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Yadav RN, Oravec DJ, Morrison CK, Bevins NB, Rao SD, Yeni YN. Digital wrist tomosynthesis (DWT)-based finite element analysis of ultra-distal radius differentiates patients with and without a history of osteoporotic fracture. Bone 2023; 177:116901. [PMID: 37714502 DOI: 10.1016/j.bone.2023.116901] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/03/2023] [Accepted: 09/12/2023] [Indexed: 09/17/2023]
Abstract
Despite effective therapies for those at risk of osteoporotic fracture, low adherence to screening guidelines and limited accuracy of bone mineral density (BMD) in predicting fracture risk preclude identification of those at risk. Because of high adherence to routine mammography, bone health screening at the time of mammography using a digital breast tomosynthesis (DBT) scanner has been suggested as a potential solution. BMD and bone microstructure can be measured from the wrist using a DBT scanner. However, the extent to which biomechanical variables can be derived from digital wrist tomosynthesis (DWT) has not been explored. Accordingly, we measured stiffness from a DWT based finite element (DWT-FE) model of the ultra-distal (UD) radius and ulna, and correlate these to reference microcomputed tomography image based FE (μCT-FE) from five cadaveric forearms. Further, this method is implemented to determine in vivo reproducibility of FE derived stiffness of UD radius and demonstrate the in vivo utility of DWT-FE in bone quality assessment by comparing two groups of postmenopausal women with and without a history of an osteoporotic fracture (Fx; n = 15, NFx; n = 51). Stiffness obtained from DWT and μCT had a strong correlation (R2 = 0.87, p < 0.001). In vivo repeatability error was <5 %. The NFx and Fx groups were not significantly different in DXA derived minimum T-scores (p > 0.3), but stiffness of the UD radius was lower for the Fx group (p < 0.007). Logistic regression models of fracture status with stiffness of the nondominant arm as the predictor were significant (p < 0.01). In conclusion this study demonstrates the feasibility of fracture risk assessment in mammography settings using DWT imaging and FE modeling in vivo. Using this approach, bone and breast screening can be performed in a single visit, with the potential to improve both the prevalence of bone health screening and the accuracy of fracture risk assessment.
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Affiliation(s)
- Ram N Yadav
- Bone and Joint Center, Henry Ford Health, Detroit, MI, USA
| | | | | | | | - Sudhaker D Rao
- Division of Endocrinology, Diabetes and Bone, Mineral Disorders, and Bone, Mineral Research Laboratory, Henry Ford Health, Detroit, MI, USA
| | - Yener N Yeni
- Bone and Joint Center, Henry Ford Health, Detroit, MI, USA; Henry Ford Health + Michigan State University Health Sciences, Detroit, MI, USA.
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Keruakous AR, Soror N, Jiménez S, Ashley R, Keruakous M, Sadek BT. Barriers driving health care disparities in utilization of age-appropriate screening. Front Public Health 2023; 11:1100466. [PMID: 36935668 PMCID: PMC10020215 DOI: 10.3389/fpubh.2023.1100466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/15/2023] [Indexed: 03/06/2023] Open
Affiliation(s)
- Amany R Keruakous
- Department of Internal Medicine, Georgia Cancer Center, Augusta University at Medical College of Georgia, Augusta, GA, United States
| | - Noha Soror
- Section of Hematology-Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Sarah Jiménez
- Department of Internal Medicine, Georgia Cancer Center, Augusta University at Medical College of Georgia, Augusta, GA, United States
| | - Rachel Ashley
- Department of Internal Medicine, Georgia Cancer Center, Augusta University at Medical College of Georgia, Augusta, GA, United States
| | - Mai Keruakous
- Mercer County Community College, West Windsor, NJ, United States
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Guan Y, Haardörfer R, McBride CM, Lipscomb J, Escoffery C. Factors Associated with Mammography Screening Choices by Women Aged 40-49 at Average Risk. J Womens Health (Larchmt) 2022; 31:1120-1126. [PMID: 35171027 DOI: 10.1089/jwh.2021.0232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The U.S. Preventive Services Task Force (USPSTF) does not recommend routine mammogram screening for women aged 40-49 years at average risk for breast cancer. We aimed to assess the extent to which women were following guideline recommendations and to examine whether guideline awareness and other individual-level factors were associated with adherence. Materials and Methods: We surveyed a nationally representative panel of 383 U.S. women aged 40-49 years at low risk for hereditary breast cancer in October 2019. Results: Only 29% of women reported not having initiated screening mammography. Most women (80%) were unaware of the USPSTF screening guideline related to age of initiation and frequency of mammography. Being aware of the recommendation to initiate screening at age 50 increased the odds of not initiating screening (odds ratio [OR] = 6.70, p < 0.001), whereas being older than 45 years (OR = 0.22, p < 0.001) and having a primary care doctor decreased the odds of not initiating screening (OR = 0.25, p < 0.001). Conclusions: Mammogram screening in excess of USPSTF recommendations is prevalent among U.S. women aged 40-49 years. Efforts are needed to increase women's awareness of the rationale for guidelines and the opportunities to discuss with providers whether delaying mammograms is appropriate.
