Is clinical breast examination important for breast cancer detection?

C. SP, Giri S, Dulal BP, Joshi D, Gautam G, Baral SC. Factors associated with uptake of breast and cervical cancer screening among Nepalese women: Evidence from Nepal Demographic and Health Survey 2022

Breast cancer screening (BCS) and cervical cancer screening (CCS) are integral parts of initiatives to reduce the burden associated with these diseases. In this context, we aimed to determine factors associated with BCS and CCS uptake among Nepalese women aged 30 to 49 years using data from the Nepal Demographic Health Survey (NDHS) 2022. We performed a weighted analysis to account complex survey design of the NDHS 2022. We employed univariable and multivariable logistic regression to determine factors associated with the uptake of BCS and CCS and results were presented as crude odds ratio and adjusted odds ratio (AOR) along with 95% confidence interval (CI). The uptake of BCS and CCS among Nepalese women aged 30 to 49 years were 6.5% and 11.4% respectively. Women from Terai compared to mountain region (AOR = 0.54, 95%CI: 0.31, 0.93) and those engaged in agriculture compared to non-working (AOR = 0.59, 95%CI: 0.42, 0.82) women had lower odds of BCS uptake. Conversely, Dalit women compared to Brahmin/Chhetri (AOR = 2.08, 95%CI: 1.37, 3.16), and women with basic (AOR = 1.49, 95%CI: 1.04, 2.13), secondary (AOR = 1.96, 95%CI: 1.33, 2.88), and higher education (AOR = 2.80, 95% CI: 1.51, 5.19) compared to those with no education had higher odds of BCS uptake. Women from rural areas (AOR = 0.76, 95%CI: 0.61, 0.96), and those living in Bagmati (AOR = 2.16, 95% CI: 1.44, 3.23) and Gandaki (AOR = 2.09, 95%CI: 1.40, 3.14) provinces had higher odds of CCS uptake compared to their urban counterparts and those living in Koshi province, respectively. The odds of CCS increased with age (AOR = 1.06, 95%CI: 1.04, 1.08). Women with secondary education (AOR = 1.47, 95%CI: 1.06, 2.04) had higher odds of CCS uptake compared to those without education. Similarly, married women (AOR = 8.24, 95%CI: 1.03, 66.21), and those with health insurance (AOR = 1.41, 95%CI: 1.08, 1.83) had higher odds of CCS. In conclusion, the uptake of both BCS and CCS was relatively poor among Nepalese women indicating a need for targeted and tailored intervention to increase BCS and CCS uptake.

Targeting the Oxytocin Receptor for Breast Cancer Management: A Niche for Peptide Tracers

Breast cancer is a leading cause of death in women, and its management highly depends on early disease diagnosis and monitoring. This remains challenging due to breast cancer's heterogeneity and a scarcity of specific biomarkers that could predict responses to therapy and enable personalized treatment. This Perspective describes the diagnostic landscape for breast cancer management, molecular strategies targeting receptors overexpressed in tumors, the theranostic potential of the oxytocin receptor (OTR) as an emerging breast cancer target, and the development of OTR-specific optical and nuclear tracers to study, visualize, and treat tumors. A special focus is on the chemistry and pharmacology underpinning OTR tracer development, preclinical in vitro and in vivo studies, challenges, and future directions. The use of peptide-based tracers targeting upregulated receptors in cancer is a highly promising strategy complementing current diagnostics and therapies and providing new opportunities to improve cancer management and patient survival.

Fusion of transfer learning models with LSTM for detection of breast cancer using ultrasound images

Breast Cancer (BC) is one of the top reasons for fatality in women worldwide. As a result, timely identification is critical for successful therapy and excellent survival rates. Transfer Learning (TL) approaches have recently shown promise in aiding in the early recognition of BC. In this work, three TL models, MobileNetV2, ResNet50, and VGG16, were combined with LSTM to extract the features from Ultrasound Images (USIs). Furthermore, the Synthetic Minority Over-sampling Technique (SMOTE) with Tomek (SMOTETomek) was employed to balance the extracted features. The proposed method with VGG16 achieved an F1 score of 99.0 %, Matthews Correlation Coefficient (MCC) and Kappa Coefficient of 98.9 % with an Area Under Curve (AUC) of 1.0. The K-fold method was applied for cross-validation and achieved an average F1 score of 96 %. Moreover, the Gradient-weighted Class Activation Mapping (Grad-CAM) method was applied for visualization, and the Local Interpretable Model-agnostic Explanations (LIME) method was applied for interpretability. The Normal Approximation Interval (NAI) and bootstrapping methods were used to calculate Confidence Intervals (CIs). The proposed method achieved a Lower CI (LCI), Upper CI (UCI), and Mean CI (MCI) of 96.50 %, 99.75 %, and 98.13 %, respectively, with the NAI, while 95 % LCI of 93.81 %, an UCI of 96.00 %, and a bootstrap mean of 94.90 % with the bootstrap method. Furthermore, the performance of the six state-of-the-art (SOTA) TL models, such as Xception, NASNetMobile, InceptionResNetV2, MobileNetV2, ResNet50, and VGG16, were compared with the proposed method.

The role of clinical breast examination and fine needle aspiration cytology in early detection of breast cancer: A cross-sectional study nested in a cohort in a low-resource setting

BACKGROUND

Breast cancer is prevalent worldwide, with disparities in screening, diagnosis, treatment outcomes, and survival. In Africa, the majority of women are diagnosed at advanced stages, affecting treatment outcomes. Screening is one of the best strategies to reduce mortality rates caused by this cancer. Yet in a resource-constrained setting, there is limited access to screening and early detection services, which are available only at a few referral hospitals.

OBJECTIVES

We aimed to evaluate the prevalence and screening results of breast cancer using clinical breast examination coupled with fine needle aspiration cytology in a resource-constraint setting.

DESIGN

A combined cross-sectional and cohort study.

METHODS

Women at risk of developing breast cancer in the Kilimanjaro region of Tanzania were invited, through public announcements, to their primary healthcare facilities. A questionnaire was used to assess the participants' characteristics. The women received a clinical breast examination, and detectable lesions were subjected to a confirmatory fine needle aspiration cytology or an excisional biopsy. Preliminary data from this ongoing breast cancer control program were extracted and analyzed for this study.

RESULTS

A total of 3577 women were screened for breast cancer; their mean age was 47 ± 7.53 years. About a third of them (1145, 32%) were practicing self-breast examination at least once a month. Of 200 (5.6%) with abnormal clinical breast examination, 18 (9%) were confirmed to be breast cancer, making the prevalence to be 0.5%. The vast majority of participants with breast cancer (13, 72.2%) had early disease stages, and infiltrating ductal carcinoma, no special type, was the most common (15, 83.3%) histopathology subtype. Hormonal receptor status determination results indicated that 11 (61.1%), 7 (38.9%), and 5 (27.8%) of the tumors overexpressed estrogen receptor, progesterone receptor, and human epidermal receptor-2, respectively.

