Mammography: review of the controversy, health disparities, and impact on young african american women

Video Interventions for Reducing Health Inequity in Cancer Screening Programmes: a Systematic Review

BACKGROUND

Health equity can lead to disparities in cancer screening, treatment, and mortality. This systematic review aims to identify and describe interventions that used video or DVD formats to reduce health inequity in cancer screening and review the effectiveness of such interventions in increasing screening rates compared to usual care conditions.

METHODS

We searched PubMed, Web of Science, Embase, and Cochrane databases for randomized control trials (RCTs) published until 18/01/2023 that compared intervention versus usual care control groups, with the percentage of cancer screening uptake during follow-up as an outcome. The risk of Bias was assessed with the Cochrane Collaboration tool.

RESULTS

After screening 4201 abstracts, 192 full texts were assessed for eligibility and 18 were included that focused on colorectal (n = 9), cervical (n = 5), breast (n = 5), and prostate (n = 1) cancer screening. All were based in the USA except one and most focused on ethnicity/race, while some included low-income populations. Most of the video interventions used to increase cervical cancer screening reported positive results. Studies aimed at increasing mammography uptake were mostly effective only in specific groups of participants, such as low-income or less-educated African American women. Results for colorectal cancer screening were conflicting. Videos that were culturally tailored or used emotive format were generally more effective than information-only videos.

CONCLUSIONS

Video interventions to increase cancer screening among populations with low screening uptake show some positive effects, though results are mixed. Interventions that use individual and cultural tailoring of the educational material should be further developed and investigated outside of the USA.

The diagnostic performance of shear wave velocity ratio for the differential diagnosis of benign and malignant breast lesions: Compared with VTQ, and mammography

PURPOSE

To evaluate the diagnostic value of shear wave velocity (SWV) ratio for the differential diagnosis of benign and malignant breast lesions.

MATERIAL AND METHODS

Our retrospective study included 151 breast lesions that were diagnosed by biopsy and surgical pathology. All of the breast lesions were detected by conventional ultrasound and Virtual Touch tissue quantification (VTQ) and mammography. The sonographic characteristics of the breast lesion, such as the internal echo, shape, margin, color flow, and calcification so on, were also observed. The SWV in lesions and surrounding parenchyma were measured and the SWV ratio between the lesion and surrounding parenchyma was calculated. Pathological results were used as a diagnosis standard to compare the value of SWV ratio, VTQ, and mammography in the diagnosis of benign and malignant breast lesions.

RESULTS

The 151 breast lesions included 96 benign lesions and 55 malignant lesions. The cutoff value of VTQ in the diagnosis of benign and malignant breast lesions was 5.01 m/s, of SWV ratio was 2.43, and mammography was BI-RADS 4B. The sensitivity, specificity, accuracy and the area under the ROC curve (AUC) of the SWV ratio were 78.2%, 86.5%, 83.4%, and 0.83 respectively. While of SWV ratio with mammography was 86.4%, 89.4%, 88.3% and 0.87, respectively. The sensitivity, specificity, accuracy, and AUC of SWV ratio and SWV ratio with mammography were statistically higher than those of mammography, no statistically higher than VTQ and VTQ with mammography.

CONCLUSION

The SWV ratio can improve the sensitivity without sacrificing diagnostic specificity in the process of breast cancer diagnostic, provide a better diagnostic performance, and avoid unnecessary biopsy or surgery.

Mobile Mammography Participation Among Medically Underserved Women: A Systematic Review

Introduction

Although breast cancer deaths have declined, the mortality rate among women from medically underserved communities is disproportionally high. Screening mammography is the most effective tool for detecting breast cancer in its early stages, yet many women from medically underserved communities do not have adequate access to screening mammograms. Mobile mammography may be able to bridge this gap by providing screening mammograms at no cost or low cost and delivering services to women in their own neighborhoods, thus eliminating cost and transportation barriers. The objective of this systematic review was to describe the scope and impact of mobile mammography programs in promoting mammographic screening participation among medically underserved women.

