lee JM, Partridge SC, Liao GJ, Hippe DS, Kim AE, Lee CI, Rahbar H, Scheel JR, Lehman CD. Double reading of automated breast ultrasound with digital mammography or digital breast tomosynthesis for breast cancer screening. Clin Imaging 2019; 55:119-125. [PMID: 30807927 DOI: 10.1016/j.clinimag.2019.01.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the impact of double reading automated breast ultrasound (ABUS) when added to full field digital mammography (FFDM) or digital breast tomosynthesis (DBT) for breast cancer screening. METHODS From April 2014 to June 2015, 124 women with dense breasts and intermediate to high breast cancer risk were recruited for screening with FFDM, DBT, and ABUS. Readers used FFDM and DBT in clinical practice and received ABUS training prior to study initiation. FFDM or DBT were first interpreted alone by two independent readers and then with ABUS. All recalled women underwent diagnostic workup with at least one year of follow-up. Recall rates were compared using the sign test; differences in outcomes were evaluated using Fisher's exact test. RESULTS Of 121 women with complete follow-up, all had family (35.5%) or personal (20.7%) history of breast cancer, or both (43.8%). Twenty-four women (19.8%) were recalled by at least one modality. Recalls increased from 5.0% to 13.2% (p = 0.002) when ABUS was added to FFDM and from 3.3% to 10.7% (p = 0.004) when ABUS was added to DBT. Findings recalled by both readers were more likely to result in a recommendation for short term follow-up imaging or tissue biopsy compared to findings recalled by only one reader (100% vs. 42.1%, p = 0.041). The cancer detection rate was 8.3 per 1000 screens (1/121); mode of detection: FFDM and DBT. CONCLUSIONS Adding ABUS significantly increased the recall rate of both FFDM and DBT screening. Double reading of ABUS during early phase adoption may reduce false positive recalls.
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Affiliation(s)
- Janie M Lee
- University of Washington, Department of Radiology, Seattle Cancer Care Alliance, 825 Eastlake Avenue East, G2-600, Seattle, WA 98109-1023, United States of America.
| | - Savannah C Partridge
- University of Washington, Department of Radiology, Seattle Cancer Care Alliance, 825 Eastlake Avenue East, G2-600, Seattle, WA 98109-1023, United States of America
| | - Geraldine J Liao
- University of Washington, Department of Radiology, Seattle Cancer Care Alliance, 825 Eastlake Avenue East, G2-600, Seattle, WA 98109-1023, United States of America
| | - Daniel S Hippe
- University of Washington, Department of Radiology, Seattle Cancer Care Alliance, 825 Eastlake Avenue East, G2-600, Seattle, WA 98109-1023, United States of America
| | - Adrienne E Kim
- University of Washington, Department of Radiology, Seattle Cancer Care Alliance, 825 Eastlake Avenue East, G2-600, Seattle, WA 98109-1023, United States of America
| | - Christoph I Lee
- University of Washington, Department of Radiology, Seattle Cancer Care Alliance, 825 Eastlake Avenue East, G2-600, Seattle, WA 98109-1023, United States of America
| | - Habib Rahbar
- University of Washington, Department of Radiology, Seattle Cancer Care Alliance, 825 Eastlake Avenue East, G2-600, Seattle, WA 98109-1023, United States of America
| | - John R Scheel
- University of Washington, Department of Radiology, Seattle Cancer Care Alliance, 825 Eastlake Avenue East, G2-600, Seattle, WA 98109-1023, United States of America
| | - Constance D Lehman
- Massachusetts General Hospital, Department of Radiology, 15 Parkman St., Boston, MA 02114, United States of America
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Santiago-Rivas M, Benjamin S, Andrews JZ, Jandorf L. Breast Density Awareness and Knowledge, and Intentions for Breast Cancer Screening in a Diverse Sample of Women Age Eligible for Mammography. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:90-97. [PMID: 28808894 PMCID: PMC5812844 DOI: 10.1007/s13187-017-1271-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The objectives of this study were to assess breast density knowledge and breast density awareness, and to identify information associated with intention to complete routine and supplemental screening for breast cancer in a diverse sample of women age eligible for mammography. We quantitatively (self-report) assessed breast density awareness and knowledge (N = 264) in black (47.7%), Latina (35.2%), and white (17%) women recruited online and in the community. Most participants reported having heard about breast density (69.2%); less than one third knew their own breast density status (30.4%). Knowing their own breast density, believing that women should be notified of their breast density in their mammogram report, and feeling informed if being provided this information are associated with likelihood of completing mammogram. Intending mammogram completion and knowledge regarding the impact of breast density on mammogram accuracy are associated with likelihood of completing supplemental ultrasound tests of the breast. These findings help inform practitioners and policy makers about information and communication factors that influence breast cancer screening concerns and decisions. Knowing this information should prepare practitioners to better identify women who may have not been exposed to breast density messages.
