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Breast Cancer Screening

Breast cancer screening programs have the potential to catch breast cancer at a less advanced stage, with a better chance of survival. However, experience with screening programmes in a number of countries, show screening is not without risks. For example in the UK screening women aged 50 for the next 20 years, for every 10,000 women screened approximately 43 deaths will be prevented, however 129 will be overdiagnosed (Independent UK Panel on Breast Cancer Screening, 2011). That translates to 1 breast cancer death being prevented for about every 3 overdiagnosed cases identified and treated. Overdiagnosis is where screening identifies a tumour, which is then treated (possibly with surgery, radiotherapy and medication), but which would otherwise have remained undetected for the rest of the woman’s life, without causing illness, if it had not been detected by screening.

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Breast Cancer

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  • PubMed search for publications about Breast Cancer Screening - Limit search to: [Reviews]

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    MeSH term: Breast Neoplasms
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Latest Research Publications

This list of publications is regularly updated (Source: PubMed).

Cai D, Lin T, Jiang K, Sun Z
Diagnostic value of MRI combined with ultrasound for lymph node metastasis in breast cancer: Protocol for a meta-analysis.
Medicine (Baltimore). 2019; 98(30):e16528 [PubMed] Related Publications
BACKGROUND: Early diagnosis and treatment of breast cancer are important to prevent fatal tumor progression. Axillary lymph node (ALN) status is the most significant prognostic factor for diagnosing overall survival in breast cancer patients. Axillary lymph node dissection (ALND) is regarded as the reference standard for determining ALN status. However, ALND is an invasive therapy with high morbidity and complications such as lymphedema, seroma and nerve injury. Comparatively, magnetic resonance imaging (MRI) and ultrasound are noninvasive and non-radiative techniques that are common imaging methods to diagnose breast cancer lymph node metastasis. Many studies have investigated the diagnostic value of MRI combined with ultrasound for breast cancer ALN metastasis, but the evidence has been insufficient to apply these modalities when diagnosing new patients.
METHODS: We will search electronic databases including PubMed, EMbase, The Cochrane Library, Chinese Biomedical Database, WangFang Database, and China National Knowledge Infrastructure. The language of studies is limited in English or Chinese. The final search includes articles published in June, 2018. Stata 14.0 software will be used for all statistical analyses, and Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) will be utilized to evaluate the quality of the included studies. Meta-regression and subgroup analyses will be performed to explore heterogeneity, which will be derived from the different countries of origin of the included studies. Deeks' funnel plot asymmetry test will be demonstrated the inexistence of publication bias.
RESULT: This study will provide a rational synthesis of current evidences for magnetic resonance imaging combined with ultrasound for breast cancer.
CONCLUSION: The conclusion of this study will provide evidence for the diagnostic value of MRI combined with ultrasound for lymph node metastasis in breast cancer.

Evans KK, Culpan AM, Wolfe JM
Detecting the "gist" of breast cancer in mammograms three years before localized signs of cancer are visible.
Br J Radiol. 2019; 92(1099):20190136 [PubMed] Article available free on PMC after 01/07/2020 Related Publications
OBJECTIVES: After a 500 ms presentation, experts can distinguish abnormal mammograms at above chance levels even when only the breast contralateral to the lesion is shown. Here, we show that this signal of abnormality is detectable 3 years before localized signs of cancer become visible.
METHODS: In 4 prospective studies, 59 expert observers from 3 groups viewed 116-200 bilateral mammograms for 500 ms each. Half of the images were prior exams acquired 3 years prior to onset of visible, actionable cancer and half were normal. Exp. 1D included cases having visible abnormalities. Observers rated likelihood of abnormality on a 0-100 scale and categorized breast density. Performance was measured using receiver operating characteristic analysis.
RESULTS: In all three groups, observers could detect abnormal images at above chance levels 3 years prior to visible signs of breast cancer (
CONCLUSIONS: Imaging specialists can detect signals of abnormality in mammograms acquired years before lesions become visible. Detection may depend on expertise acquired by reading large numbers of cases.
ADVANCES IN KNOWLEDGE: Global gist signal can serve as imaging risk factor with the potential to identify patients with elevated risk for developing cancer, resulting in improved early cancer diagnosis rates and improved prognosis for females with breast cancer.

