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Veenhuizen SGA, van Grinsven SEL, Laseur IL, Bakker MF, Monninkhof EM, de Lange SV, Pijnappel RM, Mann RM, Lobbes MBI, Duvivier KM, de Jong MDF, Loo CE, Karssemeijer N, van Diest PJ, Veldhuis WB, van Gils CH. Re-attendance in supplemental breast MRI screening rounds of the DENSE trial for women with extremely dense breasts. Eur Radiol 2024; 34:6334-6347. [PMID: 38639912 PMCID: PMC11399182 DOI: 10.1007/s00330-024-10685-9] [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: 06/29/2023] [Revised: 01/19/2024] [Accepted: 02/03/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES Supplemental MRI screening improves early breast cancer detection and reduces interval cancers in women with extremely dense breasts in a cost-effective way. Recently, the European Society of Breast Imaging recommended offering MRI screening to women with extremely dense breasts, but the debate on whether to implement it in breast cancer screening programs is ongoing. Insight into the participant experience and willingness to re-attend is important for this discussion. METHODS We calculated the re-attendance rates of the second and third MRI screening rounds of the DENSE trial. Moreover, we calculated age-adjusted odds ratios (ORs) to study the association between characteristics and re-attendance. Women who discontinued MRI screening were asked to provide one or more reasons for this. RESULTS The re-attendance rates were 81.3% (3458/4252) and 85.2% (2693/3160) in the second and third MRI screening round, respectively. A high age (> 65 years), a very low BMI, lower education, not being employed, smoking, and no alcohol consumption were correlated with lower re-attendance rates. Moderate or high levels of pain, discomfort, or anxiety experienced during the previous MRI screening round were correlated with lower re-attendance rates. Finally, a plurality of women mentioned an examination-related inconvenience as a reason to discontinue screening (39.1% and 34.8% in the second and third screening round, respectively). CONCLUSIONS The willingness of women with dense breasts to re-attend an ongoing MRI screening study is high. However, emphasis should be placed on improving the MRI experience to increase the re-attendance rate if widespread supplemental MRI screening is implemented. CLINICAL RELEVANCE STATEMENT For many women, MRI is an acceptable screening method, as re-attendance rates were high - even for screening in a clinical trial setting. To further enhance the (re-)attendance rate, one possible approach could be improving the overall MRI experience. KEY POINTS • The willingness to re-attend in an ongoing MRI screening study is high. • Pain, discomfort, and anxiety in the previous MRI screening round were related to lower re-attendance rates. • Emphasis should be placed on improving MRI experience to increase the re-attendance rate in supplemental MRI screening.
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Affiliation(s)
- Stefanie G A Veenhuizen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Stratenum 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Sophie E L van Grinsven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Stratenum 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Isabelle L Laseur
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Stratenum 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Marije F Bakker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Stratenum 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Stratenum 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Stéphanie V de Lange
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Stratenum 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
- Department of Radiology, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Ruud M Pijnappel
- Department of Radiology, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
- Dutch Expert Centre for Screening, P.O. Box 6873, 6503 GJ, Nijmegen, The Netherlands
| | - Ritse M Mann
- Department of Radiology, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Medical Imaging, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Katya M Duvivier
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Mathijn D F de Jong
- Department of Radiology, Jeroen Bosch Hospital, P.O. Box 90153, 5200 ME, 'S-Hertogenbosch, The Netherlands
| | - Claudette E Loo
- Department of Radiology, the Netherlands Cancer Institute - Antoni Van Leeuwenhoek Hospital, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
| | - Nico Karssemeijer
- Department of Radiology, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Wouter B Veldhuis
- Department of Radiology, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Stratenum 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
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Marcon M, Fuchsjäger MH, Clauser P, Mann RM. ESR Essentials: screening for breast cancer - general recommendations by EUSOBI. Eur Radiol 2024; 34:6348-6357. [PMID: 38656711 PMCID: PMC11399176 DOI: 10.1007/s00330-024-10740-5] [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: 10/12/2023] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 04/26/2024]
Abstract
Breast cancer is the most frequently diagnosed cancer in women accounting for about 30% of all new cancer cases and the incidence is constantly increasing. Implementation of mammographic screening has contributed to a reduction in breast cancer mortality of at least 20% over the last 30 years. Screening programs usually include all women irrespective of their risk of developing breast cancer and with age being the only determining factor. This approach has some recognized limitations, including underdiagnosis, false positive cases, and overdiagnosis. Indeed, breast cancer remains a major cause of cancer-related deaths in women undergoing cancer screening. Supplemental imaging modalities, including digital breast tomosynthesis, ultrasound, breast MRI, and, more recently, contrast-enhanced mammography, are available and have already shown potential to further increase the diagnostic performances. Use of breast MRI is recommended in high-risk women and women with extremely dense breasts. Artificial intelligence has also shown promising results to support risk categorization and interval cancer reduction. The implementation of a risk-stratified approach instead of a "one-size-fits-all" approach may help to improve the benefit-to-harm ratio as well as the cost-effectiveness of breast cancer screening. KEY POINTS: Regular mammography should still be considered the mainstay of the breast cancer screening. High-risk women and women with extremely dense breast tissue should use MRI for supplemental screening or US if MRI is not available. Women need to participate actively in the decision to undergo personalized screening. KEY RECOMMENDATIONS: Mammography is an effective imaging tool to diagnose breast cancer in an early stage and to reduce breast cancer mortality (evidence level I). Until more evidence is available to move to a personalized approach, regular mammography should be considered the mainstay of the breast cancer screening. High-risk women should start screening earlier; first with yearly breast MRI which can be supplemented by yearly or biennial mammography starting at 35-40 years old (evidence level I). Breast MRI screening should be also offered to women with extremely dense breasts (evidence level I). If MRI is not available, ultrasound can be performed as an alternative, although the added value of supplemental ultrasound regarding cancer detection remains limited. Individual screening recommendations should be made through a shared decision-making process between women and physicians.
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Affiliation(s)
- Magda Marcon
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Institute of Radiology, Hospital Lachen, Oberdorfstrasse 41, 8853, Lachen, Switzerland.
| | - Michael H Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Research Group: Molecular and Gender Imaging, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Austria
| | - Ritse M Mann
- Department of Diagnostic Imaging, Radboud University Medical Centre, Geert Grotteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
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Miglioretti DL, Abraham L, Sprague BL, Lee CI, Bissell MCS, Ho TQH, Bowles EJA, Henderson LM, Hubbard RA, Tosteson ANA, Kerlikowske K. Association Between False-Positive Results and Return to Screening Mammography in the Breast Cancer Surveillance Consortium Cohort. Ann Intern Med 2024. [PMID: 39222505 DOI: 10.7326/m24-0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND False-positive results on screening mammography may affect women's willingness to return for future screening. OBJECTIVE To evaluate the association between screening mammography results and the probability of subsequent screening. DESIGN Cohort study. SETTING 177 facilities participating in the Breast Cancer Surveillance Consortium (BCSC). PATIENTS 3 529 825 screening mammograms (3 184 482 true negatives and 345 343 false positives) performed from 2005 to 2017 among 1 053 672 women aged 40 to 73 years without a breast cancer diagnosis. MEASUREMENTS Mammography results (true-negative result or false-positive recall with a recommendation for immediate additional imaging only, short-interval follow-up, or biopsy) from 1 or 2 screening mammograms. Absolute differences in the probability of returning for screening within 9 to 30 months of false-positive versus true-negative screening results were estimated, adjusting for race, ethnicity, age, time since last mammogram, BCSC registry, and clustering within women and facilities. RESULTS Women were more likely to return after a true-negative result (76.9% [95% CI, 75.1% to 78.6%]) than after a false-positive recall for additional imaging only (adjusted absolute difference, -1.9 percentage points [CI, -3.1 to -0.7 percentage points]), short-interval follow-up (-15.9 percentage points [CI, -19.7 to -12.0 percentage points]), or biopsy (-10.0 percentage points [CI, -14.2 to -5.9 percentage points]). Asian and Hispanic/Latinx women had the largest decreases in the probability of returning after a false positive with a recommendation for short-interval follow-up (-20 to -25 percentage points) or biopsy (-13 to -14 percentage points) versus a true negative. Among women with 2 screening mammograms within 5 years, a false-positive result on the second was associated with a decreased probability of returning for a third regardless of the first screening result. LIMITATION Women could receive care at non-BCSC facilities. CONCLUSION Women were less likely to return to screening after false-positive mammography results, especially with recommendations for short-interval follow-up or biopsy, raising concerns about continued participation in routine screening among these women at increased breast cancer risk. PRIMARY FUNDING SOURCE National Cancer Institute.