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Affiliation(s)
- Marimer Santiago-Rivas
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1130, New York, NY, 10029, USA.
| | - Shayna Benjamin
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1130, New York, NY, 10029, USA
| | - Janna Z Andrews
- Department of Radiation Medicine, Hofstra Northwell School of Medicine at Hofstra University, Hempstead, NY, 11549, USA
| | - Lina Jandorf
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1130, New York, NY, 10029, USA
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18
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Saraiya A, Baird GL, Lourenco AP. Breast Density Notification Letters and Websites: Are They Too "Dense"? J Am Coll Radiol 2019; 16:717-723. [PMID: 30686686 DOI: 10.1016/j.jacr.2018.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate grade-level readability of dense breast notification letters (DBNs) and popular websites. METHODS HIPAA-compliant, institutional review board-exempt study. As of April 2018, letter characteristics and grade-level readability were evaluated from states with mandated text using five readability metrics, one of which was the Flesch-Kincaid Grade Level. For states that had mandated DBNs in 2016, the 2016 data were compared with 2018. Readability was also assessed for common websites about dense breasts. RESULTS Thirty states had mandated text for DBNs. All were written above a Flesch-Kincaid sixth-grade level. Eight state DBNs were around or below a Flesch-Kincaid eighth-grade level. Connecticut was the highest (19.4) and Alabama and New York lowest (both at 7.2). For all states, the mean readability score using the five metrics exceeded an eighth-grade level. Of states that had updated DBNs since 2016, only one state significantly improved readability (Missouri 13.1 to 8.5). All DBNs discussed that breast density may mask cancer on a mammogram, 20 discussed the association with increased risk of breast cancer, and 23 discussed supplemental screening. For websites, the range of Flesch-Kincaid grade-level readability was 6 to 11.3. The lowest was the American Cancer Society dense breast website (6.0) followed by ACR dense breast patient pamphlet (7.2). CONCLUSION As of 2018, the mean readability score using five metrics for all state-mandated DBNs exceeded an eighth-grade reading level. Compared with 2016, only one state significantly decreased DBN grade-level readability. Publicly available websites performed relatively better.