CONCLUSION

Our study demonstrates 5.6% of Tanzanian women have abnormal clinical breast examination findings, with 9% having breast cancer. Nearly three-quarters (72.2%) of breast cancer screened for early disease were detected in the early disease stages. This finding suggests that organized screening with clinical breast examination coupled with fine needle aspiration cytology, which is a simple and cost-effective screening method, has the potential to improve early detection and outcomes for breast cancer patients in a resource-constraint setting.

Effectiveness of triennial screening with clinical breast examination: 14-years follow-up outcomes of randomized clinical trial in Trivandrum, India

BACKGROUND

This study presents the preliminary results of a randomized controlled trial (RCT) initiated in January 2006 in India to evaluate the effectiveness of clinical breast examination (CBE) in reducing breast cancer mortality as compared to a no-screening control group reported significant downstaging in the intervention group. The present manuscript reports long-term follow-up outcomes.

METHODS

Women 30-69 years old from 133 intervention clusters and 141 control clusters were invited to participate. Women in the intervention arm underwent three rounds of CBE every 3 years. CBE-positive women were reexamined by a physician, and triple-assessment was performed on those confirmed to have abnormalities. All participants were followed through home visits and linkage with population-based cancer registry.

RESULTS

Of the 55,843 eligible women in the intervention arm, 95.7% had CBE at least once and 11.5% were CBE-positive. Breast cancers were diagnosed in 335 participants in the intervention group and 273 in the control group (N = 59,447). Age-standardized incidence rate of early cancer was 30.4 of 100,000 in the intervention and 21.9 of 100,000 in the control group, with a rate ratio (RR) of 1.4 (95% confidence interval [CI], 1.1-1.8). The age-standardized breast cancer mortality rates were 11.3 and 11.1 per 100,000 in intervention and control arms, respectively (RR, 1.1; 95% CI, 0.8-1.5) after 15 years. Five-year breast cancer survival rates were 77.0% in the intervention and 71.2% in the control groups (overall p value = .043).

CONCLUSIONS

Triennial CBE screening failed to demonstrate any mortality benefit despite achieving a shift toward earlier stage at detection and improved survival in the intervention arm. CBE is a valuable tool for diagnosis of breast cancer in symptomatic women especially in areas where mammography and/or breast cancer screening programs are not widely available.

Practice of breast self-examination and associated factors among female health professionals working in public hospitals of Harari regional state: Eastern Ethiopia multicenter study

Breast cancer is the most frequent malignancy among women in both developed and developing countries. Early detection of breast cancer using breast self-examination plays a substantial role in reducing its morbidity and mortality. Despite improved availability of health information the morbidity and mortality caused by breast cancer among females were increasing from time to time and there is no information regarding the practice of breast self-examination in our study area.

Objective

This study was aimed at assessing breast self-examination practice and associated factors among female health professionals who were working in public hospitals of Harari Regional State in 2022.

Methods

Institutional-based quantitative cross-sectional study design was used to assess the practice of breast self-examination and associated factors among female health professionals who have been working in a public hospital in Harari regional state from March 25 to April 05, 2022. The study subjects were selected using a simple random sampling technique and data were collected by a self-administered and structured questionnaire. The collected data was edited, cleaned, coded, and entered into Epi-Data version 3.1 software and analyzed using the statistical package for social science software version 20. Bivariable and multivariable logistic regression analysis was carried out to see the association between independent and dependent variables. Variable with P-value less than 0.05 at final model were regarded as statistically significant.

Result

Among a total of 362 female health professionals, 171 (47.2%) respondents were ever practiced breast self-examination, 229(63.3%) had good knowledge of breast self-examination and 252(69.6%) had a favorable attitude toward breast self-examination. Work experience of ≥5 year (AOR = 2.51; 95% CI: 1.31–4.82), educational status of degree and above (AOR = 7.2; 95% CI: 3.82–10.58), good knowledge about breast self-examination (AOR = 3.4; 95% CI: 1.41–5.40) and favorable attitude toward breast self-examination (AOR = 3.1; 95% CI: 2.11–4.10) were significantly associated with breast self-examination practice.

Conclusion

The finding of this study implies that the practice of breast self-examination among female health professionals is low. Work experience of ≥5 year, educational status of degree and above, having a good knowledge and favorable attitude toward breast self-examination were significantly associated with breast self-examination.

CmP Signaling Network Leads to Identification of Prognostic Biomarkers for Triple-Negative Breast Cancer in Caucasian Women

Objective: Triple-negative breast cancer (TNBC) constitutes ∼15% of all diagnosed invasive breast cancer cases with limited options for treatment since immunotherapies that target ER, PR, and HER2 receptors are ineffective. Progesterone (PRG) can induce its effects through either classic, nonclassic, or combined responses by binding to classic nuclear PRG receptors (nPRs) or nonclassic membrane PRG receptors (mPRs). Under PRG-induced actions, we previously demonstrated that the CCM signaling complex (CSC) can couple both nPRs and mPRs into a CmPn signaling network, which plays an important role during nPR(+) breast cancer tumorigenesis. We recently defined the novel CmP signaling network in African American women (AAW)-derived TNBC cells, which overlapped with our previously defined CmPn network in nPR(+) breast cancer cells. Methods: Under mPR-specific steroid actions, we measured alterations to key tumorigenic pathways in Caucasian American women (CAW)- derived TNBC cells, with RNAseq/proteomic and systems biology approaches. Exemption from ethics approval from IRB: This study only utilized cultured NBC cell lines with publicly available TNBC clinical data sets. Results: Our results demonstrated that TNBCs in CAW share similar altered signaling pathways, as TNBCs in AAW, under mPR-specific steroid actions, demonstrating the overall aggressive nature of TNBCs, regardless of racial differences. Furthermore, in this report, we have deconvoluted the CmP signalosome, using systems biology approaches and CAW-TNBC clinical data, to identify 21 new CAW-TNBC-specific prognostic biomarkers that reinforce the definitive role of CSC and mPR signaling during CAW-TNBC tumorigenesis. Conclusion: This new set of potential prognostic biomarkers may revolutionize molecular mechanisms and currently known concepts of tumorigenesis in CAW-TNBCs, leading to hopeful new therapeutic strategies.

The Efficacy of Clinical Breast Exams and Breast Self-Exams in Detecting Malignancy or Positive Ultrasound Findings

Objective

A breast exam is a low-risk, low-cost method for early detection, which is crucial for improved mortality. However, clinical breast exams (CBE) and breast self-exams (BSEs) remain controversial with unclear guidelines. This study analyzes the efficacy of these two exam types in evaluating palpable breast masses.