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Affiliation(s)
- Diana L Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, School of Medicine, Davis, California, and Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington (D.L.M.)
| | - Linn Abraham
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington (L.A., E.J.A.B.)
| | - Brian L Sprague
- Department of Surgery, Office of Health Promotion Research, Larner College of Medicine at the University of Vermont and University of Vermont Cancer Center, Burlington, Vermont (B.L.S.)
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine; Department of Health Systems and Population Health, University of Washington School of Public Health; and Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington (C.I.L.)
| | | | - Thao-Quyen H Ho
- Department of Training and Scientific Research, University Medical Center, and Breast Imaging Unit, Diagnostic Imaging Center, Tam Anh General Hospital, Ho Chi Minh City, Vietnam (T.H.H.)
| | - Erin J A Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington (L.A., E.J.A.B.)
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina (L.M.H.)
| | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (R.A.H.)
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Dartmouth Cancer Center, Lebanon, New Hampshire (A.N.A.T.)
| | - Karla Kerlikowske
- General Internal Medicine Section, Department of Veterans Affairs, and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California (K.K.)
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Henderson JT, Webber EM, Weyrich MS, Miller M, Melnikow J. Screening for Breast Cancer: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2024; 331:1931-1946. [PMID: 38687490 DOI: 10.1001/jama.2023.25844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Importance Breast cancer is a leading cause of cancer mortality for US women. Trials have established that screening mammography can reduce mortality risk, but optimal screening ages, intervals, and modalities for population screening guidelines remain unclear. Objective To review studies comparing different breast cancer screening strategies for the US Preventive Services Task Force. Data Sources MEDLINE, Cochrane Library through August 22, 2022; literature surveillance through March 2024. Study Selection English-language publications; randomized clinical trials and nonrandomized studies comparing screening strategies; expanded criteria for screening harms. Data Extraction and Synthesis Two reviewers independently assessed study eligibility and quality; data extracted from fair- and good-quality studies. Main Outcomes and Measures Mortality, morbidity, progression to advanced cancer, interval cancers, screening harms. Results Seven randomized clinical trials and 13 nonrandomized studies were included; 2 nonrandomized studies reported mortality outcomes. A nonrandomized trial emulation study estimated no mortality difference for screening beyond age 74 years (adjusted hazard ratio, 1.00 [95% CI, 0.83 to 1.19]). Advanced cancer detection did not differ following annual or biennial screening intervals in a nonrandomized study. Three trials compared digital breast tomosynthesis (DBT) mammography screening with digital mammography alone. With DBT, more invasive cancers were detected at the first screening round than with digital mammography, but there were no statistically significant differences in interval cancers (pooled relative risk, 0.87 [95% CI, 0.64-1.17]; 3 studies [n = 130 196]; I2 = 0%). Risk of advanced cancer (stage II or higher) at the subsequent screening round was not statistically significant for DBT vs digital mammography in the individual trials. Limited evidence from trials and nonrandomized studies suggested lower recall rates with DBT. An RCT randomizing individuals with dense breasts to invitations for supplemental screening with magnetic resonance imaging reported reduced interval cancer risk (relative risk, 0.47 [95% CI, 0.29-0.77]) and additional false-positive recalls and biopsy results with the intervention; no longer-term advanced breast cancer incidence or morbidity and mortality outcomes were available. One RCT and 1 nonrandomized study of supplemental ultrasound screening reported additional false-positives and no differences in interval cancers. Conclusions and Relevance Evidence comparing the effectiveness of different breast cancer screening strategies is inconclusive because key studies have not yet been completed and few studies have reported the stage shift or mortality outcomes necessary to assess relative benefits.
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Affiliation(s)
- Jillian T Henderson
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Portland, Oregon
| | - Elizabeth M Webber
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Portland, Oregon
| | - Meghan S Weyrich
- University of California Davis Center for Healthcare Policy and Research, Sacramento
| | - Marykate Miller
- University of California Davis Center for Healthcare Policy and Research, Sacramento
| | - Joy Melnikow
- University of California Davis Center for Healthcare Policy and Research, Sacramento
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5
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Chu CD, Smith CE, Gorski J, Smolkin M, Zhao H, Jones RA, Hollen P, Dengel LT. Implementation of a Novel Patient Decision Aid for Women with Elevated Breast Cancer Risk Who Are Considering MRI Screening: A Pilot Study. Ann Surg Oncol 2023; 30:6152-6158. [PMID: 37505352 DOI: 10.1245/s10434-023-13901-w] [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: 04/24/2023] [Accepted: 06/14/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE To determine the feasibility and acceptability of using a patient decision aid (DA) for women with elevated breast cancer risk who are considering MRI screening. METHODS This pilot study employed a mixed methods design to develop, modify, and test an interactive DA. The DA was administered among a consecutive patient sample with an estimated Tyrer-Cuzick v.8 lifetime breast cancer risk of 20% or greater and without a pathologic genetic mutation. The decisional conflict scale was used to measure decisional conflict. Post-intervention provider and patient feedback evaluated shared decision-making, feasibility, and acceptability. RESULTS Twenty-four patients participated, with a median age of 44 years. Prior to DA use, sixteen patients (67%) were unsure whether to add MRI to their screening, six patients elected MRI (25%), and two patients declined MRI (8%). Following DA use, thirteen of sixteen of the initially undecided participants (81%) established a preference, with eleven electing to add MRI screening. Of participants with an initial preference, all maintained the same decision following use of the DA. Prior to the DA, the median decisional conflict score among participants was 25% (range 0-60%) compared with 0% (range 0-25%) after the DA. Healthcare providers reported that the DA was useful and easily incorporated into clinical workflow. CONCLUSIONS This pilot study shows that there may be a benefit to DA utilization in the high-risk breast cancer clinic to guide shared decision-making in establishing a screening preference. The findings warrant further research to test the use of the DA in a larger, multi-site trial.
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Affiliation(s)
- Crystal D Chu
- University of Virginia School of Nursing, Charlottesville, VA, USA.
| | - Caleigh E Smith
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Mark Smolkin
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Hui Zhao
- James Madison University School of Nursing, Harrisonburg, VA, USA
| | - Randy A Jones
- University of Virginia School of Nursing, Charlottesville, VA, USA
| | - Patricia Hollen
- University of Virginia School of Nursing, Charlottesville, VA, USA
| | - Lynn T Dengel
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
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Santos ROMD, Assis MD, Dias MBK, Tomazelli JG. [Risk of false-positive result in mammography screening in Brazil]. CAD SAUDE PUBLICA 2023; 39:e00117922. [PMID: 37255192 PMCID: PMC10641911 DOI: 10.1590/0102-311xpt117922] [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: 06/23/2022] [Revised: 03/09/2023] [Accepted: 03/17/2023] [Indexed: 06/01/2023] Open
Abstract
False-positive results on mammography screening are common, putting a burden on both women and the health care system. This study aimed to estimate the risk of false-positive results in Brazilian mammography screening based on data from the Brazilian Unified National Health System (SUS) information systems. A retrospective cohort study was conducted with women aged 40-69 years, who underwent mammography screening and breast histopathological examination at SUS from 2017 to 2019. The rate of false-positive results was estimated based on the prevalence of altered BI-RADS results on mammography screening and the proportion of benign results on breast histopathological examination. Of the 10,671 women with histopathological examination at SUS, 46.2% had a benign result, and this proportion was significantly higher in women aged 40-49 years compared to women aged 50-69 years. The estimate of false-positive results was 8.18 cases per 100 women aged 40-49 years and 6.06 per 100 women aged 50-69 years. This information is useful for public managers in evaluating mammography screening programs, as well as for health care providers to guide women on the implications of mammography screening.
