Receipt of mammography recommendations among White and non-White women before and after the 2009 United States Preventive Services Task Force recommendation change

A catchment and location-allocation analysis of mammography access in Delaware, US: implications for disparities in geographic access to breast cancer screening

BACKGROUND

Despite a 40% reduction in breast cancer mortality over the last 30 years, not all groups have benefited equally from these gains. A consistent link between later stage of diagnosis and disparities in breast cancer mortality has been observed by race, socioeconomic status, and rurality. Therefore, ensuring equitable geographic access to screening mammography represents an important priority for reducing breast cancer disparities. Access to breast cancer screening was evaluated in Delaware, a state that experiences an elevated burden from breast cancer but is otherwise representative of the US in terms of race and urban-rural characteristics. We first conducted a catchment analysis of mammography facilities. Finding evidence of disparities by race and rurality, we next conducted a location-allocation analysis to identify candidate locations for the establishment of new mammography facilities to optimize equitable access.

METHODS

A catchment analysis using the ArcGIS Pro Service Area analytic tool characterized the geographic distribution of mammography sites and Breast Imaging Centers of Excellence (BICOEs). Poisson regression analyses identified census tract-level correlates of access. Next, the ArcGIS Pro Location-Allocation analytic tool identified candidate locations for the placement of additional mammography sites in Delaware according to several sets of breast cancer screening guidelines.

RESULTS

The catchment analysis showed that for each standard deviation increase in the number of Black women in a census tract, there were 68% (95% CI 38-85%) fewer mammography units and 89% (95% CI 60-98%) fewer BICOEs. The more rural counties in the state accounted for 41% of the population but only 22% of the BICOEs. The results of the location-allocation analysis depended on which set of screening guidelines were adopted, which included increasing mammography sites in communities with a greater proportion of younger Black women and in rural areas.

CONCLUSIONS

The results of this study illustrate how catchment and location-allocation analytic tools can be leveraged to guide the equitable selection of new mammography facility locations as part of a larger strategy to close breast cancer disparities.

A Catchment and Location-Allocation Analysis of Mammography Access in Delaware, US: Implications for disparities in geographic access to breast cancer screening

Background

Despite a 40% reduction in breast cancer mortality over the last 30 years, not all groups have benefited equally from these gains. A consistent link between later stage of diagnosis and disparities in breast cancer mortality has been observed by race, socioeconomic status, and rurality. Therefore, ensuring equitable geographic access to screening mammography represents an important priority for reducing breast cancer disparities. This study conducted a catchment and location-allocation analysis of mammography access in Delaware, a state that is representative of the US in terms of race and urban-rural characteristics and experiences an elevated burden from breast cancer.

Methods

A catchment analysis using the ArcGIS Pro Service Area analytic tool characterized the geographic distribution of mammography sites and Breast Imaging Centers of Excellence (BICOEs). Poisson regression analyses identified census tract-level correlates of access. Next, the ArcGIS Pro Location-Allocation analytic tool identified candidate locations for the placement of additional mammography sites in Delaware according to several sets of breast cancer screening guidelines.

Results

The catchment analysis showed that for each standard deviation increase in the number of Black women in a census tract, there were 64% (95% CI, 0.18-0.66) fewer mammography units and 85% (95% CI, 0.04-0.48) fewer BICOEs. The more rural counties in the state accounted for 41 % of the population but only 22% of the BICOEs. The results of the location-allocation analysis depended on which set of screening guidelines were adopted, which included increasing mammography sites in communities with a greater proportion of younger Black women and in rural areas.

Conclusions

The results of this study illustrate how catchment and location-allocation analytic tools can be leveraged to guide the equitable selection of new mammography facility locations as part of a larger strategy to close breast cancer disparities.

Hereditary Breast Cancer Risk Analysis in Uninsured Mexican-Origin Women Living in the U.S.–Mexico Border Region

Purpose:

This article describes the risk of hereditary breast cancer (HBC) in low-income Hispanic women living on the U.S.–Mexico border using the Pedigree Assessment Tool (PAT).

Method:

The PAT was administered as part of the El Paso and Hudspeth County Breast Cancer Education, Screening and NavigaTion program (BEST). Baseline data ( n = 1,966) from this program was used to analyze risk factors for HBC. Analysis was conducted to determine significant covariates associated with the presence of any PAT risk factors.