Methods

This retrospective cross-sectional study included 2019 medical records from Epic of women with breast lumps. Patient demographics, provider types, and breast exam types were recorded. Primary outcomes were detection of cancer and positive ultrasound finding. Fisher’s exact tests and two-sample t-tests determined the statistical significance of the association between the outcomes and categorical and continuous variables.

Results

Of 462 breast masses, 69 demonstrated positive ultrasound findings, with 26 of those yielding cancer; 96% of cancers and 81% of ultrasound findings resulted from patient-identified lumps. Of provider-identified lumps, 100% of cancers and 92.3% of positive ultrasound findings were diagnosed by MDs (doctors of medicine) rather than midlevel providers. There was no statistically significant difference in identifying cancer or positive ultrasound finding between CBEs and BSEs (p = 0.3709 and p = 0.1556).

Conclusion

Despite no difference between CBEs and BSEs in identifying cancer or positive ultrasound finding, 25 of the 26 breast cancers were initially detected by patients, while only one of 26 was detected by CBE. BSEs detect breast cancers. Although some guidelines encourage CBEs over self-exams, not all CBEs are equal.

Key message

There is no significant difference between CBEs and BSEs in identifying cancer or positive ultrasound finding. The majority of cancers were initially identified by patients. BSEs detect breast cancers and women should continue performing them. Not all CBEs are equal. CBEs by MDs, especially women health specialists, are generally more effective than those by midlevel providers.

Evaluation of breast stiffness pathology based on breast compression during mammography: Proposal for novel breast stiffness scale classification

Breast cancer is diagnosed through a patient's Breast Self-Examination (BSE), Clinical Breast Examination (CBE), or para-clinical methods. False negativity of PCM in breast cancer diagnostics leads to a persisting problem associated with breast tumors diagnosed only in advanced stages. As the tumor volume/size at which it becomes invasive is not clear, BSE and CBE play an exceedingly important role in the early diagnosis of breast cancer. The quality and effectiveness of BSE and CBE depend on several factors, among which breast stiffness is the most important one. In this study, the authors present four methods for evaluating breast stiffness pathology during mammography examination based on the outputs obtained during the breast compression process, id est, without exposing the patient to X-Ray radiation. Based on the subjective assessment of breast stiffness by experienced medical examiners, a novel breast stiffness classification was designed, and the best method of its objective measurement was calibrated to fit the scale. Hence, this study provides an objective tool for the identification of patients who, being unable to perform valid BSE, could benefit from an increased frequency of mammography screening. Dum vivimus servimus.

Practical Utility of Diagnostic Clinical Breast Examination in the Diagnosis of Breast Cancer

Objectives We aimed to investigate the effectiveness of physician-performed diagnostic clinical breast examination (DCBE) for the diagnosis of breast cancer in clinical practice and to determine the rates of breast cancer diagnosed with DCBE compared to the results of breast ultrasonography (US), mammography (MG), and histopathology. Methods In the retrospective cohort study, the files of female patients diagnosed with breast cancer and admitted to the general surgery outpatient clinics of a university hospital over a 10-year period (2011-2021) were examined. Patients with complete DCBE findings in their files were identified and analyzed (n = 1,091). The examinations of the patients were performed by general surgery specialists with 5-22 years of experience and by radiologists with 4-15 years of experience. Results The mean age of breast cancer diagnosis of the patients was 55.1 ± 13.5 years. While the sensitivity of DCBE was found to be 88.9%, MG sensitivity was 89.8% and breast US sensitivity was 95.1%. Cancer was detected by MG, breast US, and DCBE in 47.9% (n = 523), by breast US and DCBE in 38.9% (n = 424), by MG and breast US in 5.6% (n = 61), by DCBE alone in 3.6% (n = 39), by MG and DCBE in 2.4% (n = 26), and by breast US alone in 1.6% (n = 18). Early-stage breast cancer (p = 0.00) consisted of 73.2% (n = 383) of cancers detected with DCBE, breast US and MG, 74.6% (n = 316) of cancers detected with DCBE and breast US, 93.4% of cancers detected with breast US and MG (n = 57), 92.3% (n = 24) of cancers detected with DCBE and MG, 94.4% (n = 17) of cancers detected with breast US alone, and 69.2% of cancers detected with DCBE alone (n = 27). Conclusions CBE still maintains its importance in societies where screening participation and awareness of breast cancer are low. A breast cancer diagnosis is often done after a complaint of a palpable mass in the breast, and only then are more advanced-stage breast cancers are seen. CBE is among the important diagnostic methods preventing breast cancer from being overlooked, especially in places where health resources are limited.

Clinical Utility of a Hand-Held Scanner for Breast Cancer Early Detection and Patient Triage

PURPOSE

Globally, breast cancer represents the most common cause of cancer death among women. Early cancer diagnosis is difficult in low- and middle-income countries, most of which are unable to support population-based mammographic screening. Triage on the basis of clinical breast examination (CBE) alone can be difficult to implement. In contrast, piezo-electric palpation (intelligent Breast Exam [iBE]) may improve triage because it is portable, low cost, has a short learning curve, and provides electronic documentation for additional diagnostic workup. We compared iBE and CBE performance in a screening patient cohort from a Western mammography center.

METHODS

Women presenting for screening or diagnostic workup were enrolled and underwent iBE then CBE, followed by mammography. Mammography was classified as negative (BI-RADS 1 or 2) or positive (BI-RADS 3, 4, or 5). Measures of accuracy and κ score were calculated.

RESULTS

Between April 2015 and May 2017, 516 women were enrolled. Of these patients, 486 completed iBE, CBE, and mammography. There were 101 positive iBE results, 66 positive CBE results, and 35 positive mammograms. iBE and CBE demonstrated moderate agreement on categorization (κ = 0.53), but minimal agreement with mammography (κ = 0.08). iBE had a specificity of 80.3% and a negative predictive value of 94%. In this cohort, only five of 486 patients had a malignancy; iBE and CBE identified three of these five. The two cancers missed by both modalities were small—a 3-mm retro-areolar and a 1-cm axillary tail.

CONCLUSION

iBE performs comparably to CBE as a triage tool. Only minimal cancers detected through mammographic screening were missed on iBE. Ultimately, our data suggest that iBE and CBE can synergize as triage tools to significantly reduce the numbers of patients who need additional diagnostic imaging in resource-limited areas.