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Affiliation(s)
| | - Mônica de Assis
- Coordenação de Prevenção e Vigilância, Instituto Nacional de Câncer, Rio de Janeiro, Brasil
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Alikhassi A, Li X, Au F, Kulkarni S, Ghai S, Allison G, Freitas V. False-positive incidental lesions detected on contrast-enhanced breast MRI: clinical and imaging features. Breast Cancer Res Treat 2023; 198:321-334. [PMID: 36740611 DOI: 10.1007/s10549-023-06861-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 01/08/2023] [Indexed: 02/07/2023]
Abstract
PURPOSE To identify demographic and imaging features of MRI-detected enhancing lesions without clinical, ultrasound, and mammographic correlation associated with false-positive outcomes, impacting patient care. MATERIALS AND METHODS A retrospective multi-institutional study of imaging studies and patient's chart review of consecutive women with MRI-detected enhancing lesions without clinical, mammogram, or ultrasound correlation between January and December 2018, who underwent MRI-guided biopsy. According to the BI-RADS lexicon, lesions' frequency and imaging features were recorded. The demographic and imaging characteristics variables were correlated with histopathology as the gold standard and an uneventful follow-up of at least one year. Univariate logistic regression analysis was used to explore the correlation between the baseline variables such as age, genetic mutation, family history of breast cancer, personal history of breast cancer, MRI indication, background parenchymal enhancement, and MRI characteristic of the lesion with the false-positive results in main data and subgroup analysis. RESULTS Two hundred nineteen women (median age 49 years; range 26-85 years) with 219 MRI-detected enhancing lesions that underwent MRI-guided vacuum-assisted biopsy during the study period fulfilled the study criteria and formed the study cohort. Out of 219, 180 lesions (82.2%) yielded benign pathology results, including 137 benign outcomes (76%) and 43 high-risk lesions (24%). Most demographic and imaging characteristics variables did not help to differentiate malignant from benign lesions. The variables that showed statistically significant association with true-positive results in univariate analyses were age (OR 1.05; 95% CI 1.02-1.08; p = 0.0015), irregular mass-lesion shape when compared with oval/round mass lesion (OR 11.2; 95% CI 1.6-78.4; p = 0.015), and clumped and clustered ring of enhancement when compared with homogeneous (OR 3.22, 95% CI 1.40-7.40; p = 0.0058). For participants with mass breast lesion, the hyperintense signal on the T2-weighted sequence (compared to the normal fibroglandular signal) was significantly related to the false-positive result (OR 0.13; 95% CI 0.02-0.76; p = 0.024). CONCLUSION Young patients, oval/round mass-lesion shape, and homogeneous pattern of non-mass enhancement showed the strongest association with false-positive results of enhancing lesions depicted by MRI. For participants with mass breast lesion, T2-bright mass lesion showed significant association with false-positive result. It may impact the patient's management with a suggestion of follow-up rather than interventional procedure when these demographic and imaging parameters are present, consequently decreasing the patient's anxiety and health care costs.
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Affiliation(s)
- Afsaneh Alikhassi
- Division of Breast Imaging, Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Xuan Li
- Department of Biostatistics-Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 10Th Floor, Room 10-509, Toronto, ON, M5G 2M9, Canada
| | - Frederick Au
- Joint Department of Medical Imaging-University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Supriya Kulkarni
- Joint Department of Medical Imaging-University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Sandeep Ghai
- Joint Department of Medical Imaging-University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Grant Allison
- Joint Department of Medical Imaging-University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Vivianne Freitas
- Joint Department of Medical Imaging-University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
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8
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Ho TQH, Bissell MCS, Lee CI, Lee JM, Sprague BL, Tosteson ANA, Wernli KJ, Henderson LM, Kerlikowske K, Miglioretti DL. Prioritizing Screening Mammograms for Immediate Interpretation and Diagnostic Evaluation on the Basis of Risk for Recall. J Am Coll Radiol 2023; 20:299-310. [PMID: 36273501 PMCID: PMC10044471 DOI: 10.1016/j.jacr.2022.09.030] [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: 06/18/2022] [Revised: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE The aim of this study was to develop a prioritization strategy for scheduling immediate screening mammographic interpretation and possible diagnostic evaluation. METHODS A population-based cohort with screening mammograms performed from 2012 to 2020 at 126 radiology facilities from 7 Breast Cancer Surveillance Consortium registries was identified. Classification trees identified combinations of clinical history (age, BI-RADS® density, time since prior mammogram, history of false-positive recall or biopsy result), screening modality (digital mammography, digital breast tomosynthesis), and facility characteristics (profit status, location, screening volume, practice type, academic affiliation) that grouped screening mammograms by recall rate, with ≥12/100 considered high and ≥16/100 very high. An efficiency ratio was estimated as the percentage of recalls divided by the percentage of mammograms. RESULTS The study cohort included 2,674,051 screening mammograms in 925,777 women, with 235,569 recalls. The most important predictor of recall was time since prior mammogram, followed by age, history of false-positive recall, breast density, history of benign biopsy, and screening modality. Recall rates were very high for baseline mammograms (21.3/100; 95% confidence interval, 19.7-23.0) and high for women with ≥5 years since prior mammogram (15.1/100; 95% confidence interval, 14.3-16.1). The 9.2% of mammograms in subgroups with very high and high recall rates accounted for 19.2% of recalls, an efficiency ratio of 2.1 compared with a random approach. Adding women <50 years of age with dense breasts accounted for 20.3% of mammograms and 33.9% of recalls (efficiency ratio = 1.7). Results including facility-level characteristics were similar. CONCLUSIONS Prioritizing women with baseline mammograms or ≥5 years since prior mammogram for immediate interpretation and possible diagnostic evaluation could considerably reduce the number of women needing to return for diagnostic imaging at another visit.
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Affiliation(s)
- Thao-Quyen H Ho
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, School of Medicine, Davis, California; Breast Imaging Unit, Diagnostic Imaging Center, Tam Anh General Hospital, Ho Chi Minh City, Vietnam; Department of Training and Scientific Research, University Medical Center, Ho Chi Minh City, Vietnam
| | - Michael C S Bissell
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, School of Medicine, Davis, California
| | - Christoph I Lee
- Breast Imaging, Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington; Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington; Northwest Screening and Cancer Outcomes Research Enterprise, University of Washington, Seattle, Washington; Deputy Editor, JACR
| | - Janie M Lee
- Breast Imaging, Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington; Breast Imaging, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Brian L Sprague
- Department of Surgery, Office of Health Promotion Research, Larner College of Medicine at the University of Vermont and Co-Leader, Cancer Control and Population Health Sciences Program, University of Vermont Cancer Center, Burlington, Vermont
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Associate Director for Population Sciences, Dartmouth Cancer Center, Lebanon, New Hampshire
| | - Karen J Wernli
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina; Cancer Epidemiology Program, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California; General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, San Francisco, California; Women's Health Comprehensive Clinic, and Director, Advanced Postdoctoral Fellowship in Women's Health, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Diana L Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, School of Medicine, Davis, California; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington; Biostatistics and Population Sciences and Health Disparities Program, University of California, Davis, Comprehensive Cancer Center, Davis, California.
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9
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Michaels E, Worthington RO, Rusiecki J. Breast Cancer: Risk Assessment, Screening, and Primary Prevention. Med Clin North Am 2023; 107:271-284. [PMID: 36759097 DOI: 10.1016/j.mcna.2022.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
This review provides an outline of a risk-based approach to breast cancer screening and prevention. All women should be assessed for breast cancer risk starting at age 18 with identification of modifiable and non-modifiable risk factors. Patients can then be stratified into average, moderate, and high-risk groups with personalized screening and prevention plans. Counseling on breast awareness and lifestyle changes is recommended for all women, regardless of risk category. High-risk individuals may benefit from additional screening modalities such as MRI and chemoprevention and should be managed closely by a multidisciplinary team.
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Affiliation(s)
- Elena Michaels
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 3051, Chicago, IL 60637, USA
| | - Rebeca Ortiz Worthington
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 3051, Chicago, IL 60637, USA
| | - Jennifer Rusiecki
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 3051, Chicago, IL 60637, USA.