Results:

The PAT identified 17% (95% CI [15%, 19%]) of the women in the study as having some risk of HBC. Having had a mammogram within 3 years was significantly associated with having any PAT risk factors (odds ratio [OR] = 1.79, p = .006). Women who immigrated to the United States during childbearing age (OR = 0.610, p = .009) or during peri/menopause (OR = 0.637, p = .024) were significantly less likely to have any PAT risk factors.

Discussion:

The PAT instrument detected a substantial pool of women who may be at risk for HBC. A significant proportion of these women were not up to date mammogram.

Conclusions:

The PAT is an effective tool to identify women at risk for HBC and encourage regular screening.

Examining Breast Cancer Screening Behavior Among Southern Black Women After the 2009 US Preventive Services Task Force Mammography Guideline Revisions

Updated United States Preventive Services Task Force (USPSTF) and American Cancer Society mammography screening recommendations push for increased age of initiation and lengthened breast cancer screening intervals. These changes have implications for the reduction of breast cancer mortality in Black women. The purpose of this study was to examine breast cancer screening behavior in a cohort of Southern Black women after the release of the 2009 USPSTF recommendations. Surveys assessing cancer screening information were collected from members of Black churches between 2006 and 2013. The sample was restricted to women aged 40 to 74 years, who did not report a breast cancer diagnosis, or a recent diagnostic mammogram (n = 789). Percentages of women ever completing a mammogram (age 40-49) and annual mammography (age 50-74) in 2006-2009 and 2010-2013 were compared using chi-square statistics. Logistic regression models were fit to determine the predictors of adherence to pre-2010 screening guidelines. No significant changes in mammography rates were found for women in the 40-49 age group (X² = 0.42, p = 0.52) nor for those in the 50-74 age group (X² = 0.67, p = 0.41). Completing an annual clinical breast exam was a significant predictor of adherence to pre-2010 screening guidelines for both age groups (OR 19.86 and OR 33.27 respectively) and participation in education sessions (OR 4.26). Stability in mammography behavior may be a result of PCP's advice, or community activities grounded pre-2010 screening recommendations. More research is needed to understand how clinical interactions and community-based efforts shape Black women's screening knowledge and practices.

Factors Associated with Initial Mode of Breast Cancer Detection among Black Women in the Women's Circle of Health Study

Mammogram-detected breast cancers have a better prognosis than those identified through clinical breast exam (CBE) or through self-detection, primarily because tumors detected by mammography are more likely to be smaller and do not involve regional nodes. In a sample of 1,322 Black women, aged 40-75 years, diagnosed with breast cancer between 2002 and 2016, we evaluated factors associated with CBE and self-detection versus screening mammogram as the initial mode of breast cancer detection, using multivariable logistic regression models. Compared with screening mammogram, history of routine screening mammogram (OR 0.20, 95% CI: 0.07, 0.54) and performance of breast self-examination (BSE) (OR 0.31, 95% CI: 0.13, 0.74) before diagnosis were associated with lower odds of CBE as the initial mode of detection, while performance of CBEs before diagnosis (OR 11.04, 95% CI: 2.24, 54.55) was positively associated. Lower body mass index (<25.0 kg/m² vs. ≥35.0 kg/m²: OR 2.46, 95% CI: 1.52, 3.98), performance of BSEs before diagnosis (less than once per month: OR 4.08, 95% CI: 2.45, 6.78; at least monthly: OR 4.99, 95% CI: 3.13, 7.97), and larger tumor size (1.0-2.0 cm vs. <1.0 cm: OR 2.92, 95% CI: 1.84, 4.64; >2.0 cm vs. <1.0 cm: OR 6.41, 95% CI: 3.30, 12.46) were associated with increased odds of self-detection relative to screening mammogram. The odds of CBE and self-detection as initial modes of breast cancer detection among Black women are independently associated with breast care and breast cancer screening services before diagnosis and with larger tumors at diagnosis.

Lack of Impact of the 2009 USPSTF Guidelines on Rates of Mammography Screening

BACKGROUND

In November 2009, the United States Preventive Services Task Force (USPSTF) changed their mammography screening guidelines from recommending a screen every 1-2 years for women older than 40 years. The revised guideline recommends against regular screening for women aged 40-49 and recommends biennial screening for women aged 50-74.