Breast health screening: a UK-wide questionnaire

Background

Currently, there is an unmet clinical need in identifying and screening women at high risk of breast cancer, where tumours are often aggressive and treatment intervention is too late to prevent metastasis, recurrence and mortality. This has been brought into sharp focus by the SARS-CoV-2 global pandemic, constantly changing hospital policies and surgical guidelines in reducing access to established screening and treatment regimens. Nipple aspirate fluid (NAF), is thought to provide a unique window into the biological processes occurring within the breast, particularly in the context of a developing neoplasm. Evaluation of NAF in asymptomatic women, for novel chemical biomarkers of either early disease and/or cancer risk offers tremendous promise as a tool to facilitate early detection and to supplement screening. However, it is acceptability as a method of collection and screening by women is critical and yet unknown. A breast health questionnaire was disseminated to women through breast cancer charities, patient support groups and social media platforms, with the aim of collecting opinions on the acceptability of use of NAF as a potential screening tool.

Method

Following ethical approval a questionnaire was prepared using online surveys consisting of four parts: (a) introduction on breast health screening in the UK, (b) core demographic data, (c) questions regarding screening and the acceptability of using NAF and (d) opinions about the process of collecting and using nipple fluid for screening. The voluntary and anonymous questionnaire was disseminated through social media, professional networks, charity websites and by individuals between October 2019 and December 2020. Survey responses were collected electronically, and the data analysed using online surveys statistical tools.

Results

A total of 3178 women completed the questionnaire (65.9% Caucasian, 27.7% Asian/British Asian, 0.6% black and 5.0% other). Of these, 2650 women (83.4%) had no prior knowledge of NAF and 89.4% were unaware that NAF can be expressed in up to 90% of all women. Concerning their risk of breast cancer, 89.8% of women were keen to know their future risk of breast cancer, 8.5% were unsure whether they wanted to know their risk and a further, 1.6% did not want to know. Regarding screening, 944 women (29.8%) were unaware of the lack of routine National Health Service Breast Screening for those under the age of 47 years. Furthermore, 53.0% of women were unaware that mammographic screening is affected by breast density. In terms of the acceptability of home testing for breast health, 92.0% were keen to undergo a home test. Both 79.7% and 70.9% stated they would consider hand massage and a breast pump to acquire nipple fluid samples, respectively. A further 48.6% of women would consider the use of a hormonal nasal spray for the same purpose. However, with regards to acquiring results from NAF testing, 42.6% of women would prefer to receive results at home and 34.2% in a medical facility. Finally, 91.6% of women believed that breast health should be incorporated as part of school education curriculum.

Conclusion

Public awareness regarding breast screening protocols and limitations of mammography could be improved. Many women were unaware that NAF might be a useful biofluid for future risk prediction, and yet the concept of self-testing of nipple fluid, with either hand massage or a breast pump was well received. Efforts should be made to increase awareness of the benefits of alternative and supplementary tests, especially in the context of high-risk individuals and younger patients.

Bilateral mammary hibernoma mimicking breast carcinoma: a diagnostic challenge

We describe a 68-year-old postmenopausal woman who presented with a history of rapidly enlarging lumps in both breasts. Though the breast lumps appeared suspicious on ultrasonography, the core biopsy was reported to be benign. In view of the clinical and radiological suspicion of malignancy, she underwent a diagnostic excision of both the lumps, the histopathology was consistent with mammary hibernoma. To the best of the authors' knowledge, this is the first report of a bilateral mammary hibernoma in an elderly postmenopausal woman. Given the clinical presentation, it is important to differentiate mammary hibernoma from carcinoma breast, which is a more common condition in this age group. However, preoperative diagnosis is challenging in view of the lack of definitive radiological and histological features. Although benign, hibernoma may have a propensity for local recurrence and, therefore, complete surgical excision remains the mainstay of treatment.

Palpable Breast Findings in High-risk Patients: Are Self- and Clinical Breast Exams Worthwhile?

OBJECTIVE

To assess breast imaging findings, biopsy rates, and malignancy rates in areas of palpable concern in women at high risk for breast cancer.

METHODS

An IRB-approved retrospective review of a tertiary cancer center's breast imaging database was performed. Breast imaging and electronic medical records of high-risk women with palpable findings detected on self- or clinical breast examination from January 1, 2010, to January 1, 2016, were reviewed. Descriptive statistical analyses were conducted.

RESULTS

Imaging correlates for 322 palpable findings in 238 high-risk women included 55/203 (27.1%) on mammography, 183/302 (60.6%) on US, and 20/47 (42.6%) on MRI. Biopsies were performed for 104/322 (32.3%) palpable findings: 95/104 (91.3%) under imaging guidance and 9/104 (8.7%) under palpation after negative imaging. Of 322 palpable findings, 16 (5.0%) were malignant in 16/238 (6.7%) women, yielding a positive predictive value of biopsy of 16.8% (95% CI: 9.2%-24%). Women diagnosed with cancer had 16/16 (100%) sonographic, 9/14 (64.3%) mammographic, and 7/7 (100%) MRI correlates. Cancer histopathology included 12 invasive ductal carcinomas, 1 ductal carcinoma in situ, 1 invasive lobular carcinoma, 1 malignant phyllodes tumor, and 1 metastatic carcinoid tumor. Over two years of follow-up imaging in 183/238 (76.9%) women were reviewed; 7/183 (3.8%) were diagnosed with breast cancer at least one year after presenting with a palpable concern in a different location.

CONCLUSION

High-risk women with palpable findings exhibit a 6.7% malignancy rate, indicating the value of imaging workup in this population. In our cohort, imaging demonstrated a high negative predictive value.

Factors associated with breast cancer screening intention in Kathmandu Valley, Nepal

Background

Breast cancer burden is increasing in low-income countries (LICs). Increasing incidence and delayed presentation of breast cancer are mainly responsible for this burden. Many women do not participate in breast cancer screening despite its effectiveness. Moreover, studies are limited on the barriers associated with low utilization of breast cancer screening in LICs. This study identified breast cancer screening behavior and factors associated with breast cancer screening intention among women in Kathmandu Valley, Nepal.

Methods

A cross-sectional study was conducted among 500 women living in five municipalities of Kathmandu Valley, Nepal. Data were collected from July to September 2018, using a structured questionnaire. Interviews were conducted among women selected through proportionate random household sampling. This study was conceptualized using the theory of planned behavior, fatalism, perceived susceptibility, and perceived severity. The outcome variables included: the intention to have mammography (MMG) biennially, the intention to have clinical breast examination (CBE) annually, and the intention to perform breast self-examination (BSE) monthly. Analysis was conducted separately for each outcome variable using partial proportional odds model.

Results

Out of 500 women, 3.4% had undergone MMG biennially, 7.2% CBE annually, and 14.4% BSE monthly. Women with a positive attitude, high subjective norms, and high perceived behavioral control were more likely to have the intention to undergo all three screening methods. Similarly, women were more likely to have intention to undergo CBE and MMG when they perceived themselves susceptible to breast cancer. Conversely, women were less likely to have intention to undergo CBE when they had high fatalistic beliefs towards breast cancer.