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10
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Ro V, Jones T, Silverman T, McGuinness JE, Guzman A, Amenta J, Kukafka R, Crew KD. Patient, primary care provider, and stakeholder perspectives on mammography screening frequency: lessons learned from a qualitative study. BMC Cancer 2022; 22:819. [PMID: 35897000 PMCID: PMC9326136 DOI: 10.1186/s12885-022-09900-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND U.S. professional organizations have provided conflicting recommendations on annual vs. biennial mammography screening. Potential harms of more frequent screening include increased anxiety and costs of false positive results, including unnecessary breast biopsies and overdiagnosis. OBJECTIVE To characterize current practices and beliefs surrounding mammography screening frequency and perspectives on using risk-based screening to inform screening intervals. DESIGN Semi-structured interviews informed by the Consolidated Framework for Implementation Research (CFIR). PARTICIPANTS Patients, primary care providers (PCPs), third-party stakeholders (breast radiologists, radiology administrators, patient advocates). MAIN MEASURES Qualitative data, with a codebook developed based upon prespecified implementation science constructs. KEY RESULTS We interviewed 25 patients, 11 PCPs, and eight key stakeholders, including three radiologists, two radiology administrators, and three patient advocates. Most patients reported having annual mammograms, however, half believed having mammograms every two years was acceptable. Some women were worried early breast cancer would be missed if undergoing biennial screening. PCPs were equally split between recommending annual and biennial mammograms. Although PCPs were interested in using breast cancer risk models to inform screening decisions, concerns raised include time burden and lack of familiarity with breast cancer risk assessment tools. All breast radiologists believed patients should receive annual mammograms, while patient advocates and radiology administrators were split between annual vs. biennial. Radiologists were worried about missing breast cancer diagnoses when mammograms are not performed yearly. Patient advocates and radiology administrators were more open to biennial mammograms and utilizing risk-based screening. CONCLUSIONS Uncertainty remains across stakeholder groups regarding appropriate mammogram screening intervals. Radiologists recommend annual mammography, whereas patients and PCPs were evenly split between annual vs. biennial screening, although both favored annual screening among higher-risk women. Breast cancer risk assessment tools may help facilitate decisions about screening intervals, but face barriers to widespread implementation in the primary care setting. These results will inform future implementation strategies to adopt risk-stratified breast cancer screening.
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Affiliation(s)
- Vicky Ro
- Columbia University Irving Medical Center, 161 Fort Washington Ave, New York, NY, 10032, USA.
| | - Tarsha Jones
- Florida Atlantic University, Boca Raton, FL, USA
| | - Thomas Silverman
- Columbia University Irving Medical Center, 161 Fort Washington Ave, New York, NY, 10032, USA
| | - Julia E McGuinness
- Columbia University Irving Medical Center, 161 Fort Washington Ave, New York, NY, 10032, USA
| | - Ashlee Guzman
- Columbia University Irving Medical Center, 161 Fort Washington Ave, New York, NY, 10032, USA
| | - Jacquelyn Amenta
- Columbia University Irving Medical Center, 161 Fort Washington Ave, New York, NY, 10032, USA
| | - Rita Kukafka
- Columbia University Irving Medical Center, 161 Fort Washington Ave, New York, NY, 10032, USA
| | - Katherine D Crew
- Columbia University Irving Medical Center, 161 Fort Washington Ave, New York, NY, 10032, USA
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11
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Hunleth J, Steinmetz E. Navigating Breast Cancer Screening in Rural Missouri: From Patient Navigation to Social Navigation. Med Anthropol 2022; 41:228-242. [PMID: 35050816 PMCID: PMC8852332 DOI: 10.1080/01459740.2021.2015347] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The National Cancer Institute recently identified rural cancer disparities as a priority issue, dedicating resources to rural cancer prevention, presenting opportunities and also risks. We bring an anthropological concept, social navigation, to bear on a popular public health intervention, patient navigation, increasingly proposed as an "evidence-based" approach to reducing health disparities. Our study of mammography in the Missouri Bootheel demonstrates how such interventions elide the shifting terrain and slow violence of rural health care where people must improvise care through trying out or sticking with providers, negotiating self-advocacy and deference, or changing screening timelines amidst structural constraints and rural stereotypes.
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Affiliation(s)
- Jean Hunleth
- Washington University School of Medicine, Division of Public Health Sciences, St. Louis, Missouri
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12
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Appold B, Soniega-Sherwood J, Persaud R, Moss R, Ramnarine M, LaVine SP, Bhansali R, Ahn S, Richman M. Reining in Unnecessary Admission EKGs: A Successful Interdepartmental High-Value Care Initiative. Cureus 2021; 13:e18351. [PMID: 34722095 PMCID: PMC8552818 DOI: 10.7759/cureus.18351] [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] [Accepted: 09/28/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Unnecessary "admission electrocardiograms (EKGs)" on admitted patients waiting ("boarding") in the emergency department (ED) are often ordered. We introduced evidence-based EKG ordering guidelines and determined changes in the percent of patients with "preadmission" and "admission" EKGs ordered before vs. after guideline introduction and which patient characteristics predicted EKG ordering. Methods In 2016, our ED, cardiology, and hospitalist services implemented EKG ordering guidelines to reduce unnecessary ED EKGs ordered after disposition. We compared pre- vs. post-guideline EKG ordering to determine whether guidelines were associated with changes in "preadmission" or "admission EKG" ordering. Patients with an admission diagnosis unrelated to cardiac or pulmonary systems were included. An EKG was "admission" if the order time was after disposition time. The numerator was the number of "admission EKGs" ordered; the denominator was the total number of such admissions; those with "preadmission EKGs" were excluded from this analysis. Variables that might influence EKG ordering were explored. The chi-square test with Bonferroni adjustment was used to compare 2015 vs. 2016 percentages of patients with an "admission EKG." Results There was a decrease in unwarranted "admission EKGs" among ED boarding patients (44.1% pre-implementation to 27.5% by two years post-implementation) and an increase in unwarranted "preadmission EKGs" (66.1% pre-implementation to 72.8% post-implementation). Age ≥40 and past medical history independently predicted EKG ordering. Discussion The decrease in the ordering of "admission EKGs" but "preadmission EKGs" suggests the decline reflects a true change in ordering and not a general environmental/ecologic decline in ordering. This highlights the importance of careful guideline development and implementation.
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Affiliation(s)
- Brendan Appold
- Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, USA
| | | | - Riaad Persaud
- Emergency Medicine, Northwell Health Long Island Jewish Medical Center, New Hyde Park, USA
| | - Rachel Moss
- Emergency Medicine, Northwell Health Long Island Jewish Medical Center, New Hyde Park, USA
| | | | - Sean P LaVine
- Internal Medicine, Northwell Health Long Island Jewish Medical Center, New Hyde Park, USA
| | - Rohan Bhansali
- Cardiology, Northwell Health Long Island Jewish Medical Center, New Hyde Park, USA
| | - Seungjun Ahn
- Biostatistics Unit, Feinstein Institute for Medical Research, Manhasset, USA
- Department of Biostatistics, University of Florida, Gainesville, USA
| | - Mark Richman
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, USA
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13
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Pagliarin F, Pylkkanen L, Salakari M, Deandrea S. Are women satisfied with their experience with breast cancer screening? Systematic review of the literature. Eur J Public Health 2021; 31:206-214. [PMID: 33200183 DOI: 10.1093/eurpub/ckaa202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The evaluation of participant experience is an essential part of monitoring the quality of breast cancer screening services. Satisfaction of services can lead to good adherence and hence affect health outcomes. METHODS We performed a systematic review to assess how satisfied women were with organized breast cancer screening programs. A literature search in Medline, CINAHL, Embase and PsycINFO from 1965 to October 2019 was performed. Articles reporting a quantitative measure of satisfaction collected via questionnaires in programs using mammography as a screening test were selected. We narratively synthesized the data and used tabulated summaries. RESULTS Out of 4310 individual citations, 3099 abstracts were reviewed by two independent researchers, and 126 articles were selected for full-text reading. Finally, 48 studies, published between 1990 and 2018, were included in analysis, reporting 54 surveys in the context of an organized screening program, 37 on satisfaction with screening mammography, 14 on satisfaction with further assessments and 3 with counseling. Most studies reported a high level of satisfaction for both mammography and further assessments. Despite commonly reported temporary pain, discomfort and anxiety, the willingness to be re-screened was very high. Effective information transfer, the staff's interpersonal skills and quick delivery of results correlated with high satisfaction. Only 7 out of 54 surveys used recognized satisfaction instruments or their modifications. CONCLUSIONS In general, satisfaction with breast cancer screening is high, but its evaluation is mainly performed using non-validated instruments. Emphasis should be put on effective communication, the staff´s interpersonal skills and quick delivery of results.