Aribal E, Mora P, Chaturvedi AK, et al.
Improvement of early detection of breast cancer through collaborative multi-country efforts: Observational clinical study.
Eur J Radiol. 2019; 115:31-38 [PubMed] Related Publications
AIM: The aim of this paper is to present baseline imaging data and the improvement that was achieved by the participating centers after applying practice-specific interventions that were identified during the course of a multicentric multinational research coordinated project.
INTRODUCTION: The incidence and mortality rates from breast cancer are rising worldwide and particularly rapidly across the countries with limited resources. Due to lack of awareness and screening options it is usually detected at a later stage. Breast cancer screening programs and even clinical services on breast cancer have been neglected in such countries particularly due to lack of available equipment, funds, organizational structure and quality criteria.
MATERIALS AND METHODS: A harmonized form was designed in order to facilitate uniformity of data collection. Baseline data such as type of equipment, number of exams, type and number of biopsy procedures, stage of cancer at detection were collected from 10 centers (9 countries: Bosnia-Herzegovina, Costa Rica, Egypt, India, North Macedonia, Pakistan, Slovenia, Turkey, Uganda) were collected. Local practices were evaluated for good practice and specific interventions such as training of professionals and quality assurance programs were identified. The centers were asked to recapture the data after a 2-year period to identify the impact of the interventions.
RESULTS: The data showed increase in the number of training of relevant professionals, positive changes in the mammography practice and image guided interventions. All the centers achieved higher levels of success in the implementation of the quality assurance procedures.
CONCLUSION: The study has encountered different levels of breast imaging practice in terms of expertise, financial and human resources, infrastructure and awareness. The most common challenges were the lack of appropriate quality assurance programs and lack of trained skilled personnel and lack of high-quality equipment. The project was able to create higher levels of breast cancer awareness, collaboration amongst participating centers and professionals. It also improved quality, capability and expertise in breast imaging particularly in centers involved diagnostic imaging.

Albright FS, Kohlmann W, Neumayer L, et al.
Population-based relative risks for specific family history constellations of breast cancer.
Cancer Causes Control. 2019; 30(6):581-590 [PubMed] Related Publications
PURPOSE: Using a large resource linking genealogy with decades of cancer data, a non-traditional approach was used to estimate individualized risk for breast cancer (BC) based on specific family history extending to first cousins, providing a clearer picture of the contribution of various aspects of both close and distant combinations of affected relatives.
METHODS: RRs for BC were estimated in 640,366 females for a representative set of breast cancer family history constellations that included number of first- (FDR), second-(SDR), and third-degree relatives (TDR), maternal and paternal relatives, and age at earliest diagnosis in a relative.
RESULTS: RRs for first-degree relatives of BC cases ranged from 1.61 (= 1 FDR affected, CI 1.56, 1.67) to 5.00 (≥ 4 FDRs affected, CI 3.35, 7.18). RRs for second-degree relatives of probands with 0 affected FDRs ranged from 1.04 (= 1 SDR affected, CI 1.00, 1.08) to 1.71 (≥ 4 SDRs affected, CI 1.26, 2.27) and for second-degree relatives of probands with exactly 1 FDR from 1.54 (0 SDRs affected, CI 1.47, 1.61) to 4.78 (≥ 5 SDRs; CI 2.47, 8.35). RRs for third-degree relatives with no closer relatives affected were significantly elevated over population risk for probands with ≥ 5 affected TDRs RR = 1.32, CI 1.11, 1.57).
CONCLUSIONS: The majority of females in the Utah resource had a positive family history of BC in FDRs to TDRs. Presence of any number of affected FDRs or SDRs significantly increased risk for BC over population risk; and more than four TDRs, even with no affected FDRs or SDRs, significantly increased risk over population risk. Risk prediction derived from the specific and extended family history constellation of affected relatives allows identification of females at increased risk even when they do not have a conventionally defined high-risk family; these risks could be a powerful, efficient tool to individualize cancer screening and prevention.