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Affiliation(s)
- Yue Guan
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Regine Haardörfer
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Colleen M McBride
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Carlos RC, Obeng-Gyasi S, Cole SW, Zebrack BJ, Pisano ED, Troester MA, Timsina L, Wagner LI, Steingrimsson JA, Gareen I, Lee CI, Adams AS, Wilkins CH. Linking Structural Racism and Discrimination and Breast Cancer Outcomes: A Social Genomics Approach. J Clin Oncol 2022; 40:1407-1413. [PMID: 35108027 PMCID: PMC9851699 DOI: 10.1200/jco.21.02004] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/03/2021] [Accepted: 01/10/2022] [Indexed: 01/23/2023] Open
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Zoorob RJ, Mejia MC, Levine RS. Clinical Prevention. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fahim SM, Huo N, Li C, Qian J. Screening Mammography Utilization Among Female Medicare Beneficiaries and Breast Cancer Survivors in 2002-2016. J Womens Health (Larchmt) 2020; 30:739-749. [PMID: 33211608 DOI: 10.1089/jwh.2020.8571] [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] [Indexed: 11/13/2022] Open
Abstract
Background: The use of screening mammography varies by patient characteristics. This study examined the annual mammography utilization trends among female Medicare beneficiaries and breast cancer survivors, overall and by beneficiary characteristics. Materials and Methods: This retrospective, serial cross-sectional study used the 2002-2016 Medicare Current Beneficiary Survey (MCBS), including fee-for-service female Medicare beneficiaries who resided in community settings and who completed the survey (n = 53,788, weighted n = 206,259,890). Self-reported mammography utilization and breast cancer history were identified through the survey. Annual trends in the proportion of using mammography were examined using simple linear regression models, overall and by beneficiary's age, race, geographic region, and count of comorbidities. Multivariable models with generalized estimating equations were used to examine factors associated with mammography utilization. Results: Overall, the mammography utilization trends significantly decreased during the 2002-2016 period for both cohorts (p = 0.004 for female beneficiaries from 50.85% in 2002 to 40.55% in 2016 and p = 0.041 for breast cancer survivors from 68.36% in 2002 to 55.21% in 2016). Among female beneficiaries, trends also significantly decreased in different age groups, Whites, residential regions (Midwest, South, West, Metro, and Nonmetro), and count of comorbid conditions (all p < 0.05). Trends also declined among the breast cancer survivors who were ≥70 years old, ≥40 years old, and in South region (all p < 0.05). Beneficiary's demographic and socioeconomic factors, comorbidity, smoking, and health status were associated with the likelihood of screening mammography utilization among female beneficiaries; however, such associations were limited among breast cancer survivors. Conclusions: In 2002-2016, the overall trends in mammography use among female Medicare beneficiaries and breast cancer survivors declined significantly. Variations in mammography use among different subgroups were observed.
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Affiliation(s)
- Shahariar Mohammed Fahim
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn, Alabama, USA
| | - Nan Huo
- Mayo Clinic, Rochester, Minnesota, USA
| | - Chao Li
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn, Alabama, USA
| | - Jingjing Qian
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn, Alabama, USA
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Zoorob RJ, Mejia MC, Levine RS. Clinical Prevention. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_7-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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