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Boyko A, Qureshi MM, Fishman MDC, Slanetz PJ. Predictors of Breast Cancer Outcome in a Cohort of Women Seeking Care at a Safety Net Hospital. Acad Radiol 2024; 31:1727-1734. [PMID: 38087721 DOI: 10.1016/j.acra.2023.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/14/2023] [Accepted: 11/26/2023] [Indexed: 05/12/2024]
Abstract
RATIONALE AND OBJECTIVES This study aimed to identify predictors associated with lower mortality in a population of women diagnosed and treated for breast cancer at a safety net hospital. METHODS From 2008 to 2014, 1115 patients were treated for breast cancer at our academic safety net hospital. 208 were excluded due to diagnosis at an outside facility, and the remaining 907 (81%) formed the study cohort. Retrospective charts and imaging reviews looked at race, ethnicity, insurance status, social determinants of health, screening utilization, treatment regimen, and 7-13-year follow-up care, including the cause of death. Multivariable logistic regression modeling assessed mortality, and adjusted odds ratios (aOR) with 95% confidence intervals (CI) were computed. RESULTS Of the 907 women, the mean age was 59 years (inter-quartile range 50-68 years), with 40% White, 46% Black, 4% Asian, and 10% Other. Increasing age (aOR=1.03, p = 0.001) and more advanced stage at diagnosis (aOR=6.37, p < 0.0001) were associated with increased mortality. There was no significant difference in mortality based on race or ethnicity (p > 0.05). Of 494 with screening prior to diagnosis, longer screening time was observed for patients with advanced stage (median 521 days) vs. early stage (median 404 days), p = 0.0004. Patients with Medicaid, insurance not specified, and no insurance were less likely to undergo screening before diagnosis than privately insured (all p < 0.05). Shorter screening time was associated with lower all-cause mortality (aOR=0.57, 95% CI=0.36-0.89, p = 0.013). DISCUSSION In a safety net population, a more advanced stage at diagnosis was associated with higher mortality and lower odds of undergoing screening mammography in the two years prior to a breast cancer diagnosis. Early screening was associated with lower mortality. Finally, given no racial or ethnic differences in mortality, the safety net infrastructure at our institution effectively provides equitable cancer care once a cancer is confirmed.
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Affiliation(s)
- Alexander Boyko
- Division of Breast Imaging, Department of Radiology, Boston Medical Center, and Boston University Chobanian & Avedisian School of Medicine, 820 Harrison Avenue, Boston, Massachusetts 02118, USA (A.B., M.D.C.F., P.J.S.)
| | - Muhammad Mustafa Qureshi
- Department of Radiation Oncology, Boston Medical Center, 830 Harrison Avenue, Boston, Massachusetts 02118, USA (M.M.Q.)
| | - Michael D C Fishman
- Division of Breast Imaging, Department of Radiology, Boston Medical Center, and Boston University Chobanian & Avedisian School of Medicine, 820 Harrison Avenue, Boston, Massachusetts 02118, USA (A.B., M.D.C.F., P.J.S.)
| | - Priscilla J Slanetz
- Division of Breast Imaging, Department of Radiology, Boston Medical Center, and Boston University Chobanian & Avedisian School of Medicine, 820 Harrison Avenue, Boston, Massachusetts 02118, USA (A.B., M.D.C.F., P.J.S.).
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Siegel SD, Zhang Y, Lynch SM, Rowland J, Curriero FC. A Novel Approach for Conducting a Catchment Area Analysis of Breast Cancer by Age and Stage for a Community Cancer Center. Cancer Epidemiol Biomarkers Prev 2024; 33:646-653. [PMID: 38451180 PMCID: PMC11062816 DOI: 10.1158/1055-9965.epi-23-1125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/07/2023] [Accepted: 03/05/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND The U.S. Preventive Services Task Force recently issued an updated draft recommendation statement to initiate breast cancer screening at age 40, reflecting well-documented disparities in breast cancer-related mortality that disproportionately impact younger Black women. This study applied a novel approach to identify hotspots of breast cancer diagnosed before age 50 and/or at an advanced stage to improve breast cancer detection within these communities. METHODS Cancer registry data for 3,497 women with invasive breast cancer diagnosed or treated between 2012 and 2020 at the Helen F. Graham Cancer Center and Research Institute (HFGCCRI) and who resided in the HFGCCRI catchment area, defined as New Castle County, Delaware, were geocoded and analyzed with spatial intensity. Standardized incidence ratios stratified by age and race were calculated for each hotspot. RESULTS Four hotspots were identified, two for breast cancer diagnosed before age 50, one for advanced breast cancer, and one for advanced breast cancer diagnosed before age 50. Younger Black women were overrepresented in these hotspots relative to the full-catchment area. CONCLUSIONS The novel use of spatial methods to analyze a community cancer center catchment area identified geographic areas with higher rates of breast cancer with poor prognostic factors and evidence that these areas made an outsized contribution to racial disparities in breast cancer. IMPACT Identifying and prioritizing hotspot breast cancer communities for community outreach and engagement activities designed to improve breast cancer detection have the potential to reduce the overall burden of breast cancer and narrow racial disparities in breast cancer.
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Affiliation(s)
- Scott D. Siegel
- Cawley Center for Translational Cancer Research, Helen F. Graham Cancer Center & Research Institute, ChristianaCare, Newark, DE, United States
| | - Yuchen Zhang
- Cawley Center for Translational Cancer Research, Helen F. Graham Cancer Center & Research Institute, ChristianaCare, Newark, DE, United States
- Center for Strategic Information Management, ChristianaCare, Newark, DE, United States
| | - Shannon M. Lynch
- Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, United States
| | - Jennifer Rowland
- Department of Radiology, Breast Imaging Section, Helen F. Graham Cancer Center & Research Institute, ChristianaCare, Newark, DE, United States
| | - Frank C. Curriero
- Johns Hopkins Spatial Science for Public Health Center, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
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Dunn MR, Metwally EM, Vohra S, Hyslop T, Henderson LM, Reeder-Hayes K, Thompson CA, Lafata JE, Troester MA, Butler EN. Understanding mechanisms of racial disparities in breast cancer: an assessment of screening and regular care in the Carolina Breast Cancer Study. Cancer Causes Control 2024; 35:825-837. [PMID: 38217760 PMCID: PMC11045315 DOI: 10.1007/s10552-023-01833-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/16/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE Screening history influences stage at detection, but regular preventive care may also influence breast tumor diagnostic characteristics. Few studies have evaluated healthcare utilization (both screening and primary care) in racially diverse screening-eligible populations. METHODS This analysis included 2,058 women age 45-74 (49% Black) from the Carolina Breast Cancer Study, a population-based cohort of women diagnosed with invasive breast cancer between 2008 and 2013. Screening history (threshold 0.5 mammograms per year) and pre-diagnostic healthcare utilization (i.e. regular care, based on responses to "During the past ten years, who did you usually see when you were sick or needed advice about your health?") were assessed as binary exposures. The relationship between healthcare utilization and tumor characteristics were evaluated overall and race-stratified. RESULTS Among those lacking screening, Black participants had larger tumors (5 + cm) (frequency 19.6% vs 11.5%, relative frequency difference (RFD) = 8.1%, 95% CI 2.8-13.5), but race differences were attenuated among screening-adherent participants (10.2% vs 7.0%, RFD = 3.2%, 0.2-6.2). Similar trends were observed for tumor stage and mode of detection (mammogram vs lump). Among all participants, those lacking both screening and regular care had larger tumors (21% vs 8%, RR = 2.51, 1.76-3.56) and advanced (3B +) stage (19% vs 6%, RR = 3.15, 2.15-4.63) compared to the referent category (screening-adherent and regular care). Under-use of regular care and screening was more prevalent in socioeconomically disadvantaged areas of North Carolina. CONCLUSIONS Access to regular care is an important safeguard for earlier detection. Our data suggest that health equity interventions should prioritize both primary care and screening.
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Affiliation(s)
- Matthew R Dunn
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
| | - Eman M Metwally
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Sanah Vohra
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Terry Hyslop
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Louise M Henderson
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Division of Pulmonary Disease and Critical Care Medicine, Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Katherine Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Division of Oncology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Caroline A Thompson
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer Elston Lafata
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Melissa A Troester
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA.
| | - Eboneé N Butler
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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Yang W, Yang Y, Zhang N, Yin Q, Zhang C, Han J, Zhou X, Liu K. The features associated with mammography-occult MRI-detected newly diagnosed breast cancer analysed by comparing machine learning models with a logistic regression model. Radiol Med 2024; 129:751-766. [PMID: 38512623 DOI: 10.1007/s11547-024-01804-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 02/14/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE To compare machine learning (ML) models with logistic regression model in order to identify the optimal factors associated with mammography-occult (i.e. false-negative mammographic findings) magnetic resonance imaging (MRI)-detected newly diagnosed breast cancer (BC). MATERIAL AND METHODS The present single-centre retrospective study included consecutive women with BC who underwent mammography and MRI (no more than 45 days apart) for breast cancer between January 2018 and May 2023. Various ML algorithms and binary logistic regression analysis were utilized to extract features linked to mammography-occult BC. These features were subsequently employed to create different models. The predictive value of these models was assessed using receiver operating characteristic curve analysis. RESULTS This study included 1957 malignant lesions from 1914 patients, with an average age of 51.64 ± 9.92 years and a range of 20-86 years. Among these lesions, there were 485 mammography-occult BCs. The optimal features of mammography-occult BC included calcification status, tumour size, mammographic density, age, lesion enhancement type on MRI, and histological type. Among the different ML models (ANN, L1-LR, RF, and SVM) and the LR-based combined model, the ANN model with RF features was found to be the optimal model. It demonstrated the best discriminative performance in predicting mammography false- negative findings, with an AUC of 0.912, an accuracy of 86.90%, a sensitivity of 85.85%, and a specificity of 84.18%. CONCLUSION Mammography-occult MRI-detected breast cancers have features that should be considered when performing breast MRI to improve the detection rate for breast cancer and aid in clinician management.
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Affiliation(s)
- Wei Yang
- Department of Radiology, General Hospital of Ningxia Medical University, 804 Shengli Road, Yinchuan, 750004, People's Republic of China.
| | - Yan Yang
- Information Technology Center, 32752 Troop, Xiangyang, 441000, People's Republic of China
| | - Ningmei Zhang
- Department of Pathology, General Hospital of Ningxia Medical University, 804 Shengli Road, Yinchuan, 750004, People's Republic of China
| | - Qingyun Yin
- Department of Medical Oncology, General Hospital of Ningxia Medical University, 804 Shengli Road, Yinchuan, 750004, People's Republic of China
| | - Chaolin Zhang
- Department of Surgical Oncology, General Hospital of Ningxia Medical University, 804 Shengli Road, Yinchuan, 750004, People's Republic of China
| | - Jinyu Han
- Department of Radiology, General Hospital of Ningxia Medical University, 804 Shengli Road, Yinchuan, 750004, People's Republic of China
| | - Xiaoping Zhou
- College of Clinical Medicine, Ningxia Medical University, 692 Shengli Road, Yinchuan, 750004, People's Republic of China
| | - Kaihui Liu
- College of Clinical Medicine, Ningxia Medical University, 692 Shengli Road, Yinchuan, 750004, People's Republic of China
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Webb AB, Berg CD, Castle PE, Crosby D, Etzioni R, Kessler LG, Menon U, Parmar M, Steele RJC, Sasieni PD. Considerations for using potential surrogate endpoints in cancer screening trials. Lancet Oncol 2024; 25:e183-e192. [PMID: 38697164 DOI: 10.1016/s1470-2045(24)00015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/18/2023] [Accepted: 01/09/2024] [Indexed: 05/04/2024]
Abstract
The requirement of large-scale expensive cancer screening trials spanning decades creates considerable barriers to the development, commercialisation, and implementation of novel screening tests. One way to address these problems is to use surrogate endpoints for the ultimate endpoint of interest, cancer mortality, at an earlier timepoint. This Review aims to highlight the issues underlying the choice and use of surrogate endpoints for cancer screening trials, to propose criteria for when and how we might use such endpoints, and to suggest possible candidates. We present the current landscape and challenges, and discuss lessons and shortcomings from the therapeutic trial setting. It is hugely challenging to validate a surrogate endpoint, even with carefully designed clinical studies. Nevertheless, we consider whether there are candidates that might satisfy the requirements defined by research and regulatory bodies.
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Affiliation(s)
| | | | - Philip E Castle
- Division of Cancer Prevention and Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Rockville, MD, USA
| | | | - Ruth Etzioni
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Larry G Kessler
- Department of Health Systems and Population Health (HSPOP), School of Public Health, University of Washington, Seattle, WA, USA
| | - Usha Menon
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Mahesh Parmar
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Robert J C Steele
- University of Dundee, Department of Surgery, Ninewells Hospital, Dundee, UK
| | - Peter D Sasieni
- The Cancer Research UK and King's College London Cancer Prevention Trials Unit, King's College London, London, UK; Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
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Mizzi D, Allely CS, Zarb F, Mercer CE. Implementing supplementary breast cancer screening in women with dense breasts: Insights from European radiographers and radiologists. Radiography (Lond) 2024; 30:908-919. [PMID: 38615593 DOI: 10.1016/j.radi.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION In response to the critical need for enhancing breast cancer screening for women with dense breasts, this study explored the understanding of challenges and requirements for implementing supplementary breast cancer screening for such women among clinical radiographers and radiologists in Europe. METHOD Fourteen (14) semi-structured online interviews were conducted with European clinical radiologists (n = 5) and radiographers (n = 9) specializing in breast cancer screening from 8 different countries: Denmark, Finland, Greece, Italy, Malta, the Netherlands, Switzerland, United Kingdom. The interview schedule comprised questions regarding professional background and demographics and 13 key questions divided into six subgroups, namely Supplementary Imaging, Training, Resources and Guidelines, Challenges, Implementing supplementary screening and Women's Perspective. Data analysis followed the six phases of reflexive thematic analysis. RESULTS Six significant themes emerged from the data analysis: Understanding and experiences of supplementary imaging for women with dense breasts; Challenges and requirements related to training among clinical radiographers and radiologists; Awareness among radiographers and radiologists of guidelines on imaging women with dense breasts; Challenges to implement supplementary screening; Predictors of Implementing Supplementary screening; Views of radiologists and radiographers on women's perception towards supplementary screening. CONCLUSION The interviews with radiographers and radiologists provided valuable insights into the challenges and potential strategies for implementing supplementary breast cancer screening. These challenges included patient and staff related challenges. Implementing multifaceted solutions such as Artificial Intelligence integration, specialized training and resource investment can address these challenges and promote the successful implementation of supplementary screening. Further research and collaboration are needed to refine and implement these strategies effectively. IMPLICATIONS FOR PRACTICE This study highlights the urgent need for specialized training programs and dedicated resources to enhance supplementary breast cancer screening for women with dense breasts in Europe. These resources include advanced imaging technologies, such as MRI or ultrasound, and specialized software for image analysis. Moreover, further research is imperative to refine screening protocols and evaluate their efficacy and cost-effectiveness, based on the findings of this study.