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Affiliation(s)
- Ami Saraiya
- Department of Diagnostic Imaging, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
| | - Grayson L Baird
- Department of Diagnostic Imaging, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ana P Lourenco
- Department of Diagnostic Imaging, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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19
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Ram S, Sarma N, López JE, Liu Y, Li CS, Aminololama-Shakeri S. Impact of the California Breast Density Law on Screening Breast MR Utilization, Provider Ordering Practices, and Patient Demographics. J Am Coll Radiol 2019; 15:594-600. [PMID: 29622173 DOI: 10.1016/j.jacr.2017.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 11/27/2017] [Accepted: 12/01/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE To assess the impact of California's Breast Density Law (BDL) on MRI utilization and clinician ordering practices. MATERIALS AND METHODS Our institutional review board approved this study that retrospectively compared the ordering pattern for screening breast MRI examinations in the 30-month period before and after the BDL was enacted. Examinations were subcategorized into those with breast density mentioned as an examination indication. Patients were classified into (1) high risk; (2) above average risk, defined but not quantified; and (3) undefined or average risk. χ2 test or Fisher's exact test was used to compare MRI utilization, use of breast density as an indication, patient demographics, and provider characteristics. RESULTS Screening MRI examinations with breast density as the indication increased from 8.5% (32 of 376) to 21.1% (136 of 646, P < .0001) after BDL. When high-risk patients were excluded, the increase was from 8% to 17.2% (P < .0001). Patient demographics before and after BDL were, by race: white 71.8% versus 71.2%; Asian 6.4% versus 10.5%; black 3.7% versus 3.1%; American Indian 0.3% versus 1.4%; Native Hawaiian or Pacific Islander 1.6% versus 1.7%; by ethnicity: Hispanic or Latino 10.6% versus 7.9%. Before and after BDL, predominantly female providers (81.4% and 77.4%, P = not significant [NS]) and specialists (62.5% and 63.5%, P = NS) ordered the majority of breast MRI examinations compared with males (18.6% and 22.6%, P = NS). CONCLUSION Screening breast MRI utilization for non-high-risk women more than doubled after the California BDL went into effect. BDL has had an impact on MRI utilization, and its clinical value for changing outcomes deserves further study.
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Affiliation(s)
- Shruthi Ram
- Department of Radiology, University of California Davis Medical Center, Sacramento, California
| | - Nandini Sarma
- University of California Davis School of Medicine, Sacramento, California
| | - Javier E López
- Internal Medicine Department, Cardiovascular Division, University of California Davis Medical Center, Davis, California
| | - Yu Liu
- Department of Statistics, University of California, Davis, California
| | - Chin-Shang Li
- Department of Public Health Sciences, Division of Biostatistics, University of California, Davis, California
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20
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The impact of legislation mandating breast density notification - Review of the evidence. Breast 2018; 42:102-112. [PMID: 30236594 DOI: 10.1016/j.breast.2018.09.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 08/31/2018] [Accepted: 09/05/2018] [Indexed: 12/17/2022] Open
Abstract
Breast density (BD) is an independent risk factor for breast cancer and reduces the sensitivity of mammography. The enactment of BD legislation in a majority of states in the USA mandating notification of risks associated with BD directly to women undergoing mammography has catapulted interest in BD among women, physicians, and policymakers. We therefore report a descriptive review of the evidence on the impact of enactment of BD legislation. Based on 22 eligible studies, we identified four broad themes of research: studies of the impact on screening rates, most showing increased utilisation of supplemental screening; studies exploring the effect on women, radiologists, or primary physicians (reporting heterogeneous effects on knowledge, awareness, perceptions, attitudes and behaviour; and changes in practice); few studies assessing the population impact (effect on screening outcomes or breast cancer stage); and studies of costs highlighting the economic burden from supplemental screening. Given that many of the studies were retrospective single institution studies (comparing pre- and post-legislation) or small surveys with a paucity of population-level studies, we highlight areas meriting additional research. The information described in this review can inform research priorities where BD legislation has been introduced and can be used to guide world-wide policy or practice decisions where BD legislation may be under debate or contemplation.