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Affiliation(s)
- Federica Pagliarin
- Department of Medicine and Surgery, University of Milano-Bicocca, Research Centre on Public Health, Monza, Italy
| | | | - Minna Salakari
- Department of Public Health, University of Turku, Turku, Finland
| | - Silvia Deandrea
- Prevention Department, Agency for Health Protection, Pavia, Italy
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14
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Squillace L, Pizzi L, Rallo F, Bazzani C, Saguatti G, Mezzetti F. Subsequent attendance in a breast cancer screening program after a false-positive result in the Local Health Authority of Bologna (Italy). Sci Rep 2021; 11:8530. [PMID: 33879804 PMCID: PMC8058078 DOI: 10.1038/s41598-021-87864-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/18/2021] [Indexed: 11/30/2022] Open
Abstract
We conducted a cross-sectional study to assess the likelihood of returning for routine breast cancer screening among women who have experienced a false-positive result (FPR) and to describe the possible individual and organizational factors that could influence subsequent attendance to the screening program. Several information were collected on demographic and clinical characteristics data. Electronic data from 2014 to 2016 related to breast screening program of the Local Health Authority (LHA) of Bologna (Italy) of women between 45 and 74 years old were reviewed. A total of 4847 women experienced an FPR during mammographic screening and were recalled to subsequent round; 80.2% adhered to the screening. Mean age was 54.2 ± 8.4 years old. Women resulted to be less likely to adhere to screening if they were not-Italian (p = 0.001), if they lived in the Bologna district (p < 0.001), if they had to wait more than 5 days from II level test to end of diagnostic procedures (p = 0.001), if the diagnostic tests were performed in a hospital with the less volume of activity and higher recall rate (RR) (p < 0.001) and if they had no previous participation to screening tests (p < 0.001). Our results are consistent with previous studies, and encourages the implementation and innovation of the organizational characteristics for breast cancer screening. The success of screening programs requires an efficient indicators monitoring strategy to develop and evaluate continuous improvement processes.
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Affiliation(s)
- Lorena Squillace
- Department of Public Health, LHA Bologna, Via Boldrini, 12, 40121, Bologna, Italy.
| | - Lorenzo Pizzi
- Department of Public Health, LHA Bologna, Via Boldrini, 12, 40121, Bologna, Italy
| | - Flavia Rallo
- Department of Biomedical and Neuromotor Sciences, School of Hygiene and Preventive Medicine, University of Bologna, Bologna, Italy
| | - Carmen Bazzani
- Department of Public Health, LHA Bologna, Via Boldrini, 12, 40121, Bologna, Italy
| | | | - Francesca Mezzetti
- Department of Public Health, LHA Bologna, Via Boldrini, 12, 40121, Bologna, Italy
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15
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The "Sweet Spot" Revisited: Optimal Recall Rates for Cancer Detection With 2D and 3D Digital Screening Mammography in the Metro Chicago Breast Cancer Registry. AJR Am J Roentgenol 2021; 216:894-902. [PMID: 33566635 DOI: 10.2214/ajr.19.22429] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE. One central question pertaining to mammography quality relates to discerning the optimal recall rate to maximize cancer detection while minimizing unnecessary downstream diagnostic imaging and breast biopsies. We examined the trade-offs for higher recall rates in terms of biopsy recommendations and cancer detection in a single large health care organization. MATERIALS AND METHODS. We included 2D analog, 2D digital, and 3D digital (tomosynthesis) screening mammography examinations among women 40-79 years old performed between January 1, 2005, and December 31, 2017, with cancer follow-up through 2018. There were 36, 67, and 38 radiologists who read at least 1000 2D analog examinations, 2D digital examinations, and 3D tomosynthesis examinations, respectively, who were included in these analyses. Using logistic regression with marginal standardization, we estimated radiologist-specific mean recall (abnormal interpretations/1000 mammograms), biopsy recommendation, cancer detection (screening-detected in situ and invasive cancers/1000 mammograms), and minimally invasive cancer detection rates while adjusting for differences in patient characteristics. RESULTS. Among 1,060,655 screening mammograms, the mean recall rate was 10.7%, the cancer detection rate was 4.0/1000 mammograms, and the biopsy recommendation rate was 1.60%. Recall rates between 7% and 9% appeared to maximize cancer detection while minimizing unnecessary biopsies. CONCLUSION. The results of this investigation are in contrast to those of a recent study suggesting appropriateness of higher recall rates. The "sweet spot" for optimal cancer detection appears to be in the recall rate range of 7-9% for both 2D digital mammography and 3D tomosynthesis. Too many women are being called back for diagnostic imaging, and new benchmarks could be set to reduce this burden.
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16
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Allweis TM, Hermann N, Berenstein-Molho R, Guindy M. Personalized Screening for Breast Cancer: Rationale, Present Practices, and Future Directions. Ann Surg Oncol 2021; 28:4306-4317. [PMID: 33398646 DOI: 10.1245/s10434-020-09426-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/13/2020] [Indexed: 12/13/2022]
Abstract
Ever since screening for early breast cancer (BC) diagnosis was shown to decrease mortality from the disease, screening programs have been widely implemented throughout the world. Targeted age groups and schedules vary between countries but the majority use a population-based approach, regardless of personal BC risk. The purpose of this review was to describe current population-based screening practices, point out some of the shortcomings of these practices, describe BC risk factors and risk assessment models, and present ongoing clinical trials of personalized risk-adapted BC screening. Three ongoing, large-scale, randomized controlled clinical trials (WISDOM in the US, MyPEBS in Europe, and TBST in Italy) were identified through a search of the MEDLINE and US National Library of Medicine (ClinicalTrials.gov) databases. In these trials, women either undergo standard or personalized screening. The trials vary in methods of risk stratification and screening modalities, but all aim to examine whether personalized risk-adapted screening can safely replace the current population-based approach and lead to rates of advanced-stage BC at diagnosis comparable with those of current screening regimens. The results of these trials may change current population-based screening practices.
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Affiliation(s)
- Tanir M Allweis
- Department of Surgery and Breast Health Center, Kaplan Medical Center, Rehovot, Israel. .,Faculty of Medicine, Hebrew University, Jerusalem, Israel.
| | - Naama Hermann
- Department of General Surgery B and Meirav Comprehensive Breast Health Center, Sheba Medical Center, Ramat Gan, Israel
| | - Rinat Berenstein-Molho
- Breast Cancer Unit, Oncology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michal Guindy
- Department of Imaging, Assuta Medical Center, Tel Aviv, Israel
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17
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Abstract
In recommending and offering screening, health services make a health claim ('it's good for you'). This article considers ethical aspects of establishing the case for cancer screening, building a service programme, monitoring its operation, improving its quality and integrating it with medical progress. The value of (first) screening is derived as a function of key parameters: prevalence of the target lesion in the detectable pre-clinical phase, the validity of the test and the respective net utilities or values attributed to four health states-true positives, false positives, false negatives and true negatives. Decision makers as diverse as public regulatory agencies, medical associations, health insurance funds or individual screenees can legitimately come up with different values even when presented with the same evidence base. The main intended benefit of screening is the reduction of cause-specific mortality. All-cause mortality is not measurably affected. Overdiagnosis and false-positive tests with their sequelae are the main harms. Harms and benefits accrue to distinct individuals. Hence the health claim is an invitation to a lottery with benefits for few and harms to many, a violation of the non-maleficence principle. While a public decision maker may still propose a justified screening programme, respect for individual rights and values requires preference-sensitive, autonomy-enhancing educational materials-even at the expense of programme effectiveness. Opt-in recommendations and more 'consumer-oriented' qualitative research are needed.
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Affiliation(s)
- Bernt-Peter Robra
- Institute for Social Medicine and Health Services Research, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, D-39140, Magdeburg, Germany.
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18
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Kotwal AA, Walter LC. Cancer Screening in Older Adults: Individualized Decision-Making and Communication Strategies. Med Clin North Am 2020; 104:989-1006. [PMID: 33099456 PMCID: PMC7594102 DOI: 10.1016/j.mcna.2020.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cancer screening decisions in older adults can be complex due to the unclear cancer-specific mortality benefits of screening and several known harms including false positives, overdiagnosis, and procedural complications from downstream diagnostic interventions. In this review, we provide a framework for individualized cancer screening decisions among older adults, involving accounting for overall health and life expectancy, individual values, and the risks and benefits of specific cancer screening tests. We then discuss strategies for effective communication of recommendations during clinical visits that are considered more effective, easy to understand, and acceptable by older adults and clinicians.