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Affiliation(s)
- D Mizzi
- Department of Radiography, Faculty of Health Sciences, University of Malta, Msida, MSD 2080, Malta.
| | - C S Allely
- School of Health and Society, University of Salford, Manchester, M5 4WT, United Kingdom.
| | - F Zarb
- Department of Radiography, Faculty of Health Sciences, University of Malta, Msida, MSD 2080, Malta.
| | - C E Mercer
- School of Health and Society, University of Salford, Manchester, M5 4WT, United Kingdom.
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Gonzalez T, Nie Q, Chaudhary LN, Basel D, Reddi HV. Methylation signatures as biomarkers for non-invasive early detection of breast cancer: A systematic review of the literature. Cancer Genet 2024; 282-283:1-8. [PMID: 38134587 DOI: 10.1016/j.cancergen.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Early detection of breast cancer would help alleviate the burden of treatment for early-stage breast cancer and help patient prognosis. There is currently no established gene panel that utilizes the potential of DNA methylation as a molecular signature for the early detection of breast cancer. This systematic review aims to identify the optimal methylation biomarkers for a non-invasive liquid biopsy assay and the gaps in knowledge regarding biomarkers for early detection of breast cancer. METHODS Following the PRISMA-ScR method, Pubmed and Google Scholar was searched for publications related to methylation biomarkers in breast cancer over a five-year period. Eligible publications were mined for key data fields such as study aims, cohort demographics, types of breast cancer studied, technologies used, and outcomes. Data was analyzed to address the objectives of the review. RESULTS Literature search identified 112 studies of which based on eligibility criteria, 13 studies were included. 28 potential methylation gene targets were identified, of which 23 were methylated at the promoter region, 1 was methylated in the body of the gene and 4 were methylated at yet to be identified locations. CONCLUSIONS Our evaluation shows that at minimum APC, RASSFI, and FOXA1 genes would be a promising set of genes to start with for the early detection of breast cancer, based on the sensitivity and specificity outlined in the studies. Prospective studies are needed to optimize biomarkers for broader impact in early detection of breast cancer.
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Affiliation(s)
- Tessa Gonzalez
- Division of Precision Medicine and Cytogenetics, Department of Pathology, Medical College of Wisconsin, CT, USA
| | - Qian Nie
- Division of Precision Medicine and Cytogenetics, Department of Pathology, Medical College of Wisconsin, CT, USA
| | - Lubna N Chaudhary
- Division of Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, CT, USA
| | - Donald Basel
- Division of Genetics, Department of Pediatrics, Medical College of Wisconsin, CT, USA
| | - Honey V Reddi
- Division of Precision Medicine and Cytogenetics, Department of Pathology, Medical College of Wisconsin, CT, USA.
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Liu Y, Sorkhei M, Dembrower K, Azizpour H, Strand F, Smith K. Use of an AI Score Combining Cancer Signs, Masking, and Risk to Select Patients for Supplemental Breast Cancer Screening. Radiology 2024; 311:e232535. [PMID: 38591971 DOI: 10.1148/radiol.232535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Background Mammographic density measurements are used to identify patients who should undergo supplemental imaging for breast cancer detection, but artificial intelligence (AI) image analysis may be more effective. Purpose To assess whether AISmartDensity-an AI-based score integrating cancer signs, masking, and risk-surpasses measurements of mammographic density in identifying patients for supplemental breast imaging after a negative screening mammogram. Materials and Methods This retrospective study included randomly selected individuals who underwent screening mammography at Karolinska University Hospital between January 2008 and December 2015. The models in AISmartDensity were trained and validated using nonoverlapping data. The ability of AISmartDensity to identify future cancer in patients with a negative screening mammogram was evaluated and compared with that of mammographic density models. Sensitivity and positive predictive value (PPV) were calculated for the top 8% of scores, mimicking the proportion of patients in the Breast Imaging Reporting and Data System "extremely dense" category. Model performance was evaluated using area under the receiver operating characteristic curve (AUC) and was compared using the DeLong test. Results The study population included 65 325 examinations (median patient age, 53 years [IQR, 47-62 years])-64 870 examinations in healthy patients and 455 examinations in patients with breast cancer diagnosed within 3 years of a negative screening mammogram. The AUC for detecting subsequent cancers was 0.72 and 0.61 (P < .001) for AISmartDensity and the best-performing density model (age-adjusted dense area), respectively. For examinations with scores in the top 8%, AISmartDensity identified 152 of 455 (33%) future cancers with a PPV of 2.91%, whereas the best-performing density model (age-adjusted dense area) identified 57 of 455 (13%) future cancers with a PPV of 1.09% (P < .001). AISmartDensity identified 32% (41 of 130) and 34% (111 of 325) of interval and next-round screen-detected cancers, whereas the best-performing density model (dense area) identified 16% (21 of 130) and 9% (30 of 325), respectively. Conclusion AISmartDensity, integrating cancer signs, masking, and risk, outperformed traditional density models in identifying patients for supplemental imaging after a negative screening mammogram. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Kim and Chang in this issue.
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Affiliation(s)
- Yue Liu
- From the Department of Computational Science and Technology (Y.L., M.S., K.S.) and Department of Robotics, Perception and Learning (H.A.), KTH Royal Institute of Technology, Brinellvägen 8, 114 28 Stockholm, Sweden; Science for Life Laboratory, Stockholm, Sweden (Y.L., M.S., K.S.); Department of Physiology and Pharmacology (K.D.) and Department of Pathology and Oncology (F.S.), Karolinska Institute, Stockholm, Sweden; Department of Radiology, Capio Saint Göran Hospital, Stockholm, Sweden (K.D.); and Department of Breast Radiology, Karolinska University Hospital, Stockholm, Sweden (F.S.)
| | - Moein Sorkhei
- From the Department of Computational Science and Technology (Y.L., M.S., K.S.) and Department of Robotics, Perception and Learning (H.A.), KTH Royal Institute of Technology, Brinellvägen 8, 114 28 Stockholm, Sweden; Science for Life Laboratory, Stockholm, Sweden (Y.L., M.S., K.S.); Department of Physiology and Pharmacology (K.D.) and Department of Pathology and Oncology (F.S.), Karolinska Institute, Stockholm, Sweden; Department of Radiology, Capio Saint Göran Hospital, Stockholm, Sweden (K.D.); and Department of Breast Radiology, Karolinska University Hospital, Stockholm, Sweden (F.S.)
| | - Karin Dembrower
- From the Department of Computational Science and Technology (Y.L., M.S., K.S.) and Department of Robotics, Perception and Learning (H.A.), KTH Royal Institute of Technology, Brinellvägen 8, 114 28 Stockholm, Sweden; Science for Life Laboratory, Stockholm, Sweden (Y.L., M.S., K.S.); Department of Physiology and Pharmacology (K.D.) and Department of Pathology and Oncology (F.S.), Karolinska Institute, Stockholm, Sweden; Department of Radiology, Capio Saint Göran Hospital, Stockholm, Sweden (K.D.); and Department of Breast Radiology, Karolinska University Hospital, Stockholm, Sweden (F.S.)
| | - Hossein Azizpour
- From the Department of Computational Science and Technology (Y.L., M.S., K.S.) and Department of Robotics, Perception and Learning (H.A.), KTH Royal Institute of Technology, Brinellvägen 8, 114 28 Stockholm, Sweden; Science for Life Laboratory, Stockholm, Sweden (Y.L., M.S., K.S.); Department of Physiology and Pharmacology (K.D.) and Department of Pathology and Oncology (F.S.), Karolinska Institute, Stockholm, Sweden; Department of Radiology, Capio Saint Göran Hospital, Stockholm, Sweden (K.D.); and Department of Breast Radiology, Karolinska University Hospital, Stockholm, Sweden (F.S.)
| | - Fredrik Strand
- From the Department of Computational Science and Technology (Y.L., M.S., K.S.) and Department of Robotics, Perception and Learning (H.A.), KTH Royal Institute of Technology, Brinellvägen 8, 114 28 Stockholm, Sweden; Science for Life Laboratory, Stockholm, Sweden (Y.L., M.S., K.S.); Department of Physiology and Pharmacology (K.D.) and Department of Pathology and Oncology (F.S.), Karolinska Institute, Stockholm, Sweden; Department of Radiology, Capio Saint Göran Hospital, Stockholm, Sweden (K.D.); and Department of Breast Radiology, Karolinska University Hospital, Stockholm, Sweden (F.S.)
| | - Kevin Smith
- From the Department of Computational Science and Technology (Y.L., M.S., K.S.) and Department of Robotics, Perception and Learning (H.A.), KTH Royal Institute of Technology, Brinellvägen 8, 114 28 Stockholm, Sweden; Science for Life Laboratory, Stockholm, Sweden (Y.L., M.S., K.S.); Department of Physiology and Pharmacology (K.D.) and Department of Pathology and Oncology (F.S.), Karolinska Institute, Stockholm, Sweden; Department of Radiology, Capio Saint Göran Hospital, Stockholm, Sweden (K.D.); and Department of Breast Radiology, Karolinska University Hospital, Stockholm, Sweden (F.S.)
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Al-Balas M, Al-Balas H, AlAmer Z, Al-Taweel G, Ghabboun A, Al Bzoor F, Abumkarab S, Bakr TA, Eleiwat B. Clinical outcomes of screening and diagnostic mammography in a limited resource healthcare system. BMC Womens Health 2024; 24:191. [PMID: 38515093 PMCID: PMC10956363 DOI: 10.1186/s12905-024-03007-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 02/28/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION Breast cancer is a significant public health concern in Jordan. It is the most common cancer among Jordanian women. Despite its high incidence and advanced stage at time of diagnosis, the uptake of breast cancer screening in Jordan is low. This study aims to compare clinical outcomes of both screening and diagnostic mammogram among women in Jordan. METHODS A retrospective cohort of 1005 women who underwent mammography in breast imaging unit in a tertiary hospital in Jordan. It aimed to investigate outcomes of screening and diagnostic mammography. recall rates, clinical manifestations and cancer rates were investigated. RESULTS A total of 1005 participants were involved and divided into screening group (n = 634) and diagnostic group (n = 371). Women in the diagnostic group were more likely to be younger, premenopausal, smokers with higher BMI. Among the screening group, 22.3% were labeled with abnormal mammogram, 26% recalled for ultrasound, 46 patients underwent tissue biopsy and a total of 12 patients had a diagnosis of breast carcinoma. Among the diagnostic group, the most commonly reported symptoms were a feeling of breast mass, mastalgia and nipple discharge. Abnormal mammogram was reported in 50.4% of women, a complementary ultrasound was performed for 205 patients. A diagnostic Tru-cut biopsy for 144 patients and diagnostic excisional biopsy for 17 patients were performed. A total of 131 had a diagnosis of carcinoma. CONCLUSION With the high possibility of identifying a carcinoma in mammography among symptomatic women and low uptake of screening mammogram, efforts to increase awareness and improve access to screening services are crucial in reducing the burden of breast cancer in Jordan.
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Affiliation(s)
- Mahmoud Al-Balas
- Department of General Surgery, Urology and Anesthesia, The Hashemite University, Zarqa, 13133, Jordan.
| | - Hamzeh Al-Balas
- Department of General Surgery, Urology and Anesthesia, The Hashemite University, Zarqa, 13133, Jordan
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10
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Yu ZH, Lin Y, Wu PS, Lee CH, Chou CP. A prognostic nomogram for predicting breast cancer survival based on mammography and AJCC staging. Heliyon 2024; 10:e27072. [PMID: 38449621 PMCID: PMC10915383 DOI: 10.1016/j.heliyon.2024.e27072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 02/16/2024] [Accepted: 02/23/2024] [Indexed: 03/08/2024] Open
Abstract
Rationale and objectives To develop a prognostic nomogram using mammography data and AJCC staging to predict breast cancer survival. Materials and methods A prognostic nomogram was created using data from 1000 women diagnosed with breast cancer at a medical cancer center in Taiwan between 2011 and 2015. The variables included age at diagnosis (≤60 or > 60 years), mammography purpose (screening or diagnostic), mammography modality (digital mammogram or digital breast tomosynthesis), and the 7th American Joint Committee on Cancer (AJCC) stage. The outcome predicted was breast cancer-related mortality. The nomogram utilized Kaplan-Meier analysis for all subsets and Cox proportional hazards regression analysis for prediction. The nomogram's accuracy was internally validated using the concordance index and receiver operating characteristic (ROC) curve analysis, focusing on 3-year and 5-year survival predictions. Results Participants' mean age at breast cancer diagnosis was 54 years (SD = 11.2 years). The 1-year, 3-year, and 5-year overall survival (OS) rates were found to be 99.7%, 95.3%, and 91.4%, respectively. The bootstrap-corrected concordance indices indicated the following: nomogram, 0.807 and AJCC, 0.759. A significant difference was observed between the nomogram's area under the curve (AUC) and the AJCC stage in predicting the probability of 5-year survival (p = 0.005). A nomogram, constructed based on mammography and AJCC, demonstrated excellent calibration through internal validation using bootstrapping. Conclusion The utilization of a nomogram that incorporates mammography data and the AJCC registry data has been demonstrated to be a reliable predictor of breast cancer survival.
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Affiliation(s)
- Zi-Han Yu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Radiology, Jiannren Hospital, Kaohsiung, Taiwan
| | - Yun Lin
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Pei-Shan Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chao-Hsien Lee
- Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Chen-Pin Chou
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Fooyin University, Kaohsiung, Taiwan
- Department of Pharmacy, College of Pharmacy, Tajen University, Pingtung, Taiwan
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Duffy SW, Yen AMF, Tabar L, Lin ATY, Chen SLS, Hsu CY, Dean PB, Smith RA, Chen THH. Beneficial effect of repeated participation in breast cancer screening upon survival. J Med Screen 2024; 31:3-7. [PMID: 37437178 PMCID: PMC10878004 DOI: 10.1177/09691413231186686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/09/2023] [Accepted: 06/19/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES The benefit of mammography screening in reducing population mortality from breast cancer is well established. In this paper, we estimate the effect of repeated participation at scheduled screens on case survival. METHODS We analysed incidence and survival data on 37,079 women from nine Swedish counties who had at least one to five invitation(s) to screening prior to diagnosis, and were diagnosed with breast cancer between 1992 and 2016. Of these, 4564 subsequently died of breast cancer. We estimated the association of survival with participation in up to the most recent five screens before diagnosis. We used proportional hazards regression to estimate the effect on survival of the number of scheduled screens in which subjects participated prior to the diagnosis of breast cancer. RESULTS There was successively better survival with an increasing number of screens in which the subject participated. For a woman with five previous screening invitations who participated in all five, the hazard ratio was 0.28 (95% confidence interval (CI) 0.25-0.33, p < 0.0001) compared to a woman attending none (86.9% vs 68.9% 20-year survival). Following a conservative adjustment for potential self-selection factors, the hazard ratio was 0.34 (95% CI 0.26-0.43, p < 0.0001), an approximate three-fold reduction in the hazard of dying from breast cancer. CONCLUSION For those women who develop breast cancer, regular prior participation in mammography screening confers significantly better survival.