Conclusion

Women in this study had poor screening behavior. The practice of breast self-examination was comparatively higher than clinical breast examination and mammography. Multidimensional culturally sensitive interventions are needed to enhance screening intentions. Efforts should be directed to improve attitude, family support, and fatalistic belief towards cancer. Furthermore, the proper availability of screening methods should be ensured while encouraging women to screen before the appearance of symptoms.

Overview in Breast Cancer Screening in Lebanon

Breast cancer (BC) is the most common cancer in women and men combined, and it is the second cause of cancer deaths in women after lung cancer. In Lebanon, the same epidemiological profile applies where BC is the leading cancer among Lebanese females, representing 38.2% of all cancer cases. As per the Center for Disease Control, there was a decline in BC mortality rate from 2003 to 2012 reflecting the adoption of national mammographic screening as the gold standard for BC detection by Western countries. The aim of this review study is to summarize current recommendations for BC screening and the available modalities for detecting BC in different countries, particularly in Lebanon. It also aims at exploring the impact of screening campaigns on BC early stage diagnosis in Lebanon. Despite the considerable debates whether screening mammograms provides more harm than benefits, screening awareness should be stressed since its benefits far outweigh its risks. In fact, the majority of BC mortality cases in Western countries are non-preventable by the use of screening mammograms alone. As such, Lebanon adopted a public focus on education and awareness campaigns encouraging early BC screening. Several studies showed the impact of early detection that is reflected by an increase in early stage disease and a decrease in more aggressive stages. Further studies should shed the light on the effect of awareness campaigns on early breast cancer diagnosis and clinical down staging at a national scope; therefore, having readily available data on pre- and post-adoption of screening campaigns is crucial for analyzing trends in mortality of breast cancer origin and reduction in advanced stages diseases. There is still room for future studies evaluating post-campaigns knowledge, attitudes, and practices of women having participated, emphasizing on the barriers refraining Lebanese women to contribute in BC screening campaigns.

Breast self-examination practice and associated factors among female healthcare workers in Ethiopia: A systematic review and meta-analysis

Background

Breast cancer is common global public health problem. It is the principal cause of cancer related death. In Ethiopia, study findings regarding prevalence and associated factors of BSE among female healthcare workers have been inconsistently reported and highly variable. Thus, this systematic review and meta-analysis aimed to determine the pooled prevalence of breast self-examination practice and determinants in Ethiopia.

Methods

A systematic search of PubMed, Medline, EMBASE, Global Health, Google Scholar, CINAHL and Scopus from April 2, 2020 to April 24, 2020. Data were extracted from articles included in the review using a data extraction tool which was adapted from the Joanna Briggs Institute. the quality of each included article was evaluated using the Newcastle-Ottawa scale. Data analysis was done using STATA 11. The Cochrane Q and I² test were used to assess heterogeneity between the studies; and publication bias was assessed using funnel plots and Egger’s test. A random effects meta-analysis was computed to determine the pooled prevalence of breast self-examination. The determinants for breast self-examination were examined. Forest plots were used to present the prevalence and odds ratio with 95% confidence interval.

Results

After reviewing 9605 studies, 12 studies involving 4129 female healthcare workers were included for this review and meta-analysis. The pooled prevalence of breast self-examination practice among healthcare workers in Ethiopia was 56.31% (95% CI: 44.37, 68.25). The subgroup analysis further revealed that the higher breast self-examination practice was observed among other healthcare workers, 58.60% (95% CI: 43.31, 73.90). Good knowledge (AOR = 3.02; 95% CI: 1.24, 7.35), positive attitude (AOR = 2.73; 95% CI: 1.95, 4.13) and family history of breast cancer (AOR = 3.21; 95% CI: 1.22, 6.52) were significantly associated with breast self-examination practice among healthcare workers.

Conclusion

This meta-analysis found that nearly half of the female healthcare workers were not performed breast self-examination. The finding of this study suggests the need of strengthening early diagnosis of breast cancer and control strategies with a collaborative effort of policymakers and other concerned stakeholders.

Accuracy of breast MRI in patients receiving neoadjuvant endocrine therapy: comprehensive imaging analysis and correlation with clinical and pathological assessments

Purpose

To assess the accuracy of magnetic resonance imaging (MRI) measurements in locally advanced oestrogen receptor-positive and human epidermal growth factor receptor 2-negative breast tumours before, during and after neoadjuvant endocrine treatment (NET) for evaluation of tumour response in comparison with clinical and pathological assessments.

Methods

This prospective study enrolled postmenopausal patients treated neoadjuvant with letrozole and exemestane given sequentially in an intra-patient cross-over regimen. Fifty-four patients were initially recruited, but only 35 fulfilled the inclusion criteria and confirmed to participate with a median age of 77. Tumours were scanned with MRI prior to treatment, during the eighth week of treatment and prior to surgery. Additionally, changes in longest diameter on clinical examination (CE) and tumour size at pathology were determined. Pre- and post-operative measurements of tumour size were compared in order to evaluate tumour response.

Results

The correlation between post-treatment MRI size and pathology was moderate and higher with a correlation coefficient (r) 0.64 compared to the correlation between CE and pathology r = 0.25. Post-treatment MRI and clinical results had a negligible bias towards underestimation of lesion size. Tumour size on MRI and CE had 0.82 cm and 0.52 cm lower mean size than tumour size measured by pathology, respectively.

Conclusions

The higher correlation between measurements of residual disease obtained on MRI and those obtained with pathology validates the accuracy of imaging assessment during NET. MRI was found to be more accurate for estimating complete responses than clinical assessments and warrants further investigation in larger cohorts to validate this finding.

Electronic supplementary material

The online version of this article (10.1007/s10549-020-05852-7) contains supplementary material, which is available to authorized users.

Can Breast Self-examination and Clinical Breast Examination Along With Increasing Breast Awareness Facilitate Earlier Detection of Breast Cancer in Populations With Advanced Stages at Diagnosis?

Breast cancer is the most common form of cancer among women worldwide. Early detection is central to improving disease outcomes. Three main screening methods - mammography, breast self-examination (BSE), and clinical breast examination (CBE) - have been developed and tested in Western nations. There is ongoing debate regarding the efficacy of BSE and CBE in terms of mortality reduction, and a number of international organizations no longer recommend them as screening methods. In technically less developed countries, however, where women are usually diagnosed with breast cancer at advanced stages and younger ages, the benefits of BSE and CBE might outweigh the harm and facilitate early detection of breast cancer. This paper reviews the history of BSE and CBE and discusses their value as early detection methods. It can contribute to informed decision-making by health policy-makers and clinicians who are involved in breast cancer screening in the developing world to improve women's well-being.