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Affiliation(s)
- Ashwin A Kotwal
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
| | - Louise C Walter
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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19
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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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20
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Healy NA, O'Brien A, Knox M, Hargaden G, Smith C, Fenlon H, McNicholas M, Phelan N, Flanagan F. Consensus Review of Discordant Imaging Findings after the Introduction of Digital Screening Mammography: Irish National Breast Cancer Screening Program Experience. Radiology 2020; 295:35-41. [PMID: 32043946 DOI: 10.1148/radiol.2020181454] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background When there are discordant results between individual readers interpreting screening mammograms, consensus by independent readers may reduce unnecessary recalls for further work-up. Few studies have looked at consensus outcomes following the introduction of full-field digital mammography (FFDM). Purpose To determine outcomes of women discussed at consensus meetings during a 5-year period after introduction of FFDM, including recall rates, cancer detection, and interval cancers. Materials and Methods In this retrospective study from January 2010 to December 2014, the authors reviewed all screening mammograms from a single unit of a biennial Irish national breast screening program after the introduction of FFDM. Screening mammograms were double reported. Abnormalities detected at discordant screening mammography readings were discussed at biweekly consensus meetings. Outcomes of consensus meetings were reviewed in terms of referral for assessment, biopsy rates, cancer detection, and outcomes from later rounds of screening. Statistical analysis was performed by using a χ2 test to compare recall rate and cancer detection rates between FFDM and screen-film mammography based on a previously published study from the authors' institution. Results A total of 2565 women (age range, 50-64 years) with discordant mammographic findings were discussed at consensus meetings. Of these 2565 women, 1037 (40%) were referred for further assessment; 108 cancers were detected in these women. Of the 1285 women who returned to biennial screening, malignancy was detected at the site of original concern in 12 women at a further round of screening. Three true interval cancers were identified. Sensitivity (88.5% [108 of 122]; 95% confidence interval [CI]: 81.5%, 93.6%) and negative predictive value (99.1% [1528 of 1542]; 95% CI: 98.5%, 99.4%) of consensus review remained stable after the introduction of FFDM. Specificity of consensus review increased from 57.6% (729 of 1264; 95% CI: 54.9%, 60.4%) to 62.2% (1528 of 2457; 95% CI: 60.2%, 64.1%) (P = .008). Conclusion Consensus review of discordant mammographic screening-detected abnormalities remains a valuable tool after introduction of full-field digital mammography as it reduces recall for assessment and demonstrates persistently high sensitivity and negative predictive values. © RSNA, 2020 See also the editorial by Hofvind and Lee in this issue.
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Affiliation(s)
- Nuala A Healy
- From the Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom (N.A.H.); BreastCheck (The Irish National Breast Screening Program), Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.)
| | - Angela O'Brien
- From the Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom (N.A.H.); BreastCheck (The Irish National Breast Screening Program), Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.)
| | - Mark Knox
- From the Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom (N.A.H.); BreastCheck (The Irish National Breast Screening Program), Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.)
| | - Gormlaith Hargaden
- From the Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom (N.A.H.); BreastCheck (The Irish National Breast Screening Program), Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.)
| | - Clare Smith
- From the Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom (N.A.H.); BreastCheck (The Irish National Breast Screening Program), Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.)
| | - Helen Fenlon
- From the Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom (N.A.H.); BreastCheck (The Irish National Breast Screening Program), Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.)
| | - Michelle McNicholas
- From the Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom (N.A.H.); BreastCheck (The Irish National Breast Screening Program), Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.)
| | - Niall Phelan
- From the Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom (N.A.H.); BreastCheck (The Irish National Breast Screening Program), Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.)
| | - Fidelema Flanagan
- From the Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom (N.A.H.); BreastCheck (The Irish National Breast Screening Program), Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.)
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Abrao Nemeir I, Saab J, Hleihel W, Errachid A, Jafferzic-Renault N, Zine N. The Advent of Salivary Breast Cancer Biomarker Detection Using Affinity Sensors. SENSORS (BASEL, SWITZERLAND) 2019; 19:E2373. [PMID: 31126047 PMCID: PMC6566681 DOI: 10.3390/s19102373] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/09/2019] [Accepted: 05/20/2019] [Indexed: 12/14/2022]
Abstract
Breast Cancer is one of the world's most notorious diseases affecting two million women in 2018 worldwide. It is a highly heterogeneous disease, making it difficult to treat. However, its linear progression makes it a candidate for early screening programs, and the earlier its detection the higher the chance of recovery. However, one key hurdle for breast cancer screening is the fact that most screening techniques are expensive, time-consuming, and cumbersome, making them impractical for use in several parts of the world. One current trend in breast cancer detection has pointed to a possible solution, the use of salivary breast cancer biomarkers. Saliva is an attractive medium for diagnosis because it is readily available in large quantities, easy to obtain at low cost, and contains all the biomarkers present in blood, albeit in lower quantities. Affinity sensors are devices that detect molecules through their interactions with biological recognition molecules. Their low cost, high sensitivity, and selectivity, as well as rapid detection time make them an attractive alternative to traditional means of detection. In this review article, we discuss the current status of breast cancer diagnosis, its salivary biomarkers, as well as the current trends in the development of affinity sensors for their detection.
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Affiliation(s)
- Imad Abrao Nemeir
- Faculty of Sciences, Holy Spirit University of Kaslik, 446 Jounieh, Mount Lebanon, Lebanon.
- Institut des Sciences Analytiques, Université de Lyon, Claude Bernard Lyon 1, UMR 5280, CNRS - 5, rue de la Doua, 69100 Villeurbanne, France.
| | - Joseph Saab
- Faculty of Sciences, Holy Spirit University of Kaslik, 446 Jounieh, Mount Lebanon, Lebanon.
| | - Walid Hleihel
- Faculty of Sciences, Holy Spirit University of Kaslik, 446 Jounieh, Mount Lebanon, Lebanon.
| | - Abdelhamid Errachid
- Institut des Sciences Analytiques, Université de Lyon, Claude Bernard Lyon 1, UMR 5280, CNRS - 5, rue de la Doua, 69100 Villeurbanne, France.
| | - Nicole Jafferzic-Renault
- Institut des Sciences Analytiques, Université de Lyon, Claude Bernard Lyon 1, UMR 5280, CNRS - 5, rue de la Doua, 69100 Villeurbanne, France.
| | - Nadia Zine
- Institut des Sciences Analytiques, Université de Lyon, Claude Bernard Lyon 1, UMR 5280, CNRS - 5, rue de la Doua, 69100 Villeurbanne, France.
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Giess CS, Wang A, Ip IK, Lacson R, Pourjabbar S, Khorasani R. Patient, Radiologist, and Examination Characteristics Affecting Screening Mammography Recall Rates in a Large Academic Practice. J Am Coll Radiol 2018; 16:411-418. [PMID: 30037704 DOI: 10.1016/j.jacr.2018.06.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/10/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The aims of this study were to evaluate patient, radiologist, and examination characteristics affecting screening mammography recall rates in an academic breast imaging practice and to identify modifiable factors that could reduce recall variation. METHODS This institutional review board-approved retrospective study included screening mammographic examinations in female patients interpreted by 13 breast imaging specialists at an academic center and two outpatient centers from October 1, 2012, to May 31, 2015. Patient demographics were extracted via electronic medical record. Natural language processing captured breast density, BI-RADS assignment, and current and prior screening examination findings. Radiologists' annual screening volumes, clinical experience, and concentration in breast imaging were calculated. Risk aversion, stress from uncertainty, and malpractice concerns were derived via survey. Univariate and multivariate analyses assessed patient, radiologist, and examination characteristics associated with likelihood of mammography recall. The Pearson product-moment correlation coefficient was used to assess the relationship between cancer detection rate and recall rate. RESULTS Overall, 5,678 of 61,198 screening examinations (9.3%) were recalled. In multivariate analysis, patient and radiologist characteristics associated with higher odds of recall included patient's age < 50 years (P < .0001), prior mammographic findings (calcification [P < .0001], mass [P < .0001], higher density category [P < .0001]), baseline examination (P < .0001), annual reading volume < 1,250 examinations (P = .0282), and <10 years of experience (P = .0036). Radiologist's risk aversion, stress from uncertainty, malpractice concerns, and cancer detection rates were not associated with higher recall rates (r = -0.36, P = .23). CONCLUSIONS In addition to patient and examination factors, screening recall variations were associated with radiologists' annual reading volume and experience. Interventions targeting radiologist factors (screening volumes, second review of potential recalls) may help reduce unwarranted variation in screening recall.