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Affiliation(s)
- Stephen W Duffy
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | | | - Abbie Ting-Yu Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chen-Yang Hsu
- Master of Public Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | | | - Tony Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Kopans DB, Sharpe RE, Eby PR. Including the method of detection for breast cancer in the Surveillance, Epidemiology, and End Results database is long overdue. J Med Screen 2024; 31:1-2. [PMID: 37624726 DOI: 10.1177/09691413231197131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
Debates about breast cancer screening have continued in part because the Surveillance, Epidemiology, and End Results database, which began in 1974, has never included the method of detection so that it has been impossible to determine the role that early detection has played in the major decline in deaths from breast cancer that we have seen in the US since 1990. Method of detection should be added to the Surveillance, Epidemiology, and End Results database as soon as possible.
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Affiliation(s)
- Daniel B Kopans
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | | | - Peter R Eby
- Department of Radiology, Virginia Mason Medical Center, Seattle, WA, USA
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13
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Bai S, Song D, Chen M, Lai X, Xu J, Dong F. The association between mammographic density and breast cancer risk in Chinese women: a systematic review and meta-analysis. BMC Womens Health 2024; 24:131. [PMID: 38378562 PMCID: PMC10877813 DOI: 10.1186/s12905-024-02960-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/08/2024] [Indexed: 02/22/2024] Open
Abstract
PURPOSE Breast density has consistently been shown to be an independent risk factor for breast cancer in Western populations; however, few studies have evaluated this topic in Chinese women and there is not yet a unified view. This study investigated the association between mammographic density (MD) and breast cancer risk in Chinese women. METHODS The PubMed, Cochrane Library, Embase, and Wanfang databases were systematically searched in June 2023 to include all studies on the association between MD and breast cancer risk in Chinese women. A total of 13,977 breast cancer cases from 14 studies were chosen, including 10 case-control/cross-sectional studies, and 4 case-only studies. For case-control/cross-sectional studies, the odds ratios (ORs) of MD were combined using random effects models, and for case-only studies, relative odds ratios (RORs) were combinations of premenopausal versus postmenopausal breast cancer cases. RESULTS Women with BI-RADS density category II-IV in case-control/cross-sectional studies had a 0.93-fold (95% confidence interval [CI] 0.55, 1.57), 1.08-fold (95% CI 0.40, 2.94), and 1.24-fold (95% CI 0.42, 3.69) higher risk compared to women with the lowest density category. Combined RORs for premenopausal versus postmenopausal women in case-only studies were 3.84 (95% CI 2.92, 5.05), 22.65 (95% CI 7.21, 71.13), and 42.06 (95% CI 4.22, 419.52), respectively, for BI-RADS density category II-IV versus I. CONCLUSIONS For Chinese women, breast cancer risk is weakly associated with MD; however, breast cancer risk is more strongly correlated with mammographic density in premenopausal women than postmenopausal women. Further research on the factors influencing MD in premenopausal women may provide meaningful insights into breast cancer prevention in China.
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Affiliation(s)
- Song Bai
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, 518020, China
| | - Di Song
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, 518020, China
| | - Ming Chen
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, 518020, China
| | - Xiaoshu Lai
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, 518020, China
| | - Jinfeng Xu
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, 518020, China.
| | - Fajin Dong
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, 518020, China.
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Almutairy A, Alhamed A, Grant SG, Sarachine Falso MJ, Day BW, Simmons CR, Latimer JJ. Cancer-Specific Alterations in Nuclear Matrix Proteins Determined by Multi-omics Analyses of Ductal Carcinoma in Situ. bioRxiv 2024:2024.02.13.580215. [PMID: 38405693 PMCID: PMC10888842 DOI: 10.1101/2024.02.13.580215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Breast cancer (BC) is the most common cancer affecting women in the United States. Ductal carcinoma in situ (DCIS) is the earliest identifiable pre-invasive BC lesion. Estimates show that 14 to 50% of DCIS cases progress to invasive BC. Our objective was to identify nuclear matrix proteins (NMP) with specifically altered expression in DCIS and later stages of BC compared to non-diseased breast reduction mammoplasty and a contralateral breast explant using mass spectrometry and RNA sequencing to accurately identify aggressive DCIS. Sixty NMPs were significantly differentially expressed between the DCIS and non-diseased breast epithelium in an isogenic contralateral pair of patient-derived extended explants. Ten of the sixty showed significant mRNA expression level differences that matched the protein expression. These 10 proteins were similarly expressed in non-diseased breast reduction cells. Three NMPs (RPL7A, RPL11, RPL31) were significantly upregulated in DCIS and all other BC stages compared to the matching contralateral breast culture and an unrelated non-diseased breast reduction culture. RNA sequencing analyses showed that these three genes were upregulated increasingly with BC progression. Finally, we identified three NMPs (AHNAK, CDC37 and DNAJB1) that were significantly downregulated in DCIS and all other BC stages compared to the isogenically matched contralateral culture and the non-diseased breast reduction culture using both proteomics and RNA sequencing techniques.
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15
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Goh CQ, Kaur R, Ayeni FE, Eslick GD, Edirimanne S. Bidirectional association between breast cancer and meningioma: a systematic review and meta-analysis. ANZ J Surg 2024. [PMID: 38361312 DOI: 10.1111/ans.18898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/22/2024] [Accepted: 01/27/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND An association between breast cancer and meningioma has been suggested in cohort studies. We aimed to perform a systematic review and meta-analysis to determine whether there is an association between initial breast cancer and subsequent meningioma diagnosis and vice versa. METHODS A systematic literature search was performed on Medline, Embase, Scopus and Google scholar from inception up to April 2023. A meta-analysis of selected studies was performed using Review Manager 5.4. RESULTS There were eight studies included in the systematic review. Seven had reported Standardized Incidence Ratio (SIR) for female patients and were suitable for the meta-analysis. Only one study reported SIR for male patients. For the association between initial breast cancer and subsequent meningioma, in 795 000 female patients with follow-up ranging from 7 to 13 years, the SIR was 1.27 (95% CI: 1.20-1.34, P-value <0.00001). For the association between initial meningioma and subsequent breast cancer, in 28 000 female patients with follow-up ranging from 6 to 15 years, the SIR was 1.32 (95% CI: 1.21-1.45, P-value <0.00001). There were low heterogeneity and no significant publication bias. CONCLUSION There was a small but significant association between initial breast cancer and subsequent meningioma as well as initial meningioma and subsequent breast cancer in female patients. The potential underlying mechanisms and risk factors were unclear from current literature and would be a potential area for future research.
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Affiliation(s)
- Chia Qi Goh
- Department of Surgery, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
| | - Rajneesh Kaur
- Department of Surgery, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
| | - Femi E Ayeni
- Nepean Institute of Academic Surgery, Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Guy D Eslick
- Department of Surgery, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
| | - Senarath Edirimanne
- Department of Surgery, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
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Li M, Wang H, Qu N, Piao H, Zhu B. Breast cancer screening and early diagnosis in China: a systematic review and meta-analysis on 10.72 million women. BMC Womens Health 2024; 24:97. [PMID: 38321439 PMCID: PMC10848517 DOI: 10.1186/s12905-024-02924-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/22/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND The incidence of breast cancer among Chinese women has gradually increased in recent years. This study aims to analyze the situation of breast cancer screening programs in China and compare the cancer detection rates (CDRs), early-stage cancer detection rates (ECDRs), and the proportions of early-stage cancer among different programs. METHODS We conducted a systematic review and meta-analysis of studies in multiple literature databases. Studies that were published between January 1, 2010 and June 30, 2023 were retrieved. A random effects model was employed to pool the single group rate, and subgroup analyses were carried out based on screening model, time, process, age, population, and follow-up method. RESULTS A total of 35 studies, including 47 databases, satisfied the inclusion criteria. Compared with opportunistic screening, the CDR (1.32‰, 95% CI: 1.10‰-1.56‰) and the ECDR (0.82‰, 95% CI: 0.66‰-0.99‰) were lower for population screening, but the proportion of early-stage breast cancer (80.17%, 95% CI: 71.40%-87.83%) was higher. In subgroup analysis, the CDR of population screening was higher in the urban group (2.28‰, 95% CI: 1.70‰-2.94‰), in the breast ultrasonography (BUS) in parallel with mammography (MAM) group (3.29‰, 95% CI: 2.48‰-4.21‰), and in the second screening follow-up group (2.47‰, 95% CI: 1.64‰-3.47‰), and the proportion of early-stage breast cancer was 85.70% (95% CI: 68.73%-97.29%), 88.18% (95% CI: 84.53%-91.46%), and 90.05% (95% CI: 84.07%-94.95%), respectively. CONCLUSION There were significant differences between opportunistic and population screening programs. The results of these population screening studies were influenced by the screening process, age, population, and follow-up method. In the future, China should carry out more high-quality and systematic population-based screening programs to improve screening coverage and service.
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Affiliation(s)
- Mengdan Li
- Department of Liaoning Office for Cancer Prevention and Control, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No.44 Xiaoheyan Road, Dadong District, Shenyang, Liaoning, 110042, China
| | - Hongying Wang
- Department of School of Public Health, China Medical University, Shenyang, Liaoning, 110122, China
| | - Ning Qu
- Department of Radiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, Liaoning, 110042, China
| | - Haozhe Piao
- Department of Neurosurgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No.44 Xiaoheyan Road, Dadong District, Shenyang, Liaoning, 110042, China.
| | - Bo Zhu
- Department of Liaoning Office for Cancer Prevention and Control, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No.44 Xiaoheyan Road, Dadong District, Shenyang, Liaoning, 110042, China.
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Cohen EO, Perry RE, Legha RS, Tso HH, Shin K, Speer ME, Phalak KA, Sun J, Leung JWT. Suspicious Ultrasound-Occult Non-Calcified Mammographic Masses, Asymmetries, and Architectural Distortions Are Moderate Probability for Malignancy. Cancers (Basel) 2024; 16:655. [PMID: 38339406 PMCID: PMC10854793 DOI: 10.3390/cancers16030655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/26/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
Suspicious non-calcified mammographic findings have not been evaluated with modern mammographic technique, and the purpose of this work is to compare the likelihood of malignancy for those findings. To do this, 5018 consecutive mammographically guided biopsies performed during 2016-2019 at a large metropolitan, community-based hospital system were retrospectively reviewed. In total, 4396 were excluded for targeting calcifications, insufficient follow-up, or missing data. Thirty-seven of 126 masses (29.4%) were malignant, 44 of 194 asymmetries (22.7%) were malignant, and 77 of 302 architectural distortions (AD, 25.5%) were malignant. The combined likelihood of malignancy was 25.4%. Older age was associated with a higher likelihood of malignancy for each imaging finding type (all p ≤ 0.006), and a possible ultrasound correlation was associated with a higher likelihood of malignancy when all findings were considered together (p = 0.012). Two-view asymmetries were more frequently malignant than one-view asymmetries (p = 0.03). There were two false-negative biopsies (98.7% sensitivity and 100% specificity). In conclusion, the 25.4% likelihood of malignancy confirms the recommendation for biopsy of suspicious, ultrasound-occult, mammographic findings. Mammographically guided biopsies were highly sensitive and specific in this study. Older patient age and a possible ultrasound correlation should raise concern given the increased likelihood of malignancy in those scenarios.
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Affiliation(s)
- Ethan O. Cohen
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.E.P.); (R.S.L.); (H.H.T.); (K.S.); (M.E.S.); (K.A.P.); (J.W.T.L.)
| | - Rachel E. Perry
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.E.P.); (R.S.L.); (H.H.T.); (K.S.); (M.E.S.); (K.A.P.); (J.W.T.L.)
| | - Ravinder S. Legha
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.E.P.); (R.S.L.); (H.H.T.); (K.S.); (M.E.S.); (K.A.P.); (J.W.T.L.)
| | - Hilda H. Tso
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.E.P.); (R.S.L.); (H.H.T.); (K.S.); (M.E.S.); (K.A.P.); (J.W.T.L.)
| | - Kyungmin Shin
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.E.P.); (R.S.L.); (H.H.T.); (K.S.); (M.E.S.); (K.A.P.); (J.W.T.L.)
| | - Megan E. Speer
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.E.P.); (R.S.L.); (H.H.T.); (K.S.); (M.E.S.); (K.A.P.); (J.W.T.L.)
| | - Kanchan A. Phalak
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.E.P.); (R.S.L.); (H.H.T.); (K.S.); (M.E.S.); (K.A.P.); (J.W.T.L.)
| | - Jia Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Jessica W. T. Leung
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.E.P.); (R.S.L.); (H.H.T.); (K.S.); (M.E.S.); (K.A.P.); (J.W.T.L.)
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Udayakumar D, Madhuranthakam AJ, Doğan BE. Magnetic Resonance Perfusion Imaging for Breast Cancer. Magn Reson Imaging Clin N Am 2024; 32:135-150. [PMID: 38007276 DOI: 10.1016/j.mric.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
Breast cancer is the most frequently diagnosed cancer among women worldwide, carrying a significant socioeconomic burden. Breast cancer is a heterogeneous disease with 4 major subtypes identified. Each subtype has unique prognostic factors, risks, treatment responses, and survival rates. Advances in targeted therapies have considerably improved the 5-year survival rates for primary breast cancer patients largely due to widespread screening programs that enable early detection and timely treatment. Imaging techniques are indispensable in diagnosing and managing breast cancer. While mammography is the primary screening tool, MRI plays a significant role when mammography results are inconclusive or in patients with dense breast tissue. MRI has become standard in breast cancer imaging, providing detailed anatomic and functional data, including tumor perfusion and cellularity. A key characteristic of breast tumors is angiogenesis, a biological process that promotes tumor development and growth. Increased angiogenesis in tumors generally indicates poor prognosis and increased risk of metastasis. Dynamic contrast-enhanced (DCE) MRI measures tumor perfusion and serves as an in vivo metric for angiogenesis. DCE-MRI has become the cornerstone of breast MRI, boasting a high negative-predictive value of 89% to 99%, although its specificity can vary. This review presents a thorough overview of magnetic resonance (MR) perfusion imaging in breast cancer, focusing on the role of DCE-MRI in clinical applications and exploring emerging MR perfusion imaging techniques.