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21
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de Lange SV, Bakker MF, Monninkhof EM, Peeters PHM, de Koekkoek-Doll PK, Mann RM, Rutten MJCM, Bisschops RHC, Veltman J, Duvivier KM, Lobbes MBI, de Koning HJ, Karssemeijer N, Pijnappel RM, Veldhuis WB, van Gils CH. Reasons for (non)participation in supplemental population-based MRI breast screening for women with extremely dense breasts. Clin Radiol 2018; 73:759.e1-759.e9. [PMID: 29759590 DOI: 10.1016/j.crad.2018.04.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/05/2018] [Indexed: 11/25/2022]
Abstract
AIM To determine the willingness of women with extremely dense breasts to undergo breast cancer screening with magnetic resonance imaging (MRI) in a research setting, and to examine reasons for women to participate or not. MATERIALS AND METHODS Between 2011 and 2015, 8,061 women (50-75 years) were invited for supplemental MRI as part of the Dense Tissue and Early Breast Neoplasm Screening (DENSE) trial (ClinicalTrials.gov Identifier: NCT01315015), after a negative screening mammography in the national population-based mammography screening programme. Demographics of participants and non-participants were compared. All invitees were asked to report reasons for (non)participation. Ethical approval was obtained. Participants provided written informed consent. RESULTS Of the 8,061 invitees, 66% answered that they were interested, and 59% eventually participated. Participants were on average 54-years old (interquartile range: 51-59 years), comparable to women with extremely dense breasts in the population-based screening programme (55 years). Women with higher socio-economic status (SES) were more often interested in participation than women with lower SES (68% versus 59%, p<0.001). The most frequently stated reasons for non-participation were "MRI-related inconveniences and/or self-reported contraindications to MRI" (27%) and "anxiety regarding the result of supplemental screening" (21%). "Expected personal health benefit" (68%) and "contribution to science" (43%) were the most frequent reasons for participation. CONCLUSION Of women invited for MRI because of extremely dense breasts, 59% participated. Common reasons for non-participation were "MRI-related inconveniences" and "anxiety regarding the result of supplemental screening". In case of future implementation, availability of precise evidence on benefits and harms might reduce this anxiety.
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Affiliation(s)
- S V de Lange
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - M F Bakker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - E M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - P H M Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, The Netherlands; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
| | - P K de Koekkoek-Doll
- Department of Radiology, Antoni van Leeuwenhoek Hospital, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands
| | - R M Mann
- Department of Radiology, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - M J C M Rutten
- Department of Radiology, Jeroen Bosch Hospital, P.O. Box 90153, 5200 ME 's-Hertogenbosch, The Netherlands
| | - R H C Bisschops
- Department of Radiology, Albert Schweitzer Hospital, P.O. Box 444, 3300 AK Dordrecht, The Netherlands
| | - J Veltman
- Department of Radiology, Hospital Group Twente (ZGT), P.O. Box 7600, 7600 SZ Almelo, The Netherlands
| | - K M Duvivier
- Department of Radiology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - M B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - H J de Koning
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - N Karssemeijer
- Department of Radiology, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - R M Pijnappel
- LRCB - Dutch Expert Centre for Screening, PO Box 6873, 6503 GJ Nijmegen, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - W B Veldhuis
- Department of Radiology, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - C H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
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Horný M, Cohen AB, Duszak R, Christiansen CL, Shwartz M, Burgess JF. Dense Breast Notification Laws: Impact on Downstream Imaging After Screening Mammography. Med Care Res Rev 2018; 77:143-154. [DOI: 10.1177/1077558717751941] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Dense breast tissue is a common finding that decreases the sensitivity of mammography in detecting cancer. Many states have recently enacted dense breast notification (DBN) laws to provide patients with information to help them make better-informed decisions about their health. To test whether DBN legislation affected the probability of screening mammography follow-up by ultrasound and magnetic resonance imaging (MRI), we examined the proportion of times screening mammography was followed by ultrasound or MRI for a series of months pre- and post-legislation. The subjects were women aged 40 to 64 years, covered by private health insurance, undergoing screening mammography from 2007 to 2014. Except for Hawaii, Maryland, and New York, DBN legislation significantly increased the probability of ultrasound follow-up in all states that implemented DBN legislation before December 2014. It also increased the probability of MRI follow-up in California, North Carolina, Pennsylvania, and Texas. The financial and access consequences merit further study.