Comparative Proteome Analysis of Breast Cancer Tissues Highlights the Importance of Glycerol-3-phosphate Dehydrogenase 1 and Monoacylglycerol Lipase in Breast Cancer Metabolism

BACKGROUND/AIM

Breast cancer (BC) incidence and mortality rates have been increasing due to the lack of appropriate diagnostic tools for early detection. Proteomics-based studies may provide novel targets for early diagnosis and efficient treatment. The aim of this study was to investigate the global changes occurring in protein profiles in breast cancer tissues to discover potential diagnostic or prognostic biomarkers.

MATERIALS AND METHODS

BC tissues and their corresponding healthy counterparts were collected, subtyped, and subjected to comparative proteomics analyses using two-dimensional gel electrophoresis (2-DE) and two-dimensional electrophoresis fluorescence difference gel (DIGE) coupled to matrix-assisted laser desorption/ionisation-time of flight mass spectrometry (MALDI-TOF/TOF) to explore BC metabolism at the proteome level. Western blot analysis was used to verify changes occurring at the protein levels.

RESULTS

Bioinformatics analyses performed with differentially regulated proteins highlighted the changes occurring in triacylglyceride (TAG) metabolism, and directed our attention to TAG metabolism-associated proteins, namely glycerol-3-phosphate dehydrogenase 1 (GPD1) and monoacylglycerol lipase (MAGL). These proteins were down-regulated in tumor groups in comparison to controls.

CONCLUSION

GPD1 and MAGL might be promising tissue-based protein biomarkers with a predictive potential for BC.

Practice and Attitudes of Donor Coordinator Roles Regarding Physical Examination of Potential Organ and Tissue Donors in Australia

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Background.

Physical examination of potential organ and tissue donors is standard practice to mitigate risks and optimize outcomes for transplant recipients, but the content and process of the examination has not been investigated. The aim of this study was to determine current practice of performing a physical examination on potential organ and tissue donors in Australia.

Methods.

An online cross-sectional survey was circulated to all Australian Donor Coordinators (n = 125).

Results.

There were 75 responses (60% response rate) to the online survey. Respondents perform a mean 10.5 physical examinations per year. Inconsistencies were observed in the approach to the physical examination, inclusive of assessment techniques used to perform the examination such as palpation. Specific staff training and education to perform the examination was reportedly provided to 77% of respondents. There was less variation reported in examination findings classified as higher risk and escalation procedures with the 3 most common findings of injection sites / track marks (86%), suspicious moles (77%), and unexplained scarring (51%), and with 97% seeking a second opinion. Current and previously removed melanomas were the main examination findings that stopped a donation from proceeding, as reported to have occurred by 18 respondents.

Conclusions.

This study has identified variations in current physical examination practice and provided the evidence to pursue practice improvement. The inconsistencies can be partly attributed to discrepancies in training and education of staff and no standardized national guidelines to clearly outline expected practice.

Inquiry and computer program Onko-Online: 25 years of clinical registry for breast cancer at the University Medical Centre Maribor

Background High-quality routine care data collected in the clinical registry play a significant role in improving the management of cancer patients. Clinical cancer registries record important data in the course of cancer diagnosis, treatment, follow-up and survival. Analyses of such comprehensive data pool make it possible to improve the quality of patients care and compare with other health care providers. Methods The first inquiry at the Department of Gynaecologic and Breast Oncology of the then General Hospital Maribor to follow breast cancer patients has been introduced in 1994. Based on our experience and new approaches in breast cancer treatment, the context of inquiry has been changed and extended to the present form, which served as a model for developing a relevant computer programme named Onko-Online in 2014. Results During the 25-year period, we collected data from about 3,600 breast cancer patients. The computer program Onko-Online allowed for quick and reliable collection, processing and analysis of 167 different data of breast cancer patients including general information, medical history, diagnostics, treatment, and follow-up. Conclusions The clinical registry for breast cancer Onko-Online provides data that help us to improve diagnostics and treatment of breast cancer patients, organize the daily practice and to compare the results of our treatment to the national and international standards. A limitation of the registry is the potentially incomplete or incorrect data input by different healthcare providers, involved in the treatment of breast cancer patients.

Assessment of breast self- examination practice and associated factors among female workers in Debre Tabor Town public health facilities, North West Ethiopia, 2018: Cross- sectional study

Background

Although breast Self-Examination is no longer tenable as a standard method to detect early breast cancer, world health organization recommends breast self -examination for raising awareness of women about breast cancer. Secondary prevention through monthly breast self-examination is the best option to tackle the rising incidence of breast cancer. Therefore, the aim of this study was to assess breast self -examination practice and associated factors.

Methods

This cross-sectional study was conducted from April 23 to May 23, 2018. A total of 421 female workers in Debre Tabor Town public health facilities were included. The study participants were selected using simple random sampling technique from the study population. The collected data were checked for completeness. The data were entered and cleaned using EpiData version 3.1 then exported to SPSS version 20 for analysis. Crude odd ratio and probability value were identified for each independent variable and all independent variables with probability value of less than 0.2 were entered into multivariables logistic regression. Statistically significant associated factors were identified based on probability value (p-value) less than 0.05 and adjusted odd ratio with 95% confidence interval.

Result

The mean age of participants was 25.2 (S.D = 4.12) and 137 (32.5%) of the participants had practiced breast self -examination and 64 (15.2%) of them performed it monthly. Family history of breast cancer (adjusted OR = 6.5, CI = 1.54–21.4), Knowledge about breast -self examination (adjusted OR = 5.74, CI = 2.3–14.4) and self- efficacy in practicing breast self -examination (adjusted OR = 4.7, CI = 1.84–12.11) were significantly associated with breast self -examination practice.

Conclusions

The study showed that the prevalence of breast self-examination was low. Family history of breast cancer, knowledge about breast self -examination and self- efficacy in practicing breast self- examination did have statistically significant association with breast self—examination practice.

Work Transitions in Breast Cancer Survivors and Effects on Quality of Life

Purpose Work transitions among breast cancer survivors remain an underexplored area. We aimed to examine prevalence and determinants of changes in work status, and the effect of these changes on quality of life of breast cancer survivors. Methods A cross-sectional study of 410 female breast cancer survivors randomly drawn from a larger study sample pool (n = 2644), members of "Leumit" healthcare fund, who were diagnosed with primary nonmetastatic invasive breast cancer in the years 2002-2012. The study questionnaire included questions on work characteristics and health-related quality-of-life and was completed by all women contacted. Work transition was defined as a downgrade (from full-time to part-time), termination, or retirement, and was contrasted to no change in work status (retention of full-time or part-time). Work transition was assessed at two intervals: between breast cancer diagnosis and treatment, and between breast cancer diagnosis and time of the survey. Results A total of 206 breast cancer survivors (50%) were employed prior to their diagnosis, of whom 12% stopped working, and 79% downgraded to part-time during treatment. At the time of survey (mean 8 ± 3 years post-diagnosis), 33% of those employed prior to their diagnosis stopped working or retired, 48% downgraded to part-time, and 19% had no change in their work situation. Work transition between diagnosis and time of the survey was significantly associated with poorer quality-of-life. In multivariable analyses, work transition between diagnosis and time of the survey was positively associated with being immigrant compared to native-born Israeli (odds ratio (OR) 4.65; 95% confidence interval (CI) 1.91-11.37; P = .001), and inversely with education level of college or over compared to high school or less (OR 0.27; 95% CI 0.09-0.86; P = .026). Conclusions Breast cancer survivors with characteristics pointing at underprivileged social circumstances more often experienced changes in work status after surviving breast cancer, irrespective of diagnosis, comorbidity or treatment. Breast cancer patients with immigrant status and/or lower educational attainment need more support to be able to keep their job.