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Affiliation(s)
- Durga Udayakumar
- Department of Radiology, Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX 75390, USA.
| | - Ananth J Madhuranthakam
- Department of Radiology, Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Başak E Doğan
- Department of Radiology, Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX 75390, USA
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Siegel SD, Rowland JP, Leonard DJ, Katurakes N, Bittner-Fagan H, Hoffman M, Hall-McBride R, Hicks LS, Petrelli NJ. A Population Health Proposal for Increasing Breast Cancer Screening to Reduce Racial Disparities in Breast Cancer: Getting the Village Back Together. Popul Health Manag 2024; 27:84-86. [PMID: 37909492 DOI: 10.1089/pop.2023.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Affiliation(s)
- Scott D Siegel
- Helen F. Graham Cancer Center and Research Institute, ChristianaCare, Newark, Delaware, USA
| | - Jennifer P Rowland
- Helen F. Graham Cancer Center and Research Institute, ChristianaCare, Newark, Delaware, USA
| | - Dawn J Leonard
- Helen F. Graham Cancer Center and Research Institute, ChristianaCare, Newark, Delaware, USA
| | - Nora Katurakes
- Helen F. Graham Cancer Center and Research Institute, ChristianaCare, Newark, Delaware, USA
| | | | - Matthew Hoffman
- Obstetrics and Gynecology, ChristianaCare, Newark, Delaware, USA
| | - Robert Hall-McBride
- Helen F. Graham Cancer Center and Research Institute, ChristianaCare, Newark, Delaware, USA
| | - LeRoi S Hicks
- Internal Medicine, ChristianaCare, Newark, Delaware, USA
- Institute for Research in Equity and Community Health, ChristianaCare, Newark, Delaware, USA
| | - Nicholas J Petrelli
- Helen F. Graham Cancer Center and Research Institute, ChristianaCare, Newark, Delaware, USA
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Ozernov-Palchik O, Pollack C, Bonawitz E, Christodoulou JA, Gaab N, Gabrieli JD, Kievlan PM, Kirby C, Lin G, Luk G, Nelson CA. Reflections on the past two decades of Mind, Brain, and Education. Mind Brain Educ 2024; 18:6-16. [PMID: 38745857 PMCID: PMC11090485 DOI: 10.1111/mbe.12407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 01/23/2024] [Indexed: 05/16/2024]
Affiliation(s)
- Ola Ozernov-Palchik
- Harvard Graduate School of Education
- McGovern Institute for Brain Research, MIT
| | | | | | - Joanna A. Christodoulou
- Harvard Graduate School of Education
- McGovern Institute for Brain Research, MIT
- MGH Institute of Health Professions
| | | | - John D.E. Gabrieli
- Harvard Graduate School of Education
- McGovern Institute for Brain Research, MIT
| | | | | | - Grace Lin
- Department of Psychology, Harvard University
- Scheller Teacher Education Program The Education Arcade, MIT
| | - Gigi Luk
- Department of Educational and Counselling Psychology, McGill University
| | - Charles A. Nelson
- Harvard Graduate School of Education
- Department of Pediatrics, Harvard Medical School
- Division of Developmental Medicine, Department of Pediatrics, Boston Children’s Hospital
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21
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Yoen H, Jang MJ, Yi A, Moon WK, Chang JM. Artificial Intelligence for Breast Cancer Detection on Mammography: Factors Related to Cancer Detection. Acad Radiol 2024:S1076-6332(23)00679-7. [PMID: 38216413 DOI: 10.1016/j.acra.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 01/14/2024]
Abstract
RATIONALE AND OBJECTIVES Little is known about the factors affecting the Artificial Intelligence (AI) software performance on mammography for breast cancer detection. This study was to identify factors associated with abnormality scores assigned by the AI software. MATERIALS AND METHODS A retrospective database search was conducted to identify consecutive asymptomatic women who underwent breast cancer surgery between April 2016 and December 2019. A commercially available AI software (Lunit INSIGHT, MMG, Ver. 1.1.4.0) was used for preoperative mammography to assign individual abnormality scores to the lesions and score of 10 or higher was considered as positive detection by AI software. Radiologists without knowledge of the AI results retrospectively assessed the mammographic density and classified mammographic findings into positive and negative finding. General linear model (GLM) analysis was used to identify the clinical, pathological, and mammographic findings related to the abnormality scores, obtaining coefficient β values that represent the mean difference per unit or comparison with the reference value. Additionally, the reasons for non-detection by the AI software were investigated. RESULTS Among the 1001 index cancers (830 invasive cancers and 171 ductal carcinoma in situs) in 1001 patients, 717 (72%) were correctly detected by AI, while the remaining 284 (28%) were not detected. Multivariable GLM analysis showed that abnormal mammography findings (β = 77.0 for mass, β = 73.1 for calcification only, β = 49.4 for architectural distortion, and β = 47.6 for asymmetry compared to negative; all Ps < 0.001), invasive tumor size (β = 4.3 per 1 cm, P < 0.001), and human epidermal growth receptor type 2 (HER2) positivity (β = 9.2 compared to hormone receptor positive, HER2 negative, P = 0.004) were associated with higher mean abnormality score. AI failed to detect small asymmetries in extremely dense breasts, subcentimeter-sized or isodense lesions, and faint amorphous calcifications. CONCLUSION Cancers with positive abnormal mammographic findings on retrospective review, large invasive size, HER2 positivity had high AI abnormality scores. Understanding the patterns of AI software performance is crucial for effectively integrating AI into clinical practice.
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Affiliation(s)
- Heera Yoen
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Myoung-Jin Jang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ann Yi
- Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Woo Kyung Moon
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Jung Min Chang
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
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22
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Konstantinou E, Varveris A, Solomou G, Antoniadis C, Tolia M, Mazonakis M. Radiation Dose to Critical Cardiac Structures from Three-Dimensional Conformal Radiation Therapy (3D-CRT), Intensity-Modulated Radiation Therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) Techniques for Left-Sided Breast Cancer. J Pers Med 2024; 14:63. [PMID: 38248764 PMCID: PMC10817491 DOI: 10.3390/jpm14010063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 01/23/2024] Open
Abstract
A comparison of the radiation exposure to the left anterior descending artery (LAD) and left ventricle (LV) was performed for twenty-three left breast cancer patients. For each participant, two tangential fields 3D-CRT, two- and seven-field IMRT and two and four partial arcs VMAT plans were created. Dose constraints for CTV, ipsilateral lung and heart were followed. The V40Gy, V30Gy, Dav of LAD and V23Gy, V5Gy, Dav of LV were calculated and extracted from the plans. Parametric and non-parametric tests were applied to compare the parameters derived from the five treatment techniques. All generated plans fulfilled the dose constraints. The Dav ranges of the LAD and LV from all examined techniques were 11.77-14.73 Gy and 5.37-6.40 Gy, respectively. The V40Gy and V30Gy ranges of the LAD were 2.90-12.91% and 10.80-18.51%, respectively. The V23Gy and V5Gy of the LV were 4.29-7.43% and 18.24-30.05%, respectively. The VMAT plans and seven-field IMRT significantly reduced the V40Gy, V30Gy of LAD and V23Gy of LV compared with the two-field treatments (p < 0.05). However, 3D-CRT plans provided statistically lower values for V5Gy of LV over the other techniques (p < 0.05). The presented results provide a detailed dataset of the radiation burden of two critical cardiac structures from five radiotherapy techniques.
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Affiliation(s)
- Evgenia Konstantinou
- Department of Medical Physics, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Antonis Varveris
- Department of Radiotherapy and Oncology, University General Hospital of Heraklion, 71110 Heraklion, Greece
| | - Georgia Solomou
- Department of Medical Physics, University General Hospital of Heraklion, 71110 Heraklion, Greece
| | - Chrysostomos Antoniadis
- Department of Radiotherapy and Oncology, University General Hospital of Heraklion, 71110 Heraklion, Greece
| | - Maria Tolia
- Department of Radiotherapy and Oncology, University General Hospital of Heraklion, 71110 Heraklion, Greece
| | - Michalis Mazonakis
- Department of Medical Physics, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece
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23
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Liu Z, Shan Y, Kuo YF, Giordano SH. Rural racial disparities and barriers in mammography utilization among Medicare beneficiaries in Texas: A longitudinal study. Geriatr Nurs 2024; 55:14-20. [PMID: 37967477 DOI: 10.1016/j.gerinurse.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/17/2023]
Abstract
This study examined rural racial/ethnic disparities in long-term mammography screening practices among Medicare beneficiaries. A retrospective longitudinal study was conducted using 100% Texas Medicare data for women aged 65-74 who enrolled in Medicare between 2010-2013. Of the 114,939 eligible women, 21.2% of Hispanics, 33.3% of non-Hispanic Blacks (NHB), and 38.4% non-Hispanic Whites (NHW) in rural areas were regular users of mammography, compared to 33.5%, 44.9%, and 45.3% of their counterparts in urban areas, respectively. Stratification analyses showed rural Hispanics and NHB were 33% (95% CI, 25% - 40%) and 22% (95% CI, 6% - 36%) less likely to be regular users of mammography compared to their urban counterparts. Major barriers to routine mammography screening included the lack of a primary care provider, frequent hospitalization, and comorbidity. The findings of this study highlight the importance of addressing rural racial disparities in mammography utilization among older women to ensure equitable screening practices for all populations.
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Affiliation(s)
- Zhaoli Liu
- College of Nursing and Health Innovation, The University of Texas at Arlington, Texas, United States.
| | - Yong Shan
- Department of Biostatistics & Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, Texas, United States
| | - Yong-Fang Kuo
- Department of Biostatistics & Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, Texas, United States
| | - Sharon H Giordano
- Departments of Health Services Research and Breast Medical Oncology, MD Anderson Cancer Center, The University of Texas, Houston, Texas, United States
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24
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Chen JC, Stover DG, Ballinger TJ, Bazan JG, Schneider BP, Andersen BL, Carson WE, Obeng-Gyasi S. Racial Disparities in Breast Cancer: from Detection to Treatment. Curr Oncol Rep 2024; 26:10-20. [PMID: 38100011 DOI: 10.1007/s11912-023-01472-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 02/12/2024]
Abstract
PURPOSE OF REVIEW Update on current racial disparities in the detection and treatment of breast cancer. RECENT FINDINGS Breast cancer remains the leading cause of cancer death among Black and Hispanic women. Mammography rates among Black and Hispanic women have surpassed those among White women, with studies now advocating for earlier initiation of breast cancer screening in Black women. Black, Hispanic, Asian, and American Indian and Alaskan Native women continue to experience delays in diagnosis and time to treatment. Further, racial discrepancies in receipt of guideline-concordant care, access to genetic testing and surgical reconstruction persist. Disparities in the initiation, completion, toxicity, and efficacy of chemotherapy, endocrine therapy, and targeted drug therapy remain for racially marginalized women. Efforts to evaluate the impact of race and ethnicity across the breast cancer spectrum are increasing, but knowledge gaps remain and further research is necessary to reduce the disparity gap.
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Affiliation(s)
- J C Chen
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA
| | - Daniel G Stover
- Department of Internal Medicine, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA
| | - Tarah J Ballinger
- Department of Internal Medicine, Indiana University, Indianapolis, IN, USA
| | - Jose G Bazan
- Department of Radiation Oncology, City of Hope, Duarte, CA, USA
| | - Bryan P Schneider
- Department of Internal Medicine, Indiana University, Indianapolis, IN, USA
| | | | - William E Carson
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA.
- The Ohio State University, N924 Doan Hall, 410 West 10th, Columbus, OH, 43210, USA.
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25
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Bennett DL, Winter AM, Billadello L, Lowdermilk MC, Doherty CM, Kazmi S, Laster S, Al-Hammadi N, Hardy A, Kopans DB, Moy L. Breast cancer outcomes based on method of detection in community-based breast cancer registry. Breast Cancer Res Treat 2024; 203:215-224. [PMID: 37878149 DOI: 10.1007/s10549-023-07092-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/11/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE The impact of opportunistic screening mammography in the United States is difficult to quantify, partially due to lack of inclusion regarding method of detection (MOD) in national registries. This study sought to determine the feasibility of MOD collection in a multicenter community registry and to compare outcomes and characteristics of breast cancer based on MOD. METHODS We conducted a retrospective study of breast cancer patients from a multicenter tumor registry in Missouri from January 2004 - December 2018. Registry data were extracted by certified tumor registrars and included MOD, clinicopathologic information, and treatment. MOD was assigned as screen-detected or clinically detected. Data were analyzed at the patient level. Chi-squared tests were used for categorical variable comparison and Mann-Whitney-U test was used for numerical variable comparison. RESULTS 5351 women (median age, 63 years; interquartile range, 53-73 years) were included. Screen-detected cancers were smaller than clinically detected cancers (median size 12 mm vs. 25 mm; P < .001) and more likely node-negative (81% vs. 54%; P < .001), lower grade (P < .001), and lower stage (P < .001). Screen-detected cancers were more likely treated with lumpectomy vs. mastectomy (73% vs. 41%; P < .001) and less likely to require chemotherapy (24% vs. 52%; P < .001). Overall survival for patients with invasive breast cancer was higher for screen-detected cancers (89% vs. 74%, P < .0001). CONCLUSION MOD can be routinely collected and linked to breast cancer outcomes through tumor registries, with demonstration of significant differences in outcome and characteristics of breast cancers based on MOD. Routine inclusion of MOD in US tumor registries would help quantify the impact of opportunistic screening mammography in the US.