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Affiliation(s)
- Catherine S Giess
- Center for Evidence-Based Imaging, Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts.
| | - Aijia Wang
- Center for Evidence-Based Imaging, Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts
| | - Ivan K Ip
- Center for Evidence-Based Imaging, Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts
| | - Ronilda Lacson
- Center for Evidence-Based Imaging, Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts
| | - Sarvanez Pourjabbar
- Center for Evidence-Based Imaging, Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts; Current address: Department of Radiology & Biomedical Imaging, Yale University Medical Center, New Haven, Connecticut
| | - Ramin Khorasani
- Center for Evidence-Based Imaging, Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts
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23
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Kang SK, Jiang M, Duszak R, Heller SL, Hughes DR, Moy L. Use of Breast Cancer Screening and Its Association with Later Use of Preventive Services among Medicare Beneficiaries. Radiology 2018; 288:660-668. [PMID: 29869958 DOI: 10.1148/radiol.2018172326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Purpose To retrospectively assess whether there is an association between screening mammography and the use of a variety of preventive services in women who are enrolled in Medicare. Materials and Methods U.S. Medicare claims from 2010 to 2014 Research Identifiable Files were reviewed to retrospectively identify a group of women who underwent screening mammography and a control group without screening mammography in 2012. The screened group was divided into positive versus negative results at screening, and the positive subgroup was divided into false-positive and true-positive findings. Multivariate logistic regression models and inverse probability of treatment weighting were used to examine the relationship between screening status and the probabilities of undergoing Papanicolaou test, bone mass measurement, or influenza vaccination in the following 2 years. Results The cohort consisted of 555 705 patients, of whom 185 625 (33.4%) underwent mammography. After adjusting for patient demographics, comorbidities, geographic covariates, and baseline preventive care, women who underwent index screening mammography (with either positive or negative results) were more likely than unscreened women to later undergo Papanicolaou test (odds ratio [OR], 1.49; 95% confidence interval: 1.40, 1.58), bone mass measurement (OR, 1.70; 95% confidence interval: 1.63, 1.78), and influenza vaccine (OR, 1.45; 95% confidence interval: 1.37, 1.53). In women who had not undergone these preventive measures in the 2 years before screening mammography, use of these three services after false-positive findings at screening was no different than after true-negative findings at screening. Conclusion In beneficiaries of U.S. Medicare, use of screening mammography was associated with higher likelihood of adherence to other preventive guidelines, without a negative association between false-positive results and cervical cancer screening.
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Affiliation(s)
- Stella K Kang
- From the Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016 (S.K.K., S.L.H., L.M.); Department of Population Health, NYU Langone Medical Center, New York, NY (S.K.K.); Harvey L. Neiman Health Policy Institute, Reston, Va (M.J., D.R.H.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.D.); and School of Economics, Georgia Institute of Technology, Atlanda, Ga (D.R.H.)
| | - Miao Jiang
- From the Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016 (S.K.K., S.L.H., L.M.); Department of Population Health, NYU Langone Medical Center, New York, NY (S.K.K.); Harvey L. Neiman Health Policy Institute, Reston, Va (M.J., D.R.H.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.D.); and School of Economics, Georgia Institute of Technology, Atlanda, Ga (D.R.H.)
| | - Richard Duszak
- From the Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016 (S.K.K., S.L.H., L.M.); Department of Population Health, NYU Langone Medical Center, New York, NY (S.K.K.); Harvey L. Neiman Health Policy Institute, Reston, Va (M.J., D.R.H.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.D.); and School of Economics, Georgia Institute of Technology, Atlanda, Ga (D.R.H.)
| | - Samantha L Heller
- From the Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016 (S.K.K., S.L.H., L.M.); Department of Population Health, NYU Langone Medical Center, New York, NY (S.K.K.); Harvey L. Neiman Health Policy Institute, Reston, Va (M.J., D.R.H.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.D.); and School of Economics, Georgia Institute of Technology, Atlanda, Ga (D.R.H.)
| | - Danny R Hughes
- From the Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016 (S.K.K., S.L.H., L.M.); Department of Population Health, NYU Langone Medical Center, New York, NY (S.K.K.); Harvey L. Neiman Health Policy Institute, Reston, Va (M.J., D.R.H.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.D.); and School of Economics, Georgia Institute of Technology, Atlanda, Ga (D.R.H.)
| | - Linda Moy
- From the Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016 (S.K.K., S.L.H., L.M.); Department of Population Health, NYU Langone Medical Center, New York, NY (S.K.K.); Harvey L. Neiman Health Policy Institute, Reston, Va (M.J., D.R.H.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.D.); and School of Economics, Georgia Institute of Technology, Atlanda, Ga (D.R.H.)
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Taksler GB, Keating NL, Rothberg MB. Implications of false-positive results for future cancer screenings. Cancer 2018; 124:2390-2398. [PMID: 29682740 DOI: 10.1002/cncr.31271] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/24/2017] [Accepted: 08/28/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND False-positive cancer screening results may affect a patient's willingness to obtain future screening. METHODS The authors conducted logistic regression analysis of 450,484 person-years of electronic medical records (2006-2015) in 92,405 individuals aged 50 to 75 years. Exposures were false-positive breast, prostate, or colorectal cancer screening test results (repeat breast imaging or negative breast biopsy ≤3 months after screening mammography, repeat prostate-specific antigen [PSA] test ≤3 months after PSA test result ≥4.0 ng/mL or negative prostate biopsy ≤3 months after any PSA result, or negative colonoscopy [without biopsy/polypectomy] ≤6 months after a positive fecal occult blood test). Outcomes were up-to-date status with breast or colorectal cancer screening. Covariates included prior screening history, clinical information (eg, family history, obesity, and smoking status), comorbidity, and demographics. RESULTS Women were more likely to be up to date with breast cancer screening if they previously had false-positive mammography findings (adjusted odds ratio [AOR], 1.43 [95% confidence interval, 1.34-1.51] without breast biopsy and AOR, 2.02 [95% confidence interval, 1.56-2.62] with breast biopsy; both P<.001). The same women were more likely to be up to date with colorectal cancer screening (AOR range, 1.25-1.47 depending on breast biopsy; both P<.001). Men who previously had false-positive PSA testing were more likely to be up to date with colorectal cancer screening (AOR, 1.22 [P = .039] without prostate imaging/biopsy and AOR, 1.60 [P = .028] with imaging/biopsy). Results were stronger for individuals with more false-positive results (all P≤.005). However, women with previous false-positive colorectal cancer fecal occult blood test screening results were found to be less likely to be up to date with breast cancer screening (AOR, 0.73; P<.001). CONCLUSIONS Patients who previously had a false-positive breast or prostate cancer screening test were more likely to engage in future screening. Cancer 2018;124:2390-8. © 2018 American Cancer Society.
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Affiliation(s)
| | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.,Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Stereotactic Breast Biopsy With Benign Results Does Not Negatively Affect Future Screening Adherence. J Am Coll Radiol 2018; 15:622-629. [PMID: 29433804 DOI: 10.1016/j.jacr.2017.12.034] [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] [Received: 11/19/2017] [Revised: 12/11/2017] [Accepted: 12/22/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate whether false-positive stereotactic vacuum-assisted breast biopsy (SVAB) affects subsequent mammographic screening adherence. MATERIALS AND METHODS This Institutional Review Board-approved, HIPAA-compliant retrospective review of women with SVAB was performed between 2012 and 2014. Patient age, clinical history, biopsy pathology, and first postbiopsy screening mammogram were reviewed. Statistical analyses were performed using Fisher's exact, Mann-Whitney, and χ2 tests. RESULTS There were 913 SVABs performed in 2012 to 2014 for imaging detected lesions; of these, malignant or high-risk lesions or biopsies resulting in a recommendation of surgical excision were excluded, leaving 395 SVABs yielding benign pathology in 395 women. Findings were matched with a control population consisting of 45,126 women who had a BI-RADS 1 or 2 screening mammogram and did not undergo breast biopsy. In all, 191 of 395 (48.4%) women with a biopsy with benign results and 22,668 of 45,126 (50.2%) women without biopsy returned for annual follow-up >9 months and ≤18 months after the index examination (P = .479). In addition, 57 of 395 (14.4%) women with a biopsy with benign results and 3,336 of 45,126 (7.4%) women without biopsy returned for annual follow-up >18 months after the index examination (P < .001). Older women, women with personal history of breast cancer, and women with postbiopsy complication after benign SVAB were more likely to return for screening (P = .026, P = .028, and P = .026, respectively). CONCLUSION The findings in our study suggest that SVABs with benign results do not negatively impact screening mammography adherence. The previously described "harms" of false-positive mammography and biopsy may be exaggerated.