Determinants of Compliance to Breast Cancer Screening and Referral in Low Socio-Economic Regions of Urban India

Background:

Breast cancer (BC) is the most common cancer among women globally and also in India. Early detection by screening is likely to reduce mortality and improve survival. To study the determinants of compliance to BC screening and referral by women in a community based BC screening programme in urban India.

Methods:

A community-based one-time cancer screening programme, implemented in the urban slums of Mumbai, India. The programme involves screening for breast cancer by Clinical Breast Examination (CBE) performed by trained primary health workers (PHWs), referral of screen-positive women to the nodal hospital for further investigations, confirmation of diagnosis and treatment. Univariate and multivariate logistic regression analysis in SPSS version 16 was used.

Results:

The compliance to screening, referral and treatment were 90.58%, 74.22% and 100% respectively. The results of multivariate logistic regression analysis demonstrate literate women, having family history of cancer, with tobacco habit, being treated for breast abnormalities, being ever pregnant and having history of contraceptive use were positive predictors while, women belonging to Muslim religion or speaking mother-tongue other than Marathi or Hindi were negative predictors of participation to screening. Educational status was the only significant predictor of compliance to referral. Screen-positive women with education of secondary school level or more were more likely to comply with referral.

Conclusions:

The programme ensured good compliance with screening, referral and treatment indicating feasibility and acceptability of CBE based BC screening programme by the community.

Screening for Breast Cancer in Average-Risk Women: A Guidance Statement From the American College of Physicians

DESCRIPTION

The purpose of this guidance statement is to provide advice to clinicians on breast cancer screening in average-risk women based on a review of existing guidelines and the evidence they include.

METHODS

This guidance statement is derived from an appraisal of selected guidelines from around the world that address breast cancer screening, as well as their included evidence. All national guidelines published in English between 1 January 2013 and 15 November 2017 in the National Guideline Clearinghouse or Guidelines International Network library were included. In addition, the authors selected other guidelines commonly used in clinical practice. Web sites associated with all selected guidelines were checked for updates on 10 December 2018. The AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument was used to evaluate the quality of guidelines.

TARGET AUDIENCE AND PATIENT POPULATION

The target audience is all clinicians, and the target patient population is all asymptomatic women with average risk for breast cancer.

GUIDANCE STATEMENT 1

In average-risk women aged 40 to 49 years, clinicians should discuss whether to screen for breast cancer with mammography before age 50 years. Discussion should include the potential benefits and harms and a woman's preferences. The potential harms outweigh the benefits in most women aged 40 to 49 years.

GUIDANCE STATEMENT 2

In average-risk women aged 50 to 74 years, clinicians should offer screening for breast cancer with biennial mammography.

GUIDANCE STATEMENT 3

In average-risk women aged 75 years or older or in women with a life expectancy of 10 years or less, clinicians should discontinue screening for breast cancer.

GUIDANCE STATEMENT 4

In average-risk women of all ages, clinicians should not use clinical breast examination to screen for breast cancer.

Accuracy of clinical breast examination's abnormalities for breast cancer screening: cross-sectional study

OBJECTIVES

The guidelines for breast cancer screening with clinical breast examination (CBE) are diverging CBE is recommended in France, whereas it is not recommended in the United States and Canada, given the lack of clear benefit and the risk of overmedication. To assess the accuracy of abnormalities found during CBE for in breast cancer screening.

STUDY DESIGN

A cross-sectional study included women over 18 years with no history of breast cancer coming for a mammography at 3 ambulatory radiology practices in Paris. A questionnaire collected the risk of breast cancer on mammography according to the Breast Imaging-Reporting And Data System (Bi-RADS) (high risk: Bi-RADS 4 or 5 versus lower risk: other Bi-RADS categories), the risk factors for breast cancer and the breast clinical abnormalities (none, mass, skin abnormality, oedema, pain, nipple discharge, lymph nodes…) For each abnormality, sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated.

RESULT

Among the 3218 included patients (mean age 55.1 +/-10 years), 713 (22.2%) had an abnormal CBE and 133 (4.1%) had high-risk mammography. The sensitivity of CBE was 36%[28%;45%] and the specificity was 78%[77%;80%]. The PPV and NPV for each clinical abnormality were low, except for nipple discharge, retraction and lymph nodes, for which the PPV were 10.5[3.7;29.9], 6.6[1.4;31.6], and 5.0[1.5;17.1], respectively, but these abnormalities were rare (0.5%, 0.2% and 0.5% respectively). These values were similar across all age groups.

CONCLUSION

The accuracy of CBE for breast cancer screening appeared to be low which did not support recommending regular CBE in France.

Differentiating melanoma and healthy tissues based on elasticity-specific Brillouin microspectroscopy

The main objective of the present study is to evaluate the use of Brillouin microspectroscopy for differentiation of melanoma and normal tissues based on elasticity measurements. Previous studies of malignant melanoma show that the lesion is stiffer than the surrounding healthy tissue. We hypothesize that elasticity-specific Brillouin spectroscopy can be used to distinguish between healthy and cancerous regions of an excised melanoma from a Sinclair miniature swine. Brillouin measurements of non-regressing and regressing melanomas and the surrounding healthy tissues were performed. Based on the Brillouin measurements, the melanomas and healthy tissues can be successfully differentiated. The stiffness of both tumors is found to be significantly greater than the healthy tissues. Notably, we found that the elasticity of regressing melanoma is closer to that of the normal tissue. The results indicate that Brillouin spectroscopy can be utilized as a tool for elasticity-based differentiation between malignant melanoma and surrounding healthy tissue, with potential use for melanoma boundary identification, monitoring tumor progression, or response to treatment.

Breast Cancer Screening: Why Can't Everyone Agree?

Screening mammography and evolving treatments have improved mortality over the last 25 years. However, breast cancer remains the second leading cause of cancer-related mortality for women in the United States. There are several contradictory recommendations regarding breast cancer screening. Familiarity with these recommendations will allow physicians to counsel their patients and ensure well-informed shared decision making.