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Affiliation(s)
- Debbie Lee Bennett
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
| | | | | | | | - Christina Michelle Doherty
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Sakina Kazmi
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Noor Al-Hammadi
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Anna Hardy
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA
- Department of Radiology, Saint Louis University School of Medicine, St. Louis, USA
| | - Daniel B Kopans
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Linda Moy
- Department of Radiology, NYU Langone Health, NYU School of Medicine, New York, NY, USA
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26
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Benitez Fuentes JD, Morgan E, de Luna Aguilar A, Mafra A, Shah R, Giusti F, Vignat J, Znaor A, Musetti C, Yip CH, Van Eycken L, Jedy-Agba E, Piñeros M, Soerjomataram I. Global Stage Distribution of Breast Cancer at Diagnosis: A Systematic Review and Meta-Analysis. JAMA Oncol 2024; 10:71-78. [PMID: 37943547 PMCID: PMC10636649 DOI: 10.1001/jamaoncol.2023.4837] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/25/2023] [Indexed: 11/10/2023]
Abstract
Importance Stage at diagnosis is a key prognostic factor for cancer survival. Objective To assess the global distribution of breast cancer stage by country, age group, calendar period, and socioeconomic status using population-based data. Data Sources A systematic search of MEDLINE and Web of Science databases and registry websites and gray literature was conducted for articles or reports published between January 1, 2000, and June 20, 2022. Study Selection Reports on stage at diagnosis for individuals with primary breast cancer (C50) from a population-based cancer registry were included. Data Extraction and Synthesis Study characteristics and results of eligible studies were independently extracted by 2 pairs of reviewers (J.D.B.F., A.D.A., A.M., R.S., and F.G.). Stage-specific proportions were extracted and cancer registry data quality and risk of bias were assessed. National pooled estimates were calculated for subnational or annual data sets using a hierarchical rule of the most relevant and high-quality data to avoid duplicates. Main Outcomes and Measures The proportion of women with breast cancer by (TNM Classification of Malignant Tumors or the Surveillance, Epidemiology, and End Results Program [SEER]) stage group. Results Data were available for 2.4 million women with breast cancer from 81 countries. Globally, the proportion of cases with distant metastatic breast cancer at diagnosis was high in sub-Saharan Africa, ranging from 5.6% to 30.6% and low in North America ranging from 0.0% to 6.0%. The proportion of patients diagnosed with distant metastatic disease decreased over the past 2 decades from around 3.8% to 35.8% (early 2000s) to 3.2% to 11.6% (2015 onwards), yet stabilization or slight increases were also observed. Older age and lower socioeconomic status had the largest proportion of cases diagnosed with distant metastatic stage ranging from 2.0% to 15.7% among the younger to 4.1% to 33.9% among the oldest age group, and from 1.7% to 8.3% in the least disadvantaged groups to 2.8% to 11.4% in the most disadvantaged groups. Conclusions and Relevance Effective policy and interventions have resulted in decreased proportions of women diagnosed with metastatic breast cancer at diagnosis in high-income countries, yet inequality persists, which needs to be addressed through increased awareness of breast cancer symptoms and early detection. Improving global coverage and quality of population-based cancer registries, including the collection of standardized stage data, is key to monitoring progress.
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Affiliation(s)
- Javier David Benitez Fuentes
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon
- Department of Medical Oncology, Hospital Clinico San Carlos, IdISSC, Calle Profesor Martín Lagos, Madrid, Spain
- Velindre Cancer Centre, Cardiff, Wales, United Kingdom
| | - Eileen Morgan
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon
| | - Alicia de Luna Aguilar
- Department of Medical Oncology, Hospital Clinico San Carlos, IdISSC, Calle Profesor Martín Lagos, Madrid, Spain
- Velindre Cancer Centre, Cardiff, Wales, United Kingdom
| | - Allini Mafra
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon
| | - Richa Shah
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon
| | - Francesco Giusti
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon
- Belgian Cancer Registry, Brussels, Belgium
| | - Jérôme Vignat
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon
| | - Ariana Znaor
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon
| | | | - Cheng-Har Yip
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Ramsay Sime Darby Health Care, Kuala Lumpur, Malaysia
| | - Liesbet Van Eycken
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon
- Belgian Cancer Registry, Brussels, Belgium
| | | | - Marion Piñeros
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon
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Zeghondy J, Rassy E, Lapidari P, Eid R, Pistilli B. Telehealth in breast cancer following the coronavirus disease 2019 pandemic. Explor Target Antitumor Ther 2023; 4:1249-1259. [PMID: 38213534 PMCID: PMC10776597 DOI: 10.37349/etat.2023.00195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 11/07/2023] [Indexed: 01/13/2024] Open
Abstract
Breast cancer (BC) is the second most diagnosed cancer in 2018 with around 2.3 million cases globally in 2020. In March 2020 and after its worldwide spread, the World Health Organization (WHO) declared the coronavirus disease 2019 (COVID-19) outbreak, a respiratory disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, a pandemic. During this time, cancer patients were heavily impacted and their treatment plans were changed due to measures to fight the disease and solutions had to be found to maintain their follow-up and management from a distance. Some cancer groups worldwide have recommended then the use of telemedicine for oncology patients to ensure the continuity of medical care during the pandemic. This method was considered effective and clinicians worldwide continued using telehealth even after the cessation of worldwide restrictions. To this end, current up-to-date data on the use of telemedicine in BC patient after the COVID-19 outbreak are summarized in this narrative review.
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Affiliation(s)
- Jean Zeghondy
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France
| | - Elie Rassy
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France
| | - Pietro Lapidari
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France
| | - Roland Eid
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France
| | - Barbara Pistilli
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France
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28
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Yao MMS, Vy VPT, Chen THH, Hsu HH, Hsu GC, Lee CS, Lin LJ, Chia SL, Wu CC, Chan WP, Yen AMF. Performance measures of 8,169,869 examinations in the National Breast Cancer Screening Program in Taiwan, 2004-2020. BMC Med 2023; 21:497. [PMID: 38102671 PMCID: PMC10724902 DOI: 10.1186/s12916-023-03217-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The benefits of mammographic screening have been shown to include a decrease in mortality due to breast cancer. Taiwan's Breast Cancer Screening Program is a national screening program that has offered biennial mammographic breast cancer screening for women aged 50-69 years since 2004 and for those aged 45-69 years since 2009, with the implementation of mobile units in 2010. The purpose of this study was to compare the performance results of the program with changes in the previous (2004-2009) and latter (2010-2020) periods. METHODS A cohort of 3,665,078 women who underwent biennial breast cancer mammography screenings from 2004 to 2020 was conducted, and data were obtained from the Health Promotion Administration, Ministry of Health and Welfare of Taiwan. We compared the participation of screened women and survival rates from breast cancer in the earlier and latter periods across national breast cancer screening programs. RESULTS Among 3,665,078 women who underwent 8,169,869 examinations in the study population, the screened population increased from 3.9% in 2004 to 40% in 2019. The mean cancer detection rate was 4.76 and 4.08 cancers per 1000 screening mammograms in the earlier (2004-2009) and latter (2010-2020) periods, respectively. The 10-year survival rate increased from 89.68% in the early period to 97.33% in the latter period. The mean recall rate was 9.90% (95% CI: 9.83-9.97%) in the early period and decreased to 8.15% (95%CI, 8.13-8.17%) in the latter period. CONCLUSIONS The evolution of breast cancer screening in Taiwan has yielded favorable outcomes by increasing the screening population, increasing the 10-year survival rate, and reducing the recall rate through the participation of young women, the implementation of a mobile unit service and quality assurance program, thereby providing historical evidence to policy makers to plan future needs.
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Affiliation(s)
- Melissa Min-Szu Yao
- Department of Radiology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, 112, Taiwan
| | - Vu Pham Thao Vy
- International PhD Program of Medicine, Taipei Medical University, Taipei, 110, Taiwan
- Department of Radiology, Thai Nguyen National Hospital, Thai Nguyen, 24000, Vietnam
- YRDx-AI Lab, Ho Chi Minh City, 70000, Vietnam
| | - Tony Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, 100, Taiwan
| | - Hsian-He Hsu
- Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, 11490, Taiwan
| | - Giu-Cheng Hsu
- Department of Radiology, Kang-Ning General Hospital, Taipei, 114, Taiwan
| | - Cindy S Lee
- Department of Radiology, State University of New York, Stony Brook, NY, 11794, USA
| | - Li-Ju Lin
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, 103, Taiwan
| | - Shu-Li Chia
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, 103, Taiwan
| | - Chao-Chun Wu
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, 103, Taiwan
| | - Wing P Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, 111 Xinglong Road, Section 3, Taipei, 116, Taiwan.
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan.
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan
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29
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Oblak T, Škerl P, Narang BJ, Blagus R, Krajc M, Novaković S, Žgajnar J. Breast cancer risk prediction using Tyrer-Cuzick algorithm with an 18-SNPs polygenic risk score in a European population with below-average breast cancer incidence. Breast 2023; 72:103590. [PMID: 37857130 PMCID: PMC10587756 DOI: 10.1016/j.breast.2023.103590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023] Open
Abstract
GOALS To determine whether an 18 single nucleotide polymorphisms (SNPs) polygenic risk score (PRS18) improves breast cancer (BC) risk prediction for women at above-average risk of BC, aged 40-49, in a Central European population with BC incidence below EU average. METHODS 502 women aged 40-49 years at the time of BC diagnosis completed a questionnaire on BC risk factors (as per Tyrer-Cuzick algorithm) with data known at age 40 and before BC diagnosis. Blood samples were collected for DNA isolation. 250 DNA samples from healthy women aged 50 served as a control cohort. 18 BC-associated SNPs were genotyped in both groups and PRS18 was calculated. The predictive power of PRS18 to detect BC was evaluated using a ROC curve. 10-year BC risk was calculated using the Tyrer-Cuzick algorithm adapted to the Slovenian incidence rate (S-IBIS): first based on questionnaire-based risk factors and, second, including PRS18. RESULTS The AUC for PRS18 was 0.613 (95 % CI 0.570-0.657). 83.3 % of women were classified at above-average risk for BC with S-IBIS without PRS18 and 80.7 % when PRS18 was included. CONCLUSION BC risk prediction models and SNPs panels should not be automatically used in clinical practice in different populations without prior population-based validation. In our population the addition of an 18SNPs PRS to questionnaire-based risk factors in the Tyrer-Cuzick algorithm in general did not improve BC risk stratification, however, some improvements were observed at higher BC risk scores and could be valuable in distinguishing women at intermediate and high risk of BC.
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Affiliation(s)
- Tjaša Oblak
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Zaloška cesta 2, 1000, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia.
| | - Petra Škerl
- Department of Molecular Diagnostics, Institute of Oncology Ljubljana, Zaloška cesta 2, 1000, Ljubljana, Slovenia.
| | - Benjamin J Narang
- Institute for Biostatistics and Medical Informatics, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia; Department of Automatics, Jožef Stefan Institute, Biocybernetics and Robotics, Jamova cesta 39, Ljubljana, Slovenia; Faculty of Sport, University of Ljubljana, Gortanova 22, Ljubljana, Slovenia.
| | - Rok Blagus
- Institute for Biostatistics and Medical Informatics, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia; Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska, Glagoljaška 8, 6000, Koper, Slovenia.
| | - Mateja Krajc
- Cancer Genetics Clinic, Institute of Oncology Ljubljana, Zaloška cesta 2, 1000, Ljubljana, Slovenia.
| | - Srdjan Novaković
- Department of Molecular Diagnostics, Institute of Oncology Ljubljana, Zaloška cesta 2, 1000, Ljubljana, Slovenia.
| | - Janez Žgajnar
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Zaloška cesta 2, 1000, Ljubljana, Slovenia.
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Ng AY, Oberije CJG, Ambrózay É, Szabó E, Serfőző O, Karpati E, Fox G, Glocker B, Morris EA, Forrai G, Kecskemethy PD. Prospective implementation of AI-assisted screen reading to improve early detection of breast cancer. Nat Med 2023; 29:3044-3049. [PMID: 37973948 PMCID: PMC10719086 DOI: 10.1038/s41591-023-02625-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/04/2023] [Indexed: 11/19/2023]
Abstract
Artificial intelligence (AI) has the potential to improve breast cancer screening; however, prospective evidence of the safe implementation of AI into real clinical practice is limited. A commercially available AI system was implemented as an additional reader to standard double reading to flag cases for further arbitration review among screened women. Performance was assessed prospectively in three phases: a single-center pilot rollout, a wider multicenter pilot rollout and a full live rollout. The results showed that, compared to double reading, implementing the AI-assisted additional-reader process could achieve 0.7-1.6 additional cancer detection per 1,000 cases, with 0.16-0.30% additional recalls, 0-0.23% unnecessary recalls and a 0.1-1.9% increase in positive predictive value (PPV) after 7-11% additional human reads of AI-flagged cases (equating to 4-6% additional overall reading workload). The majority of cancerous cases detected by the AI-assisted additional-reader process were invasive (83.3%) and small-sized (≤10 mm, 47.0%). This evaluation suggests that using AI as an additional reader can improve the early detection of breast cancer with relevant prognostic features, with minimal to no unnecessary recalls. Although the AI-assisted additional-reader workflow requires additional reads, the higher PPV suggests that it can increase screening effectiveness.
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Affiliation(s)
- Annie Y Ng
- Kheiron Medical Technologies, London, UK.
| | | | | | | | | | | | | | - Ben Glocker
- Kheiron Medical Technologies, London, UK
- Department of Computing, Imperial College London, London, UK
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Webster JL, Goldstein ND, Rowland JP, Tuite CM, Siegel SD. A catchment and location-allocation analysis of mammography access in Delaware, US: implications for disparities in geographic access to breast cancer screening. Breast Cancer Res 2023; 25:137. [PMID: 37941020 PMCID: PMC10631173 DOI: 10.1186/s13058-023-01738-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023] Open
Abstract
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.
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Affiliation(s)
- Jessica L Webster
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Neal D Goldstein
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Jennifer P Rowland
- Department of Radiology, Breast Imaging Section, Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, DE, USA
| | - Catherine M Tuite
- Department of Radiology, Breast Imaging Section, Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, DE, USA
| | - Scott D Siegel
- Cawley Center for Translational Cancer Research, Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, 4701 Ogletown-Stanton Road, Newark, DE, 19713, USA.
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Salim M, Dembrower K, Eklund M, Smith K, Strand F. Differences and similarities in false interpretations by AI CAD and radiologists in screening mammography. Br J Radiol 2023; 96:20230210. [PMID: 37660400 PMCID: PMC10607417 DOI: 10.1259/bjr.20230210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/10/2023] [Accepted: 07/20/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVE We aimed to evaluate the false interpretations between artificial intelligence (AI) and radiologists in screening mammography to get a better understanding of how the distribution of diagnostic mistakes might change when moving from entirely radiologist-driven to AI-integrated breast cancer screening. METHODS AND MATERIALS This retrospective case-control study was based on a mammography screening cohort from 2008 to 2015. The final study population included screening examinations for 714 women diagnosed with breast cancer and 8029 randomly selected healthy controls. Oversampling of controls was applied to attain a similar cancer proportion as in the source screening cohort. We examined how false-positive (FP) and false-negative (FN) assessments by AI, the first reader (RAD 1) and the second reader (RAD 2), were associated with age, density, tumor histology and cancer invasiveness in a single- and double-reader setting. RESULTS For each reader, the FN assessments were distributed between low- and high-density females with 53 (42%) and 72 (58%) for AI; 59 (36%) and 104 (64%) for RAD 1 and 47 (36%) and 84 (64%) for RAD 2. The corresponding numbers for FP assessments were 1820 (47%) and 2016 (53%) for AI; 1568 (46%) and 1834 (54%) for RAD 1 and 1190 (43%) and 1610 (58%) for RAD 2. For ductal cancer, the FN assessments were 79 (77%) for AI CAD; with 120 (83%) for RAD 1 and with 96 (16%) for RAD 2. For the double-reading simulation, the FP assessments were distributed between younger and older females with 2828 (2.5%) and 1554 (1.4%) for RAD 1 + RAD 2; 3850 (3.4%) and 2940 (2.6%) for AI+RAD 1 and 3430 (3%) and 2772 (2.5%) for AI+RAD 2. CONCLUSION The most pronounced decrease in FN assessments was noted for females over the age of 55 and for high density-women. In conclusion, AI could have an important complementary role when combined with radiologists to increase sensitivity for high-density and older females. ADVANCES IN KNOWLEDGE Our results highlight the potential impact of integrating AI in breast cancer screening, particularly to improve interpretation accuracy. The use of AI could enhance screening outcomes for high-density and older females.