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Kuhl CK, Keulers A, Strobel K, Schneider H, Gaisa N, Schrading S. Not all false positive diagnoses are equal: On the prognostic implications of false-positive diagnoses made in breast MRI versus in mammography / digital tomosynthesis screening. Breast Cancer Res 2018; 20:13. [PMID: 29426360 PMCID: PMC5807753 DOI: 10.1186/s13058-018-0937-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/17/2018] [Indexed: 12/23/2022] Open
Abstract
Background Breast magnetic resonance imaging (MRI) has been reported to frequently result in false-positive diagnoses, limiting its positive predictive value (PPV). However, for PPV calculation, all nonmalignant tissue changes are equally considered false-positive, although the respective prognostic importance, and thus patient management implications, of different pathologies may well differ. We investigated the pathology of false-positive diagnoses made by MRI compared with radiographic (digital mammography/tomosynthesis [DM/DBT]) screening. Methods We conducted an institutional review board-approved prospective analysis of 710 consecutive asymptomatic women at average risk for breast cancer who underwent vacuum biopsy with or without surgical biopsy for screen-detected DM/DBT (n = 344) or MRI (n = 366) findings. We compared the frequency of false-positive biopsies (given by PPV3), as well as the types of nonmalignant tissue changes that caused the respective false-positive biopsies. In an order of increasing relative risk of subsequent breast cancer, pathologies of false-positive biopsies were categorized as nonproliferative, simple proliferative, complex proliferative, or atypical proliferative (including lobular carcinoma in situ/lobular intraepithelial neoplasia). The Mann-Whitney U test was used to compare distributions. Results Histology yielded nonmalignant tissue in 202 of 366 biopsies done for positive MRI studies and 195 of 344 biopsies for positive DM/DBT studies, respectively, yielding a similar PPV3 percentages of 44.8% (164 of 202) and 43.3% (149 of 202) for both methods. However, the distribution of tissue types that caused false-positive diagnoses differed significantly (p < 0.0001). On the basis of MRI, high-risk atypical proliferative changes (40.1%; 81 of 202) were most common, followed by complex proliferative changes (23.8%; 48 of 202). In DM/DBT, low-risk, nonproliferative changes were the dominant reason for false-positive diagnoses (49.7%; 97 of 195), followed by simple proliferative changes (25.2%; 51 of 195). Low-risk nonproliferative changes resulted in false-positive diagnoses based on MRI as infrequently as did high-risk atypical proliferative changes based on DM/DBT (18.8% [38 of 202] vs. 18.0% [35 of 195]). The likelihood of a false-positive diagnosis including atypias was twice as high in women undergoing biopsy for MRI findings (81 of 202; 40%) as for those with DM/DBT findings (35 of 195; 18%). Conclusions The prognostic importance, and thus the clinical implications, of false-positive diagnoses made on the basis of breast MRI vs. radiographic screening differed significantly, with a reversed prevalence of high- and low-risk lesions. This should be taken into account when discussing the rate of false-positive diagnoses (i.e., PPV levels of MRI vs. radiographic screening). Current benchmarks that rate the utility of breast cancer screening programs (i.e., cancer detection rates and PPVs) do not reflect these substantial biological differences and the different prognostic implications.
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Affiliation(s)
- Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, Hospital of the University of Aachen, RWTH, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - Annika Keulers
- Department of Diagnostic and Interventional Radiology, Hospital of the University of Aachen, RWTH, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Kevin Strobel
- Department of Diagnostic and Interventional Radiology, Hospital of the University of Aachen, RWTH, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Hannah Schneider
- Department of Diagnostic and Interventional Radiology, Hospital of the University of Aachen, RWTH, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Nadine Gaisa
- Department of Pathology, Hospital of the University of Aachen, RWTH, Aachen, Germany
| | - Simone Schrading
- Department of Diagnostic and Interventional Radiology, Hospital of the University of Aachen, RWTH, Pauwelsstrasse 30, 52074, Aachen, Germany
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Esserman LJ. The WISDOM Study: breaking the deadlock in the breast cancer screening debate. NPJ Breast Cancer 2017; 3:34. [PMID: 28944288 PMCID: PMC5597574 DOI: 10.1038/s41523-017-0035-5] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/09/2017] [Accepted: 07/11/2017] [Indexed: 11/17/2022] Open
Abstract
There are few medical issues that have generated as much controversy as screening for breast cancer. In science, controversy often stimulates innovation; however, the intensely divisive debate over mammographic screening has had the opposite effect and has stifled progress. The same two questions—whether it is better to screen annually or bi-annually, and whether women are best served by beginning screening at 40 or some later age—have been debated for 20 years, based on data generated three to four decades ago. The controversy has continued largely because our current approach to screening assumes all women have the same risk for the same type of breast cancer. In fact, we now know that cancers vary tremendously in terms of timing of onset, rate of growth, and probability of metastasis. In an era of personalized medicine, we have the opportunity to investigate tailored screening based on a woman’s specific risk for a specific tumor type, generating new data that can inform best practices rather than to continue the rancorous debate. It is time to move from debate to wisdom by asking new questions and generating new knowledge. The WISDOM Study (Women Informed to Screen Depending On Measures of risk) is a pragmatic, adaptive, randomized clinical trial comparing a comprehensive risk-based, or personalized approach to traditional annual breast cancer screening. The multicenter trial will enroll 100,000 women, powered for a primary endpoint of non-inferiority with respect to the number of late stage cancers detected. The trial will determine whether screening based on personalized risk is as safe, less morbid, preferred by women, will facilitate prevention for those most likely to benefit, and adapt as we learn who is at risk for what kind of cancer. Funded by the Patient Centered Outcomes Research Institute, WISDOM is the product of a multi-year stakeholder engagement process that has brought together consumers, advocates, primary care physicians, specialists, policy makers, technology companies and payers to help break the deadlock in this debate and advance towards a new, dynamic approach to breast cancer screening.
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Affiliation(s)
- Laura J Esserman
- Department of Surgery and Radiology, University of California, San Francisco, CA USA
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Abstract
BACKGROUND Despite reported increases in anxiety following a false-positive mammogram, there is little evidence the effect rises to the clinical level of initiating medication. OBJECTIVE To analyze the effect of a false-positive mammogram on antidepressant or anxiolytic initiation and identify subpopulations most at risk. SUBJECTS MarketScan commercial and Medicaid claims databases used to identify women ages 40-64 undergoing screening mammography with no prior antidepressant or anxiolytic claims. RESEARCH DESIGN Using a retrospective cohort design, we estimated the effects of a false-positive relative to a negative mammogram on the likelihood of initiating antidepressants or anxiolytics using multivariate logistic models estimated separately by insurance type. RESULTS At 3 months after a false-positive mammogram, the relative risk (RR) for antidepressant or anxiolytic initiation was 1.19 [95% confidence interval (CI), 1.06-1.31] for the commercially insured and 1.13 (95% CI, 0.96-1.29) in the Medicaid population. In addition, 4 subgroups were at particularly elevated risk: commercially insured women ages 40-49 (RR=1.33; 95% CI, 1.13-1.54) or whose false-positive required multiple tests to resolve (RR=1.37; 95% CI, 1.17-1.57), included a biopsy (RR=1.68; 95% CI, 1.18-2.17), or whose resolution took >1 week (RR=1.21; 95% CI, 1.07-1.34). CONCLUSIONS False-positive mammograms were associated with significant increases in antidepressant or anxiolytic imitation among the commercially insured. Follow-up resources may be particularly beneficial for cases taking longer to resolve and involving biopsies or multiple tests. The results highlight the need to resolve false-positives quickly and effectively and to monitor depressive symptoms following a positive result.
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