Methods

We searched electronic databases for English-language articles published in the United States from January 2010 through March 2018 by using the terms “mobile health unit,” “mammogram,” “mammography,” and “breast cancer screening.” Of the 93 articles initially identified, we screened 55; 16 were eligible to be assessed and 10 qualified for full text review and data extraction. Each study was coded for study purpose, research design, data collection, population targeted, location, sample size, outcomes, predictors, analytical methods, and findings.

Results

Of the 10 studies that qualified for review, 4 compared mobile mammography users with users of fixed units, and the other 6 characterized mobile mammography users only. All the mobile mammography units included reached underserved women. Most of the women screened in mobile units were African American or Latina, low income, and/or uninsured. Mobile mammography users reported low adherence to 1-year (12%–34%) and 2-year (40%–48%) screening guidelines. Some difficulties faced by mobile clinics were patient retention, patient follow-up of abnormal or inconclusive findings, and women inaccurately perceiving their breast cancer risk.

Conclusion

Mobile mammography clinics may be effective at reaching medically underserved women. Adding patient navigation to mobile mammography programs may promote attendance at mobile sites and increase follow-up adherence. Efforts to promote mammographic screening should target women from racial/ethnic minority groups, women from low-income households, and uninsured women. Future research is needed to understand how to best improve visits to mobile mammography clinics.

Bridging the Gap: Racial concordance as a strategy to increase African American participation in breast cancer research

Lack of African American females in breast cancer research has been receiving substantial attention. This study seeks to identify research perceptions and motivating factors needed to increase racial/ethnic minority participation in breast cancer research. A total of 57 African American women (Σ = 47.8 years), from Rhode Island and Texas, completed a questionnaire and focus group. While many participants were not breast cancer survivors, they reported knowledge of their racial group’s risk for breast cancer. One major finding that could be seen as both a facilitator and barrier is racial concordance between participant and researcher. Cultural sensitivity and trust building is recommended to increase minority participation.

Message Received: African American Women and Breast Cancer Screening

African American women are more likely than other women to be diagnosed with breast cancer at a young age, to be diagnosed at a late stage, and to die from the disease. Yet we see evidence of irregular screening and follow-up. Previous research on psychosocial factors influencing decisions to screen reveals barriers: fear, fatalistic perceptions of cancer, inaccurate perceptions of risk, and associations with stigma. The current qualitative research with, largely, insured African American women ( n = 26), health navigators ( n = 6), and community stakeholders ( n = 24) indicates both positive and negative factors influencing decision making. The women in our sample believe in the value of early detection and are motivated to screen in response to encouragement from health providers. However, they also report several factors that contribute to their decisions to delay or not screen. These include (1) perceptions that the health community itself is confused about the need for screening, (2) perceptions that White women are the priority population for breast cancer, (3) family roles that prohibit self-care and encourage secrecy, and (4) fear of diagnosis. Participants report not feeling included in national-level health promotion campaigns. It is argued that African American women, in particular, may benefit from more nuanced health information about their risk.

Changing global policy to deliver safe, equitable, and affordable care for women's cancers

Breast and cervical cancer are major threats to the health of women globally, particularly in low-income and middle-income countries. Radical progress to close the global cancer divide for women requires not only evidence-based policy making, but also broad multisectoral collaboration that capitalises on recent progress in the associated domains of women's health and innovative public health approaches to cancer care and control. Such multisectoral collaboration can serve to build health systems for cancer, and more broadly for primary care, surgery, and pathology. This Series paper explores the global health and public policy landscapes that intersect with women's health and global cancer control, with new approaches to bringing policy to action. Cancer is a major global social and political priority, and women's cancers are not only a tractable socioeconomic policy target in themselves, but also an important Trojan horse to drive improved cancer control and care.