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Affiliation(s)
| | | | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Kevin Smith
- Science for Life Laboratory, KTH Royal Insitute of Technology, Stockholm, Sweden
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O’Neill B, Yusuf A, Lofters A, Huang A, Ekeleme N, Kiran T, Greiver M, Sullivan F, Kurdyak P. Breast Cancer Screening Among Females With and Without Schizophrenia. JAMA Netw Open 2023; 6:e2345530. [PMID: 38019514 PMCID: PMC10687664 DOI: 10.1001/jamanetworkopen.2023.45530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/19/2023] [Indexed: 11/30/2023] Open
Abstract
Importance Breast cancer screening with mammography is recommended in Ontario, Canada, for females 50 years or older. Females with schizophrenia are at higher risk of breast cancer, but in Ontario it is currently unknown whether breast cancer screening completion differs between those with vs without schizophrenia and whether primary care payment models are a factor. Objective To compare breast cancer screening completion within 2 years after the 50th birthday among females with and without schizophrenia, and to identify the association between breast cancer screening completion and different primary care payment models. Design, Setting, and Participants This case-control study analyzed Ontario-wide administrative data on females with and without schizophrenia who turned 50 years of age between January 1, 2010, and December 31, 2019. Those with schizophrenia (cases) were matched 1:10 to those without schizophrenia (controls) on local health integration network, income quintile, rural residence, birth dates, and weighted Aggregated Diagnosis Group score. Data analysis was performed from November 2021 to February 2023. Exposures Exposures were schizophrenia and primary care payment models. Main Outcomes and Measures Outcomes included breast cancer screening completion among cases and controls within 2 years after their 50th birthday and the association with receipt of care from primary care physicians enrolled in different primary care payment models, which were analyzed using logistic regression and reported as odds ratios (ORs) and 95% CIs. Results The study included 11 631 females with schizophrenia who turned 50 years of age during the study period and a matched cohort of 115 959 females without schizophrenia, for a total of 127 590 patients. Overall, 69.3% of cases and 77.1% of controls had a mammogram within 2 years after their 50th birthday. Cases had lower odds of breast cancer screening completion within 2 years after their 50th birthday (OR, 0.67; 95% CI, 0.64-0.70). Cases who received care from a primary care physician in a fee-for-service (OR, 0.57; 95% CI, 0.53-0.60) or enhanced fee-for-service (OR, 0.79; 95% CI, 0.75-0.82) payment model had lower odds of having a mammogram than cases whose physicians were paid under a Family Health Team model. Conclusions and Relevance This case-control study found that, in Ontario, Canada, breast cancer screening completion was lower among females with schizophrenia, and differences from those without schizophrenia may partially be explained by differences in primary care payment models. Widening the availability of team-based primary care for females with schizophrenia may play a role in increased breast cancer screening rates.
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Affiliation(s)
- Braden O’Neill
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Abban Yusuf
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Ontario, Canada
| | - Aisha Lofters
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Women’s College Research Institute, Toronto, Ontario, Canada
| | | | - Ngozi Ekeleme
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Ontario, Canada
| | - Tara Kiran
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Michelle Greiver
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Department of Family and Community Medicine, North York General Hospital, Toronto, Ontario, Canada
| | - Frank Sullivan
- School of Medicine, Sir James Mackenzie Institute for Early Diagnosis, Population and Behavioural Science Division, University of St Andrews, St Andrews, Scotland
| | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Akwo JD, Trieu P, Lewis S. Does the availability of prior mammograms improve radiologists' observer performance?-a scoping review. BJR Open 2023; 5:20230038. [PMID: 37942498 PMCID: PMC10630973 DOI: 10.1259/bjro.20230038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 11/10/2023] Open
Abstract
Objective The objective of this review was to examine the impact of previous mammogram availability on radiologists' performance from screening populations and experimental studies. Materials and Methods A search of the literature was conducted using five databases: MEDLINE, PubMed, Web of Science, ScienceDirect, and CINAHL as well as Google and reference lists of articles. Keywords were combined with "AND" or "OR" or "WITH" and included "prior mammograms, diagnostic performance, initial images, diagnostic efficacy, subsequent images, previous imaging, and radiologist's performance". Studies that assessed the impact of previous mammogram availability on radiologists' performance were reviewed. The Standard for Reporting Diagnostic Accuracy guidelines was used to critically appraise individual sources of evidence. Results A total of 15 articles were reviewed. The sample of mammogram cases used across these studies varied from 36 to 1,208,051. Prior mammograms did not affect sensitivity [with priors: 62-86% (mean = 73.3%); without priors: 69.4-87.4% (mean = 75.8%)] and cancer detection rate, but increased specificity [with priors: 72-96% (mean = 87.5%); without priors: 63-87% (mean = 80.5%)] and reduced false-positive rates [with priors: 3.7 to 36% (mean = 19.9%); without priors 13.3-49% (mean = 31.4%)], recall rates [with priors: 3.8-57% (mean = 26.6%); without priors: [4.9%-67.5% (mean = 37.9%)], and abnormal interpretation rate decreased by 4% with priors. Evidence for the associations between the availability of prior mammograms and positive-predictive value, area under the curve (AUC) from the receiver operating characteristic curve (ROC) and localisation ROC AUC, and positive-predictive value of recall is limited and unclear. Conclusion Availability of prior mammograms reduces recall rates, false-positive rates, abnormal interpretation rates, and increases specificity without affecting sensitivity and cancer detection rate.
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Affiliation(s)
| | - Phuong Trieu
- Medical Image Optimisation and Perception Group, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Sarah Lewis
- Medical Image Optimisation and Perception Group, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
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Wilkinson AN, Ellison LF, Billette JM, Seely JM. Impact of Breast Cancer Screening on 10-Year Net Survival in Canadian Women Age 40-49 Years. J Clin Oncol 2023; 41:4669-4677. [PMID: 37540825 PMCID: PMC10564321 DOI: 10.1200/jco.23.00348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/26/2023] [Accepted: 06/15/2023] [Indexed: 08/06/2023] Open
Abstract
PURPOSE In Canada, some provincial/territorial mammography screening programs include women age 40-49 years, whereas others do not. This study examines the impact of this dichotomy on the 10-year breast cancer (BC) net survival (NS) among women age 40-49 years and 50-59 years at diagnosis. METHODS Using the Canadian Cancer Registry data record linked to death information, we evaluated the cohort of Canadian women age 40-49 years and 50-59 years diagnosed with BC from 2002 to 2007. We compared 10-year NS estimates in the jurisdictions with organized screening programs that included women age 40-49 years, designated as screeners (Northwest Territories, British Columbia, Alberta, Nova Scotia, and Prince Edward Island), with comparator programs that did not (Yukon, Manitoba, Saskatchewan, Ontario, Quebec, New Brunswick, and Newfoundland and Labrador). RESULTS BC was the primary cause of 10-year mortality in women age 40-49 years diagnosed with BC (90.7% of deaths). Among these women, the 10-year NS for screeners (84.8%; 95% CI, 83.8 to 85.8) was 1.9 percentage points (pp) higher than that for comparators (82.9%; 95% CI, 82.3 to 83.5; P = .001). The difference in favor of screeners was significant among women age 45-49 years (2.6 pp; P = .001) but not among women age 40-44 years (0.9 pp; P = .328). Similarly, the incidence-based BC mortality rate was significantly lower in screener jurisdictions among women age 40-49 years and 45-49 years, but not for 40-44 years. Provincial/territorial NS increased significantly with higher mammography screening participation (P = .003). The BC incidence rate was virtually identical in screener and comparator jurisdictions among women age 40-49 years (P = .976) but was significantly higher for comparators among women age 50-59 years (P < .001). CONCLUSION Screening programs that included women in their 40s were associated with a significantly higher BC 10-year NS in women age 40-49 years, but not an increased rate of BC diagnosis. These results may inform screening guidelines for women age 40-49 years.
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Affiliation(s)
| | - Larry F. Ellison
- Centre for Population Health Data at Statistics Canada, Government of Canada, Ottawa, Canada
| | - Jean-Michel Billette
- Centre for Population Health Data at Statistics Canada, Government of Canada, Ottawa, Canada
| | - Jean M. Seely
- University of Ottawa, Department of Radiology, Ottawa Hospital Research Institute, Ottawa, Canada
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Igissin N, Toguzbayeva A, Khamidullina Z, Telmanova Z, Bilyalova Z, Kudaibergenova I, Muratbekova S, Igissinova G, Rustemova K, Kulmirzayeva D, Syzdykov N, Taszhanov R, Turebayev D, Orazova G, Kassenova D, Detochkina V, Baibosynov D, Kuandykov Y. Epidemiology of Breast Cancer Mortality in Kazakhstan, trends and Geographic Distribution. Asian Pac J Cancer Prev 2023; 24:3361-3371. [PMID: 37898839 PMCID: PMC10770671 DOI: 10.31557/apjcp.2023.24.10.3361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/10/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND According to the International Agency for Research on Cancer, ongoing demographic changes will lead to an increase in the number of deaths from breast cancer (BC) per year in the vast majority of regions. In 2040 it is expected that 1.04 million people worldwide will die from this malignancy, including 2,380 women in Kazakhstan. METHODS The retrospective study (2009-2018) was done using descriptive and analytical methods of oncoepidemiology. The extensive, crude and age-specific incidence rates are determined according to the generally accepted methodology used in sanitary statistics. The data were used to calculate the average percentage change (APС) using the Joinpoint regression analysis to determine the trend over the study period. RESULTS During 10 years 12,958 women died from BC. An average age of the death was 61.6 years (95%CI=60.6-62.6) and tended to increase (APC=+0.6%, R2=0.6117). Age-specific rates had a bimodal increase with peak rates at 70-74 years - 76.7±5.5 (APC=+3.4%, R2=0.2656) and 80-84 years - 78.0±9.1 (APC=+3.7%, R2=0.0875). The age-standardized rate was 13.9 per 100,000 of female population, and the trend has decreased. When compiling thematic maps, mortality rates were determined on the basis of standardized indicators: low - up to 12.5, average - from 12.5 to 15.2, high - above 15.2 per 100,000. The results of the spatial analysis showed the regions with a higher levels of BC mortality rate per 100,000: Pavlodar (16.9), Almaty (19.2) and Astana cities (19.3). CONCLUSIONS Age-standardized mortality rates had a strong downward trend (APC=-4.0%, R2=0.9218). The decrease mostly is due to a large coverage of the population by mammography screening and to an improvement in the effectiveness of breast cancer treatment.
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Affiliation(s)
- Nurbek Igissin
- Research Institute of Life and Health Sciences, Higher School of Medicine, Kokshetau University named after Sh. Ualikhanov, Kokshetau, Kazakhstan.
- Central Asian Institute for Medical Research, Astana, Kazakhstan.
- Asian Pacific Organization for Cancer Prevention, Bishkek, Kyrgyzstan.
| | - Assem Toguzbayeva
- Central Asian Institute for Medical Research, Astana, Kazakhstan.
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan.
| | | | - Zhansaya Telmanova
- Central Asian Institute for Medical Research, Astana, Kazakhstan.
- Asian Pacific Organization for Cancer Prevention, Bishkek, Kyrgyzstan.
| | - Zarina Bilyalova
- Central Asian Institute for Medical Research, Astana, Kazakhstan.
- Asian Pacific Organization for Cancer Prevention, Bishkek, Kyrgyzstan.
| | - Indira Kudaibergenova
- Asian Pacific Organization for Cancer Prevention, Bishkek, Kyrgyzstan.
- Akhunbaev Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan.
| | - Svetlana Muratbekova
- Research Institute of Life and Health Sciences, Higher School of Medicine, Kokshetau University named after Sh. Ualikhanov, Kokshetau, Kazakhstan.
| | - Gulnur Igissinova
- Central Asian Institute for Medical Research, Astana, Kazakhstan.
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan.
| | - Kulsara Rustemova
- Central Asian Institute for Medical Research, Astana, Kazakhstan.
- Astana Medical University, Astana, Kazakhstan.
| | | | - Nariman Syzdykov
- Central Asian Institute for Medical Research, Astana, Kazakhstan.
- Health Department of the Akmola region, Kokshetau, Kazakhstan.
| | - Rustem Taszhanov
- Central Asian Institute for Medical Research, Astana, Kazakhstan.
- Kokshetau Higher Medical College, Kokshetau, Kazakhstan.
| | - Dulat Turebayev
- Central Asian Institute for Medical Research, Astana, Kazakhstan.
- Astana Medical University, Astana, Kazakhstan.
| | | | - Dinara Kassenova
- Central Asian Institute for Medical Research, Astana, Kazakhstan.
- Astana Medical University, Astana, Kazakhstan.
| | | | - Daulet Baibosynov
- Central Asian Institute for Medical Research, Astana, Kazakhstan.
- Astana Medical University, Astana, Kazakhstan.
| | - Yerlan Kuandykov
- Khoja Akhmet Yassawi International Kazakh-Turkish University, Shymkent, Kazakhstan.