RESEARCH DESIGN

We used autoregressive integrated moving-average (ARIMA) time series modeling to estimate the effect of the USPSTF 2009 guidelines on trends in screening rates. Enrollment and encounter files from the PharMetrics LifeLink+ commercial insurance claims database, years 2006-2014, were linked to determine monthly screening rates. The main outcome measure was mammography screening rates per 1,000 commercially insured women aged 40-49 or aged 50-64.

RESULTS

The study sample included 493,347 women aged 40-49 years with at least 1 month of eligibility and 658,052 women aged 50-64 years with at least 1 month of eligibility. There were 1,305,375 total screening mammograms from 2007 to 2014. Average monthly mammography screening rates from 2007 to 2014 were 40.4 per 1,000 women aged 40-49 and 54.8 per 1,000 women aged 50-64. There was a temporary decline in monthly screening rates of 11.8% and 11.2% for the 40-49 and 50-64 age groups, respectively, in the 2-month period after the guideline change (January and February 2010), but the rates quickly returned to pre-USPSTF trend levels afterward.

CONCLUSION

Implementation of the USPSTF 2009 guidelines was not associated with a persistent long-term change in mammography screening rates over the next 5 years, despite a temporary decline of 2 months immediately following the guidelines.

Germline BRCA1/BRCA2 mutations among high risk breast cancer patients in Jordan

Background

Breast cancer is the most common malignancy and the leading cause of cancer-related deaths among Jordanian women. With a median age of 50 years at diagnosis, a higher prevalence of hereditary breast cancer may be expected. The objective of this pilot study is to evaluate, for the first time, the contribution of germline mutations in BRCA1/2 to breast cancer among Jordanian patients.

Methods

Jordanian breast cancer women with a selected high risk profile were invited to participate. Peripheral blood samples were obtained for DNA extraction. A detailed 3-generation family history was also collected. BRCA sequencing was performed at a reference laboratory. Mutations were classified as deleterious, suspected deleterious, variant of uncertain significance or favor polymorphisms. Patients’ medical records were reviewed for extraction of clinical and tumor pathology data.

Results

One hundred patients were enrolled to the study. Median age was 40 (22–75) years. In total, 20 patients had deleterious and 7 suspected deleterious mutations in BRCA1 or BRCA2 genes. Seven variants of uncertain significance were also detected. After excluding patients tested subsequent to the index case in their families, highest mutation rates were observed among triple negatives (9/16, 56.3%) especially among those with positive family history of breast and/or ovarian cancer (9/13, 69.2%), patients with bilateral or second primary breast cancer (10/15, 66.7%) and those with family history of male breast cancer (2/5, 40.0%).

Conclusions

BRCA1/2 mutations are not uncommon among selected Jordanian females with breast cancer. The contribution of these findings to much younger age at diagnosis is debatable.

Although small, our selected patient cohort shows an important incidence of deleterious and suspected deleterious BRCA1/2 mutations suggesting that genetic testing should be offered to patients with certain high risk features.

[Presentation and outcome of breast cancer under 40 years - A French monocentric study]

OBJECTIVE

The aim of our study was to evaluate the impact of young age on breast cancer presentation and women's prognosis.

METHODS

We performed a descriptive retrospective study in the university teaching hospital of Tours from January 2007 to December 2013. All women managed for an invasive breast cancer were included. The population was divided in 2 groups according to age: ≤40 years and>40 years. We studied differences in histological, management and outcome characteristics.

RESULTS

Two thousand and eighty three women with an invasive breast cancer were included. A hundred and fifty five in the group of women with an age ≤40 years and 1928 in the group of women with an age>40 years. Histological characteristics of breast cancer in younger women were worse than in their older counterparts (with more aggressive features: grade 3, negative hormone receptors, positive Her 2 status, triple negative molecular sub-type). Overall survival was lower in young women than in women age>40 years (P=0.05),as was recurrence free survival (P<0.001), locoregional recurrence free survival (P=0.02) and distant metastasis free survival(P<0.001). Age≤40 years was an independent factor predictive of poor recurrence free survival.

CONCLUSION

In our study we found an impact of age≤40 years on invasive breast cancer presentation and prognosis.