Knowledge, attitude and practice regarding clinical and self breast examination among radiology professionals

Aim: This study aims to assess the knowledge, attitudes and practices of radiology professionals in Jordan in regard to breast cancer (BC) screening. Methods: An IRB approved, online-based study was carried out in Jordan. The participants were radiologists (n = 8) and radiographers (n = 64). Results: The results showed that although 61.8% of participants were knowledgeable about BC prevention, only 65.7% (n = 48) of respondents performed breast self-examinations (BSE) on themselves, 28.7% (n = 21) underwent clinical breast examination (CBE) and 15.1% (n = 5) underwent either diagnostic or screening mammography. Conclusion: Radiology professionals are generally aware of the benefits of BC screening and its ability to facilitate early diagnosis of BC. Although some practitioners advise their relatives to perform BSEs and attend CBE, low percentages of respondents performed BSEs themselves or undergo CBE.

Frequency and characteristics of contralateral breast abnormalities following recall at screening mammography

PURPOSE

To determine the frequency and characteristics of contralateral, non-recalled breast abnormalities following recall at screening mammography.

METHODS

We included a series of 130,338 screening mammograms performed between 1 January 2014 and 1 January 2016. During the 1-year follow-up, clinical data were collected for all recalls. Screening outcome was determined for recalled women with or without evaluation of contralateral breast abnormalities.

RESULTS

Of 3,995 recalls (recall rate 3.1%), 129 women (3.2%) underwent assessment of a contralateral, non-recalled breast abnormality. Most lesions were detected at clinical mammography and/or breast tomosynthesis (101 women, 78.3%). The biopsy rate was similar for recalled lesions and contralateral, non-recalled lesions, but the positive predictive value of biopsy was higher for recalled lesions (p = 0.01). A comparable proportion of the recalled lesions and contralateral, non-recalled lesions were malignant (p = 0.1). The proportion of ductal carcinoma in situ was similar for both groups, as well as invasive cancer characteristics and type of surgical treatment.

CONCLUSIONS

About 3% of recalled women underwent evaluation of contralateral, non-recalled breast lesions. Evaluation of the contralateral breast after recall is important as we found that 15.5% of contralateral, non-recalled lesions were malignant. Contralateral cancers and screen-detected cancers show similar characteristics, stage and surgical treatment.

KEY POINTS

• 3% of recalled women underwent evaluation of contralateral, non-recalled lesions • One out of seven contralateral, non-recalled lesions was malignant • A contralateral cancer was diagnosed in 0.5% of recalls • Screen-detected cancers and non-recalled, contralateral cancers showed similar histological characteristics • Tumour stage and surgical treatment were similar for both groups.

Evaluation of the Efficacy of Clinical Breast Examination Gloves in the Diagnosis of Breast Lumps

INTRODUCTION

Recent studies have questioned the efficacy of mammography in reducing breast cancer-related mortality. Additionally, the efficacies of commercially available gloves marketed as aiding the detection of breast lumps have not been independently verified.

AIM

To evaluate the efficacy of clinical breast examination gloves in the detection of breast lumps.

MATERIALS AND METHODS

During the period from October 2011 to June 2012, patients were submitted to clinical examination with and without gloves. This prospective study involved 202 patients who underwent conventional clinical breast examination (test 1) or clinical breast examination with Sensifemme^® gloves (test 2). All patients underwent subsequent bilateral ultrasonography (test 3) to confirm the findings of the physical examinations. The Chi-square test was used to compare values, while the kappa concordance index was used to determine the concordance between the diagnostic tests.

RESULTS

The mean age of the patients was 43 years; 298 breast lumps were detected. In the clinical examination group (test 1), sensitivity was 54%, specificity was 78%, and accuracy was 57%. These rates for clinical breast examinations with gloves (test 2) were 68%, 58%, and 66%, respectively. The glove increased the diagnosis of breast nodules by 14%; the rate of false-positives was also higher (42% for test 2 compared to 22% for test 1). The accuracy of the glove was found to be superior to clinical examination after 100 patients had been examined. The kappa indices for test 1 vs. test 3 and for test 2 vs. test 3 were 0.15 and 0.16, respectively.

CONCLUSION

Clinical examination using the glove was more effective than clinical examination with bare hands for the diagnosis of breast lumps, as it increased the sensitivity and accuracy of lump detection. However, this was at the expense of a higher false-positive rate, which can lead to further tests, unnecessary biopsies, and patient anxiety. The concordance of clinical examination results (whether performed with or without the glove) with those of ultrasonography is weak. Moreover, the glove has a steep learning curve that may discourage its use in certain circumstances.

Targeting breast cancer outcomes-what about the primary relatives?

BACKGROUND

Up to 65% of newly diagnosed breast cancer patients had not been screened correctly before diagnosis resulting in increased stage of cancer at presentation. This study assessed whether their primary relatives are, in turn, assessed appropriately.

METHODS

An ethically approved prospective study involving 274 primary relatives of women diagnosed with breast cancer, between 2009-2012, at a symptomatic breast unit in Ireland. Telephone interview established: demographics, menstrual history, family history verification, breast screening history. Personal risk level was calculated and whether current screening met screening guidelines. Participants were enrolled into appropriate screening programs if currently not in one and results analyzed.

RESULTS

Two hundred and fifteen of the 280 (76.8%) newly diagnosed patients responded giving details of their 274 primary relatives; this made up the study cohort. Mean age 50 ± 10 (35-75). Thirty two percent were low risk, 64% moderate and 4% high. 190/274 (69%) were being screened appropriately. Seventy five relatives were then assessed with: mammography in 55, Mg and US in 16. Four underwent a biopsy and to date none had cancer. Surveillance was: annual screening in 48%; national screening program and General Practitioner (GP) in 33%; GP only in over 65s in 13%; 6% await further assessment at specialist genetics clinics where their surveillance will be decided.

CONCLUSIONS

This study has identified an opportunity to improve the delivery of appropriate screening to higher risk primary relatives of patients with breast cancer. This necessitates an integrated national approach involving providers of primary care, patients and screening breast programs.

Recommendations on breast cancer screening and prevention in the context of implementing risk stratification: impending changes to current policies

In recent years, risk stratification has sparked interest as an innovative approach to disease screening and prevention. The approach effectively personalizes individual risk, opening the way to screening and prevention interventions that are adapted to subpopulations. The international perspective project, which is developing risk stratification for breast cancer, aims to support the integration of its screening approach into clinical practice through comprehensive tool-building. Policies and guidelines for risk stratification-unlike those for population screening programs, which are currently well regulated-are still under development. Indeed, the development of guidelines for risk stratification reflects the translational aspects of perspective. Here, we describe the risk stratification process that was devised in the context of perspective, and we then explain the consensus-based method used to develop recommendations for breast cancer screening and prevention in a risk-stratification approach. Lastly, we discuss how the recommendations might affect current screening policies.