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Martiniussen MA, Larsen M, Larsen ASF, Hovda T, Koch HW, Bjørnerud A, Hofvind S. Norwegian radiologists' expectations of artificial intelligence in mammographic screening - A cross-sectional survey. Eur J Radiol 2023; 167:111061. [PMID: 37657381 DOI: 10.1016/j.ejrad.2023.111061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/13/2023] [Accepted: 08/22/2023] [Indexed: 09/03/2023]
Abstract
PURPOSE To explore Norwegian breast radiologists' expectations of adding artificial intelligence (AI) in the interpretation procedure of screening mammograms. METHODS All breast radiologists involved in interpretation of screening mammograms in BreastScreen Norway during 2021 and 2022 (n = 98) were invited to take part in this anonymous cross-sectional survey about use of AI in mammographic screening. The questionnaire included background information of the respondents, their expectations, considerations of biases, and ethical and social implications of implementing AI in screen reading. Data was collected digitally and analyzed using descriptive statistics. RESULTS The response rate was 61% (60/98), and 67% (40/60) of the respondents were women. Sixty percent (36/60) reported ≥10 years' experience in screen reading, while 82% (49/60) reported no or limited experience with AI in health care. Eighty-two percent of the respondents were positive to explore AI in the interpretation procedure in mammographic screening. When used as decision support, 68% (41/60) expected AI to increase the radiologists' sensitivity for cancer detection. As potential challenges, 55% (33/60) reported lack of trust in the AI system and 45% (27/60) reported discrepancy between radiologists and AI systems as possible challenges. The risk of automation bias was considered high among 47% (28/60). Reduced time spent reading mammograms was rated as a potential benefit by 70% (42/60). CONCLUSION The radiologists reported positive expectations of AI in the interpretation procedure of screening mammograms. Efforts to minimize the risk of automation bias and increase trust in the AI systems are important before and during future implementation of the tool.
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Affiliation(s)
- Marit A Martiniussen
- Department of Radiology, Østfold Hospital Trust, Kalnes, Norway; University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Marthe Larsen
- Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | | | - Tone Hovda
- Department of Radiology, Vestre Viken Hospital Trust, Drammen, Norway
| | - Henrik W Koch
- Department of Radiology, Stavanger University Hospital, Stavanger, Norway; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Atle Bjørnerud
- Computational Radiology & Artificial Intelligence (CRAI) Unit, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Department of Physics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Solveig Hofvind
- Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway; Department of Health and Care Sciences, UiT, The Artic University of Norway, Tromsø, Norway.
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Gegios AR, Peterson MS, Fowler AM. Breast Cancer Screening and Diagnosis: Recent Advances in Imaging and Current Limitations. PET Clin 2023; 18:459-471. [PMID: 37296043 DOI: 10.1016/j.cpet.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Breast cancer detection has a significant impact on population health. Although there are many breast imaging modalities, mammography is the predominant tool for breast cancer screening. The introduction of digital breast tomosynthesis to mammography has contributed to increased cancer detection rates and decreased recall rates. In average-risk women, starting annual screening mammography at age 40 years has demonstrated the highest mortality reduction. In intermediate- and high-risk women as well as in those with dense breasts, additional modalities, including MRI, ultrasound, and molecular breast imaging, can also be considered for adjunct screening to improve the detection of mammographically occult malignancy.
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Affiliation(s)
- Alison R Gegios
- Section of Breast Imaging and Intervention, Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-3252, USA
| | - Molly S Peterson
- Section of Breast Imaging and Intervention, Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-3252, USA
| | - Amy M Fowler
- Section of Breast Imaging and Intervention, Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-3252, USA; University of Wisconsin Carbone Cancer Center, Madison, WI, USA; Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA.
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Abstract
Multiple tools exist to assess a patient's breast cancer risk. The choice of risk model depends on the patient's risk factors and how the calculation will impact care. High-risk patients-those with a lifetime breast cancer risk of ≥20%-are, for instance, eligible for supplemental screening with breast magnetic resonance imaging. Those with an elevated short-term breast cancer risk (frequently defined as a 5-year risk ≥1.66%) should be offered endocrine prophylaxis. High-risk patients should also receive guidance on modification of lifestyle factors that affect breast cancer risk.
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Affiliation(s)
- Amy E Cyr
- Department of Medicine, Washington University, Box 8056, 660 South Euclid Avenue, Saint Louis, MO 63110, USA.
| | - Kaitlyn Kennard
- Department of Surgery, Washington University, Box 8051, 660 South Euclid Avenue, Saint louis, MO 63110, USA
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Jaafar Sidek MA, Amajid K, Loh YS, Rosli MA, Hashim IS, Mohd Suffian NA, Abdullah N, Midin M. The prevalent factors of anxiety in women undergoing mammography. Front Psychiatry 2023; 14:1085115. [PMID: 37791131 PMCID: PMC10544569 DOI: 10.3389/fpsyt.2023.1085115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 09/01/2023] [Indexed: 10/05/2023] Open
Abstract
Background Breast cancer is the most common cancer among women in Malaysia. Anxiety is one factor that deters women from participating in mammography. This study aimed to assess the anxiety level and its associated factors in women undergoing mammography. Methods A three-month cross-sectional study was conducted using self-administered questionnaires, encompassing socio-demographic details, clinical characteristics, and the State-Trait Anxiety Inventory. Results The mean age of the participants was 57 years old (SD ±10.098). Repeat mammograms consisted of 48.8% of the participants. One-third (35.7%) of them had a history of breast disease. Most participants (84.5%) did not have a positive family history of breast cancer. The proportion of participants with moderate and high anxiety levels was 41.8%. The cause of anxiety was mainly due to the fear of the results (69%), while familiarity with the procedure reduced anxiety among respondents. Socio-demographic and clinical factors were not significantly associated with anxiety levels. However, a statistically significant positive correlation was found between state and trait anxiety scores (r = 0.568, p = 0.001, n = 213). Limitations The urban setting and absence of questions on the location of origin in the study may have excluded data from the rural population. This may have prevented a true representation of the Malaysian population. Conclusion The findings suggest a better understanding of the procedures involved as well as the subsequent disease management would be beneficial in alleviating anxiety prior to, during, and post-mammogram.
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Affiliation(s)
- Mohamed Ariff Jaafar Sidek
- Department of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - Kanchlla Amajid
- Department of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - Yi Sheng Loh
- Department of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - Muhammad Ariff Rosli
- Department of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - Iffah Syahirah Hashim
- Department of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - Nur Ashiqin Mohd Suffian
- Department of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - Norlia Abdullah
- Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - Marhani Midin
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
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Dumky H, Fridell K, Leifland K, Metsälä E. Breast cancer screening and immigrant women-A scoping review of attendance, knowledge, barriers and facilitators. Nurs Open 2023; 10:5843-5856. [PMID: 37259178 PMCID: PMC10416041 DOI: 10.1002/nop2.1865] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 03/03/2023] [Accepted: 05/07/2023] [Indexed: 06/02/2023] Open
Abstract
AIM The aim of this study was to summarize the latest research reports about immigrant women and attendance in breast cancer screening. DESIGN Scoping review. METHODS Literature searches were made in CINAHL, PubMed, Web of Science, Google Scholar, Oatd and Oalster. Twenty-three articles were included in the study. Data were analysed with inductive content analysis. RESULTS Out of data four main categories were formed: attendance rates, incidence, barriers and facilitators, and knowledge and perception. The results show that attendance rates, barriers and facilitators for attendance, knowledge and experience of breast cancer and breast cancer screening differ between several factors such as the woman's migrant background, country of origin, religion, length of stay in the new home country and sociodemographic factors.
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Affiliation(s)
- Hanna Dumky
- Department of Clinical Science, Intervention and Technology (CLINTEC)Karolinska InstitutetStockholmSweden
| | - Kent Fridell
- Department of Clinical Science, Intervention and Technology (CLINTEC)Karolinska InstitutetStockholmSweden
| | | | - Eija Metsälä
- Department of Clinical Science, Intervention and Technology (CLINTEC)Karolinska InstitutetStockholmSweden
- Metropolia University of Applied SciencesMetropoliaFinland
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Wu S, Liang D, Shi J, Li D, Liu Y, Hao Y, Shi M, Du X, He Y. Evaluation of a population-based breast cancer screening in North China. J Cancer Res Clin Oncol 2023; 149:10119-10130. [PMID: 37266660 PMCID: PMC10423103 DOI: 10.1007/s00432-023-04905-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/20/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Despite mammography-based screening for breast cancer has been conducted in many countries, there are still little data on participation and diagnostic yield in population-based breast cancer screening in China. METHODS We enrolled 151,973 eligible women from four cities in Hebei Province within the period 2013-2021 and followed up until December 31, 2021. Participants aged 40-74 who assessed as high risk were invited to undergo breast ultrasound and mammography examination. Overall and group-specific participation rates were calculated. Multivariable analyses were used to estimate the factors associated with participation rates. The diagnostic yield of both screening and no screening groups was calculated. We further analyzed the stage distribution and molecular subtype of breast cancer cases by different modes of cancer detection. RESULTS A total of 42,547 participants were evaluated to be high risk of breast cancer. Among them, 23,009 subjects undertook screening services, with participation rate of 54.08%. Multivariable logistic regression model showed that aged 45-64, high education level, postmenopausal, current smoking, alcohol consumption, family history of breast cancer, and benign breast disease were associated with increased participation of screening. After median follow-up of 3.79 years, there were 456 breast cancer diagnoses of which 65 were screen-detected breast cancers (SBCs), 27 were interval breast cancers (IBCs), 68 were no screening cancers, and 296 were cancers detected outside the screening program. Among them, 92 participants in the screening group (0.40%) and 364 in the non-screening group (0.28%) had breast cancer detected, which resulted in an odds ratio of 1.42 (95% CI 1.13-1.78; P = 0.003). We observed a higher detection rate of breast cancer in the screening group, with ORs of 2.42 (95% CI 1.72-3.41) for early stage (stages 0-I) and 2.12 (95% CI 1.26-3.54) for luminal A subtype. SBCs had higher proportion of early stage (71.93%) and luminal A subtype (47.22%) than other groups. CONCLUSIONS The significant differences in breast cancer diagnosis between the screening and non-screening group imply an urgent need for increased breast cancer awareness and early detection in China.
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Affiliation(s)
- Siqi Wu
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China
| | - Di Liang
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China
| | - Jin Shi
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China
| | - Daojuan Li
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China
| | - Yanyu Liu
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China
| | - Yahui Hao
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China
| | - Miaomiao Shi
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China
| | - Xinyu Du
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China
| | - Yutong He
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China.
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Tan MM, Jamil ASA, Ismail R, Donnelly M, Su TT. Breast cancer and breast cancer screening use-beliefs and behaviours in a nationwide study in Malaysia. BMC Public Health 2023; 23:1319. [PMID: 37430228 DOI: 10.1186/s12889-023-16227-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Many upper-middle-income countries (UMICs), including Malaysia, continue to face low breast cancer (BC) screening rates and patients with delayed presentation of BC. This study investigated the role of beliefs about BC and use of screening (e.g. beliefs about whether or not screening reduced the possibility of dying from BC). METHODS A nationwide cross-sectional study was conducted in which a total of 813 women (aged ≥ 40 years old) were randomly selected and surveyed using the validated Awareness and Beliefs about Cancer (ABC) measure. The association between BC screening use, sociodemographic characteristics, and negative beliefs about BC screening were analysed using stepwise Poisson regressions. RESULTS Seven out of ten Malaysian women believed that BC screening was necessary only when experiencing cancer symptoms. Women > 50 years and from households with more than one car or motorcycle were 1.6 times more likely to attend a mammogram or a clinical breast examination (mammogram: Prevalence Ratio (PR) = 1.60, 95% Confidence Interval (CI) = 1.19-2.14, Clinical Breast Examination (CBE): PR = 1.61, 95% CI = 1.29-1.99). About 23% of women expected to feel anxious about attending BC screening, leading them to avoid the procedure. Women who held negative beliefs about BC screening were 37% less likely to attend a mammogram (PR = 0.63, 95% CI = 0.42-0.94) and 24% less likely to seek a CBE (PR = 0.75, 95% CI = 0.60-0.95). CONCLUSIONS Public health strategies or behaviour interventions targeting negative beliefs about BC screening among Malaysian women may increase uptake and reduce late presentation and advanced-stage cancer. Insights from the study suggest that women under 50 years, in the lower income group without a car or motorcycle ownership, and of Malay or Indian ethnicity (compared to Chinese-Malay) are more likely to hold beliefs inhibiting BC screening.
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Affiliation(s)
- Min Min Tan
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor, Malaysia
| | - Aminatul Saadiah Abdul Jamil
- Health Industry Technology Programme, Faculty of Science and Technology, Universiti Sains Islam Malaysia, Negeri Sembilan, Malaysia
| | - Roshidi Ismail
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor, Malaysia
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Northern Ireland, UK.
| | - Tin Tin Su
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor, Malaysia.
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
- Centre for Public Health, Queen's University Belfast, Northern Ireland, UK.
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Wehbe A, Gonte MR, O'Neill SC, Amit‐Yousif A, Purrington K, Manning M, Simon MS. Predictors of nonadherence to breast cancer screening guidelines in a United States urban comprehensive cancer center. Cancer Med 2023; 12:15482-15491. [PMID: 37329206 PMCID: PMC10417068 DOI: 10.1002/cam4.6182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/08/2023] [Accepted: 05/20/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND This study aimed to identify predictors of nonadherence to breast cancer screening guidelines in an urban screening clinic among high- and average-risk women in the United States. METHODS We reviewed records of 6090 women who received ≥2 screening mammograms over 2 years at the Karmanos Cancer Institute to examine how breast cancer risk and breast density were associated with guideline-concordant screening. Incongruent screening was defined as receiving supplemental imaging between screening mammograms for average-risk women, and as not receiving recommended supplemental imaging for high-risk women. We used t-tests and chi-square tests to examine bivariate associations with guideline-congruent screening, and probit regression to regress guideline-congruence unto breast cancer risk, breast density, and their interaction, controlling for age and race. RESULTS Incongruent screening was more likely among high- versus average-risk women (97.7% vs. 0.9%, p < 0.01). Among average-risk women, incongruent screening was more likely among those with dense versus nondense breasts (2.0% vs. 0.1%, p < 0.01). Among high-risk women, incongruent screening was more likely among those with nondense versus dense breasts (99.5% vs. 95.2%, p < 0.01). The significant main effects of density and high-risk on increased incongruent screening were qualified by a density by high-risk interaction, showing a weaker association between risk and incongruent screening among women with dense breasts (simple slope = 3.71, p < 0.01) versus nondense breasts (simple slope = 5.79, p < 0.01). Age and race were not associated with incongruent screening. CONCLUSIONS Lack of adherence to evidence-based screening guidelines has led to underutilization of supplementary imaging for high-risk women and potential overutilization for women with dense breasts without other risk factors.