Zhao Y, Luo H, Zhang X, et al.
Clinicopathological characteristics and health care for Tibetan women with breast cancer: a cross-sectional survey.
BMC Cancer. 2019; 19(1):380 [PubMed] Article available free on PMC after 01/07/2020 Related Publications
BACKGROUND: The healthcare system (HCS) improved in Tibet Autonomous Region (TAR), China. The present study aimed to investigate whether these improvements might alter the clinicopathological characteristics of a Tibetan female with breast cancer (BC) in TAR.
METHODS: This was a single-center cross-sectional study conducted at TAR People's Hospital. All Tibetan adult women were treated for BC in this hospital between January 1, 1973 and December 31, 2015. The inclusion criteria were as follows: (1) Tibetan adult woman living in Tibet; (2) Histopathology or cytopathology or both confirming primary BC; (3) All the treatments were finished in this hospital. χ
RESULTS: A total of 273 patients with BC were included in the final analysis. Of these, 14 patients were in the free HCS, 183 patients had medical insurance combined with a new rural cooperative HCS, and 76 were in a rural and urban integration HCS. Currently, a rural and urban integration HCS is an improved system. Consequently, an increase in the proportion patients in the T1-3 stage was observed (0.198; 0.046 to 0.852) between the rural and urban integration HCS and free HCS. The proportion of patients in early (I + II) stage cancer (0.110; 0.019-0.633) also increased between these two HCSs.
CONCLUSION: This was the first report about Tibetan women with BC in Tibet. Some clinicopathological characteristics at the presentation of Tibetan women with BC may improve during different HCSs. The cancer awareness, early detection, and the overall management in patients with advanced stage BC might improve the prognosis of BC in the rural and urban integration HCS.

Houssami N, Kirkpatrick-Jones G, Noguchi N, Lee CI
Artificial Intelligence (AI) for the early detection of breast cancer: a scoping review to assess AI's potential in breast screening practice.
Expert Rev Med Devices. 2019; 16(5):351-362 [PubMed] Related Publications
INTRODUCTION: Various factors are driving interest in the application of artificial intelligence (AI) for breast cancer (BC) detection, but it is unclear whether the evidence warrants large-scale use in population-based screening.
AREAS COVERED: We performed a scoping review, a structured evidence synthesis describing a broad research field, to summarize knowledge on AI evaluated for BC detection and to assess AI's readiness for adoption in BC screening. Studies were predominantly small retrospective studies based on highly selected image datasets that contained a high proportion of cancers (median BC proportion in datasets 26.5%), and used heterogeneous techniques to develop AI models; the range of estimated AUC (area under ROC curve) for AI models was 69.2-97.8% (median AUC 88.2%). We identified various methodologic limitations including use of non-representative imaging data for model training, limited validation in external datasets, potential bias in training data, and few comparative data for AI versus radiologists' interpretation of mammography screening.
EXPERT OPINION: Although contemporary AI models have reported generally good accuracy for BC detection, methodological concerns, and evidence gaps exist that limit translation into clinical BC screening settings. These should be addressed in parallel to advancing AI techniques to render AI transferable to large-scale population-based screening.

Solikhah, Promthet S, Hurst C
Awareness Level about Breast Cancer Risk Factors, Barriers, Attitude and Breast Cancer Screening among Indonesian Women
Asian Pac J Cancer Prev. 2019; 20(3):877-884 [PubMed] Related Publications
Background: Globally, breast cancer is the second most common cancer in women and is a leading cause of mortality in Indonesia. Raising awareness of breast cancer is particularly important to help at risk women seek medical treatment for this disease. This study aimed to comprehensively investigate the Indonesian women’s level of knowledge about breast cancer risk factors, barriers, attitude and breast cancer screening. Methods: This population-based cross-sectional study administered the breast cancer awareness Indonesian scale (BCAS-I) to 856 Indonesian women. Samples were selected in rural and urban combinations from three provinces by stratified random sampling. The ordinal logistic model was used to investigate the clustering effect of the participant’s characteristics in this study. Results: Of the women, 62% lived in rural areas and 38% lived in urban areas. Living in an urban area was significantly associated with a lower knowledge of the risk factors. However, living in an urban area was significantly associated with better attitudes and healthier behaviours related to breast cancer awareness. Women with higher education levels had 70% worse attitudes toward breast cancer awareness. Women living South of Sumatera, women living in Yogyakarta, and unmarried women were 5.03, 3.84, and 1.56 times as likely to have higher perceived barriers, respectively. Conclusion: Urban women had a poorer level of knowledge of breast cancer risk factors compared to women living in more rural areas. The result of this study may reflect inadequate breast cancer awareness campaigns or a lack of breast cancer awareness campaigns. These findings suggest that additional education programs aiming to increase awareness and educate the public are needed.