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Affiliation(s)
- Michal Horný
- Emory University, Atlanta, GA, USA
- Boston University, Boston, MA, USA
| | | | | | | | - Michael Shwartz
- Boston University, Boston, MA, USA
- U.S. Department of Veterans Affairs, Center for Healthcare Organization & Implementation Research, Boston, MA, USA
| | - James F. Burgess
- Boston University, Boston, MA, USA
- U.S. Department of Veterans Affairs, Center for Healthcare Organization & Implementation Research, Boston, MA, USA
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23
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Fleury EFC, Gianini AC, Marcomini K, Oliveira V. The Feasibility of Classifying Breast Masses Using a Computer-Assisted Diagnosis (CAD) System Based on Ultrasound Elastography and BI-RADS Lexicon. Technol Cancer Res Treat 2018; 17:1533033818763461. [PMID: 29551088 PMCID: PMC5882047 DOI: 10.1177/1533033818763461] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/26/2017] [Accepted: 02/05/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To determine the applicability of a computer-aided diagnostic system strain elastography system for the classification of breast masses diagnosed by ultrasound and scored using the criteria proposed by the breast imaging and reporting data system ultrasound lexicon and to determine the diagnostic accuracy and interobserver variability. METHODS This prospective study was conducted between March 1, 2016, and May 30, 2016. A total of 83 breast masses subjected to percutaneous biopsy were included. Ultrasound elastography images before biopsy were interpreted by 3 radiologists with and without the aid of computer-aided diagnostic system for strain elastography. The parameters evaluated by each radiologist results were sensitivity, specificity, and diagnostic accuracy, with and without computer-aided diagnostic system for strain elastography. Interobserver variability was assessed using a weighted κ test and an intraclass correlation coefficient. The areas under the receiver operating characteristic curves were also calculated. RESULTS The areas under the receiver operating characteristic curve were 0.835, 0.801, and 0.765 for readers 1, 2, and 3, respectively, without computer-aided diagnostic system for strain elastography, and 0.900, 0.926, and 0.868, respectively, with computer-aided diagnostic system for strain elastography. The intraclass correlation coefficient between the 3 readers was 0.6713 without computer-aided diagnostic system for strain elastography and 0.811 with computer-aided diagnostic system for strain elastography. CONCLUSION The proposed computer-aided diagnostic system for strain elastography system has the potential to improve the diagnostic performance of radiologists in breast examination using ultrasound associated with elastography.
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Affiliation(s)
| | | | | | - Vilmar Oliveira
- School of Medical Sciences of Santa Casa de São Paulo, São Paulo, Brazil
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Roy LD, Dillon LM, Zhou R, Moore LJ, Livasy C, El-Khoury JM, Puri R, Mukherjee P. A tumor specific antibody to aid breast cancer screening in women with dense breast tissue. Genes Cancer 2017; 8:536-549. [PMID: 28680538 PMCID: PMC5489651 DOI: 10.18632/genesandcancer.134] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Screening for breast cancer has predominantly been done using mammography. Unfortunately, mammograms miss 50% cancers in women with dense breast tissue. Multi-modal screenings offer the best chance of enhancing breast cancer screening effectiveness. We evaluated the use of TAB004, an antibody that recognizes the tumor form of the glycoprotein MUC1 (tMUC1), to aid early detection of breast cancer. Our experimental approach was to follow tMUC1 from the tissue into circulation. We found that 95% of human breast cancer tissues across all subtypes stained positive for TAB004. In breast cancer cell lines, we showed that the amount of tMUC1 released from tumor cells is proportional to the cell's tMUC1 expression level. Finally, we showed that TAB004 can be used to assess circulating tMUC1 levels, which when monitored in the context of cancer immunoediting, can aid earlier diagnosis of breast cancer regardless of breast tissue density. In a blinded pilot study with banked serial samples, tMUC1 levels increased significantly up to 2 years before diagnosis. Inclusion of tMUC1 monitoring as part of a multi-modal screening strategy may lead to earlier stage diagnosis of women whose cancers are missed by mammography.
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Affiliation(s)
- Lopamudra Das Roy
- OncoTAb, Inc., Charlotte, NC, USA.,University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Lloye M Dillon
- OncoTAb, Inc., Charlotte, NC, USA.,University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Ru Zhou
- University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Laura J Moore
- University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Chad Livasy
- Carolinas Pathology Group, Carolinas Medical Center, Charlotte, NC, USA.,University of North Carolina at Chapel Hill, Charlotte, NC, USA
| | | | | | - Pinku Mukherjee
- OncoTAb, Inc., Charlotte, NC, USA.,University of North Carolina at Charlotte, Charlotte, NC, USA
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