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Affiliation(s)
- Alexandra Wehbe
- Harvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of OncologyBarbara Ann Karmanos Cancer InstituteDetroitMichiganUSA
- Population Studies and Disparities Research ProgramBarbara Ann Karmanos Cancer InstituteDetroitMichiganUSA
- Wayne State University School of MedicineDetroitMichiganUSA
| | - Madeleine R. Gonte
- Harvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Wayne State University School of MedicineDetroitMichiganUSA
| | - Suzanne C. O'Neill
- Department of Oncology, Lombardi Cancer CenterGeorgetown UniversityWashingtonDCUSA
| | - Alit Amit‐Yousif
- Center for Breast HealthOakland Macomb Obstetrics and GynecologyRochester HillsMichiganUSA
| | - Kristen Purrington
- Population Studies and Disparities Research ProgramBarbara Ann Karmanos Cancer InstituteDetroitMichiganUSA
| | - Mark Manning
- Department of PsychologyOakland UniversityRochesterMichiganUSA
- Center for Molecular Medicine and GeneticsWayne State University School of MedicineDetroitMichiganUSA
| | - Michael S. Simon
- Department of OncologyBarbara Ann Karmanos Cancer InstituteDetroitMichiganUSA
- Population Studies and Disparities Research ProgramBarbara Ann Karmanos Cancer InstituteDetroitMichiganUSA
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Tabár L, Bozó R, Dean PB, Ormándi K, Puchkova O, Oláh-Németh O, Németh IB, Veréb Z, Yen MF, Chen LS, Chen HH, Vörös A. Does Diffusely Infiltrating Lobular Carcinoma of the Breast Arise from Epithelial-Mesenchymal Hybrid Cells? Int J Mol Sci 2023; 24:10752. [PMID: 37445938 DOI: 10.3390/ijms241310752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Classic diffusely infiltrating lobular carcinoma has imaging features divergent from the breast cancers originating from the terminal ductal lobular units and from the major lactiferous ducts. Although the term "invasive lobular carcinoma" implies a site of origin within the breast lobular epithelium, we were unable to find evidence supporting this assumption. Exceptional excess of fibrous connective tissue and the unique cell architecture combined with the aberrant features at breast imaging suggest that this breast malignancy has not originated from cells lining the breast ducts and lobules. The only remaining relevant component of the fibroglandular tissue is the mesenchyme. The cells freshly isolated and cultured from diffusely infiltrating lobular carcinoma cases contained epithelial-mesenchymal hybrid cells with both epithelial and mesenchymal properties. The radiologic and histopathologic features of the tumours and expression of the mesenchymal stem cell positive markers CD73, CD90, and CD105 all suggest development in the direction of mesenchymal transition. These hybrid cells have tumour-initiating potential and have been shown to have poor prognosis and resistance to therapy targeted for malignancies of breast epithelial origin. Our work emphasizes the need for new approaches to the diagnosis and therapy of this highly fatal breast cancer subtype.
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Affiliation(s)
- László Tabár
- Falun Central Hospital, Lasarettsvägen 10, 791 82 Falun, Sweden
| | - Renáta Bozó
- Department of Dermatology and Allergology, Albert Szent-Györgyi Medical School, University of Szeged, Korányi Street 6, H-6720 Szeged, Hungary
| | - Peter B Dean
- Department of Diagnostic Radiology, Faculty of Medicine, University of Turku, FI-20014 Turun, Finland
| | - Katalin Ormándi
- Department of Radiology, University of Szeged, Semmelweis Street 6, H-6725 Szeged, Hungary
| | - Olga Puchkova
- Department of Breast Imaging, Il'inskaya Hospital, Novorizhskoye Highway 9 km, 101000 Moscow, Russia
| | - Orsolya Oláh-Németh
- Department of Pathology, University of Szeged, Állomás Street 2, H-6725 Szeged, Hungary
| | - István Balázs Németh
- Department of Dermatology and Allergology, Albert Szent-Györgyi Medical School, University of Szeged, Korányi Street 6, H-6720 Szeged, Hungary
| | - Zoltán Veréb
- Department of Dermatology and Allergology, Albert Szent-Györgyi Medical School, University of Szeged, Korányi Street 6, H-6720 Szeged, Hungary
| | - Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Wuxing Street, Taipei 110, Taiwan
| | - Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Wuxing Street, Taipei 110, Taiwan
| | - Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17 Hsuchow Road, Taipei 100, Taiwan
| | - András Vörös
- Department of Pathology, University of Szeged, Állomás Street 2, H-6725 Szeged, Hungary
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Oberije CJG, Sharma N, James JJ, Ng AY, Nash J, Kecskemethy PD. Comparing Prognostic Factors of Cancers Identified by Artificial Intelligence (AI) and Human Readers in Breast Cancer Screening. Cancers (Basel) 2023; 15:3069. [PMID: 37370680 DOI: 10.3390/cancers15123069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Invasiveness status, histological grade, lymph node stage, and tumour size are important prognostic factors for breast cancer survival. This evaluation aims to compare these features for cancers detected by AI and human readers using digital mammography. Women diagnosed with breast cancer between 2009 and 2019 from three UK double-reading sites were included in this retrospective cohort evaluation. Differences in prognostic features of cancers detected by AI and the first human reader (R1) were assessed using chi-square tests, with significance at p < 0.05. From 1718 screen-detected cancers (SDCs) and 293 interval cancers (ICs), AI flagged 85.9% and 31.7%, respectively. R1 detected 90.8% of SDCs and 7.2% of ICs. Of the screen-detected cancers detected by the AI, 82.5% had an invasive component, compared to 81.1% for R1 (p-0.374). For the ICs, this was 91.5% and 93.8% for AI and R1, respectively (p = 0.829). For the invasive tumours, no differences were found for histological grade, tumour size, or lymph node stage. The AI detected more ICs. In summary, no differences in prognostic factors were found comparing SDC and ICs identified by AI or human readers. These findings support a potential role for AI in the double-reading workflow.
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Affiliation(s)
- Cary J G Oberije
- Kheiron Medical Technologies, 112-116 Old St., London EC1V 9BG, UK
| | - Nisha Sharma
- Breast Screening Unit, Leeds Teaching Hospital NHS Trust, Leeds LS14 6UH, UK
| | - Jonathan J James
- Nottingham Breast Institute, City Hospital, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
| | - Annie Y Ng
- Kheiron Medical Technologies, 112-116 Old St., London EC1V 9BG, UK
| | - Jonathan Nash
- Kheiron Medical Technologies, 112-116 Old St., London EC1V 9BG, UK
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Crown A, Fazeli S, Kurian AW, Ochoa DA, Joseph KA. Disparity in Breast Cancer Care: Current State of Access to Screening, Genetic Testing, Oncofertility, and Reconstruction. J Am Coll Surg 2023; 236:1233-1239. [PMID: 36971366 DOI: 10.1097/xcs.0000000000000647] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Breast cancer is the most common cancer diagnosed in women, accounting for an estimated 30% of all new cancer diagnoses in women in 2022. Advances in breast cancer treatment have reduced the mortality rate over the past 25 years by up to 34% but not all groups have benefitted equally from these improvements. These disparities span the continuum of care from screening to the receipt of guideline-concordant therapy and survivorship. At the 2022 American College of Surgeons Clinical Congress, a panel session was dedicated to educating and discussing methods of addressing these disparities in a coordinated manner. While there are multilevel solutions to address these disparities, this article focuses on screening, genetic testing, reconstruction, and oncofertility.
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Affiliation(s)
- Angelena Crown
- From the True Family Women's Cancer Center, Swedish Cancer Institute, Seattle, WA (Crown)
| | | | - Allison W Kurian
- Division of Oncology, Population Sciences Program, Stanford Cancer Institute, Stanford, CA (Kurian)
- Women's Clinical Cancer Genetics Program, Stanford University School of Medicine, Stanford, CA (Kurian)
| | - Daniela A Ochoa
- Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Science, Little Rock, AR (Ochoa)
| | - Kathie-Ann Joseph
- Department of Surgery, NYU Grossman School of Medicine, New York, NY (Joseph)
- NYU Langone Health Institute for Excellence in Health Equity, New York, NY (Joseph)
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Sharma N, Ng AY, James JJ, Khara G, Ambrózay É, Austin CC, Forrai G, Fox G, Glocker B, Heindl A, Karpati E, Rijken TM, Venkataraman V, Yearsley JE, Kecskemethy PD. Multi-vendor evaluation of artificial intelligence as an independent reader for double reading in breast cancer screening on 275,900 mammograms. BMC Cancer 2023; 23:460. [PMID: 37208717 DOI: 10.1186/s12885-023-10890-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/26/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Double reading (DR) in screening mammography increases cancer detection and lowers recall rates, but has sustainability challenges due to workforce shortages. Artificial intelligence (AI) as an independent reader (IR) in DR may provide a cost-effective solution with the potential to improve screening performance. Evidence for AI to generalise across different patient populations, screening programmes and equipment vendors, however, is still lacking. METHODS This retrospective study simulated DR with AI as an IR, using data representative of real-world deployments (275,900 cases, 177,882 participants) from four mammography equipment vendors, seven screening sites, and two countries. Non-inferiority and superiority were assessed for relevant screening metrics. RESULTS DR with AI, compared with human DR, showed at least non-inferior recall rate, cancer detection rate, sensitivity, specificity and positive predictive value (PPV) for each mammography vendor and site, and superior recall rate, specificity, and PPV for some. The simulation indicates that using AI would have increased arbitration rate (3.3% to 12.3%), but could have reduced human workload by 30.0% to 44.8%. CONCLUSIONS AI has potential as an IR in the DR workflow across different screening programmes, mammography equipment and geographies, substantially reducing human reader workload while maintaining or improving standard of care. TRIAL REGISTRATION ISRCTN18056078 (20/03/2019; retrospectively registered).
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Affiliation(s)
- Nisha Sharma
- The Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Annie Y Ng
- Kheiron Medical Technologies, London, UK.
| | - Jonathan J James
- Nottingham Breast Institute, City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | | | - Gábor Forrai
- Duna Medical Center, Budapest, Hungary
- GÉ-RAD Kft, Budapest, Hungary
| | | | - Ben Glocker
- Kheiron Medical Technologies, London, UK
- Department of Computing, Imperial College London, London, UK
| | | | - Edit Karpati
- Kheiron Medical Technologies, London, UK
- Medicover, Budapest, Hungary
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Marini TJ, Castaneda B, Iyer R, Baran TM, Nemer O, Dozier AM, Parker KJ, Zhao Y, Serratelli W, Matos G, Ali S, Ghobryal B, Visca A, O'Connell A. Breast Ultrasound Volume Sweep Imaging: A New Horizon in Expanding Imaging Access for Breast Cancer Detection. J Ultrasound Med 2023; 42:817-832. [PMID: 35802491 DOI: 10.1002/jum.16047] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The majority of people in the world lack basic access to breast diagnostic imaging resulting in delay to diagnosis of breast cancer. In this study, we tested a volume sweep imaging (VSI) ultrasound protocol for evaluation of palpable breast lumps that can be performed by operators after minimal training without prior ultrasound experience as a means to increase accessibility to breast ultrasound. METHODS Medical students without prior ultrasound experience were trained for less than 2 hours on the VSI breast ultrasound protocol. Patients presenting with palpable breast lumps for standard of care ultrasound examination were scanned by a trained medical student with the VSI protocol using a Butterfly iQ handheld ultrasound probe. Video clips of the VSI scan imaging were later interpreted by an attending breast imager. Results of VSI scan interpretation were compared to the same-day standard of care ultrasound examination. RESULTS Medical students scanned 170 palpable lumps with the VSI protocol. There was 97% sensitivity and 100% specificity for a breast mass on VSI corresponding to 97.6% agreement with standard of care (Cohen's κ = 0.95, P < .0001). There was a detection rate of 100% for all cancer presenting as a sonographic mass. High agreement for mass characteristics between VSI and standard of care was observed, including 87% agreement on Breast Imaging-Reporting and Data System assessments (Cohen's κ = 0.82, P < .0001). CONCLUSIONS Breast ultrasound VSI for palpable lumps offers a promising means to increase access to diagnostic imaging in underserved areas. This approach could decrease delay to diagnosis for breast cancer, potentially improving morbidity and mortality.
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Affiliation(s)
| | | | - Radha Iyer
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Omar Nemer
- University of Rochester Medical Center, Rochester, NY, USA
| | - Ann M Dozier
- University of Rochester Medical Center, Rochester, NY, USA
| | - Kevin J Parker
- University of Rochester Medical Center, Rochester, NY, USA
| | - Yu Zhao
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Gregory Matos
- University of Rochester Medical Center, Rochester, NY, USA
| | - Shania Ali
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Adam Visca
- University of Rochester Medical Center, Rochester, NY, USA
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Weiser R, Manno GC, Cass SH, Chen L, Kuo YF, He J, Robinson AS, Posleman Monetto F, Silva HC, Klimberg VS. Fluoroscopic Intraoperative Breast Neoplasm and Node Detection. J Am Coll Surg 2023; 236:575-585. [PMID: 36728380 DOI: 10.1097/xcs.0000000000000548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Preoperative localization is necessary for nonpalpable breast lesions. A novel procedure, fluoroscopic intraoperative neoplasm and node detection (FIND), obviates the preoperative painful and potentially expensive localization by using intraoperative visualization of the standard clip placed during diagnostic biopsy. We hypothesized FIND would improve negative margin rates. STUDY DESIGN This is an IRB-approved retrospective study (September 2016 to March 2021). Electronic chart review identified breast and axillary node procedures using wire localization (WL) or FIND. Primary outcome was margin status. Secondary outcomes included re-excision rate, specimen weight, surgery time, and axillary node localization rate. RESULTS We identified 459 patients, of whom 116 (25.3%) underwent FIND and 343 (74.7%) WL. Of these, 68.1% of FIND and 72.0% of WL procedures were for malignant lesions. Final margin positivity was 5.1% (4 of 79) for FIND and 16.6% (41 of 247) for WL (p = 0.008). This difference lost statistical significance on multivariable logistic regression (p = 0.652). Re-excision rates were 7.6% and 14.6% for FIND and WL (p = 0.125), with an equivalent mean specimen weight (p = 0.502), and mean surgery time of 177.5 ± 81.7 and 157.1 ± 66.8 minutes, respectively (mean ± SD; p = 0.022). FIND identified all (29 of 29) targeted axillary nodes, and WL identified only 80.1% (21 of 26) (p = 0.019). CONCLUSIONS FIND has lower positive margin rates and a trend towards lower re-excision rates compared with WL, proving its value in localizing nonpalpable breast lesions. It also offers accurate localization of axillary nodes, valuable in the era of targeted axillary dissection. It is a method of visual localization, using a skill and equipment surgeons already have, and saves patients and medical systems an additional schedule-disruptive, painful procedure, especially valuable when using novel localization devices is cost-prohibitive.
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Affiliation(s)
- Roi Weiser
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - Gabrielle C Manno
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - Samuel H Cass
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - Lu Chen
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - Yong-Fang Kuo
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - Jing He
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - Angelica S Robinson
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - Flavia Posleman Monetto
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - H Colleen Silva
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - V Suzanne Klimberg
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
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