Saei Ghare Naz M, Darooneh T, Salmani F, et al.
Relationship of Health Locus of Control with Breast Cancer Screening Belief of Iranian Women
Asian Pac J Cancer Prev. 2019; 20(3):699-703 [PubMed] Related Publications
Promoting breast cancer screening (BCS) behavior of women can lead to a reduction in mortality. The health locus of control affects cancer screening behavior of women; however, there is not sufficient evidence regaring this issue in Iran. The overall goal of our study is to determine the relationship of the health locus of control with the breast cancer screening belief of Iranian Women. This is a cross-sectional study carried out on 325 women in Tehran. The Multidimensional Health Locus of Control (MHLC), Breast Cancer Screening Belief Questionnaire (BCSBQ), and Demographic questionnaire were used for collecting data. Statistical analyze was performed by the SPSS version 17 software. The Pearson correlation and regression model were used for data analyze. In this study, 325 women, age 18 to 75 years, participated in this study. The mean±SD of BCSBQ and MHLC score was 40.72±10.41 and 67.78±17.67 respectively. The regression analysis showed that for the one-unit increase in the Internal Health Locus of Control (IHLC), Powerful others Health Locus of Control (PHLC), and Chance Health Locus of Control (CHLC) score (dimensions of Health Locus of Control), the total BCSBQ scores increased 0.54, 0.31, and 0.57 respectively. For each unit increase in age and education, the knowledge and perceptions of the BC score increased 0.05 and 0.23 units respectively. For the one-unit increase in the IHLC, PHLC, age, and education dimensions, the attitudes towards the general health checkup score increased 0.17, 0.1, 0.05, and 0.188 respectively. The current study provided new insights about the BCSB of Iranian women with MHLC. In the study, all the dimensions of the health locus of control were useful in predicting the breast cancer screening belief of the participants.

Eniu DT, Romanciuc F, Moraru C, et al.
The decrease of some serum free amino acids can predict breast cancer diagnosis and progression.
Scand J Clin Lab Invest. 2019 Feb - Apr; 79(1-2):17-24 [PubMed] Related Publications
This study was targeted on a metabolomic approach to compare the blood serum free amino acid profiles and concentration of confirmed breast cancer (stages I-III) patients to healthy controls in order to establish reliable biomarkers of early detection and prediction of breast cancer. The ultra-high-performance liquid chromatography coupled with mass spectrometry using positive ionization electrospray was applied for the picoline-derivatized serum free amino acids using the EZ:faastTM kit. Multivariate statistical analysis principal component analysis, partial least squares discrimination analysis and univariate analysis were applied in order to discriminate between patient groups and putative amino acid biomarkers for breast cancer. A significant decrease of amino acid concentrations between the breast cancer group and the control group was positively correlated with breast cancer progression. Arginine, Alanine, Isoleucine, Tyrosine and Tryptophan were identified as being good potential discriminants (AUROC ≥0.85) and suitable candidates to diagnose and predict the breast cancer progression.

Korkut Y
Assessment of knowledge, attitudes, and behaviors regarding breast and cervical cancer among women in western Turkey.
J Int Med Res. 2019; 47(4):1660-1666 [PubMed] Article available free on PMC after 01/07/2020 Related Publications
OBJECTIVE: We aimed to assess knowledge, attitudes, and practices regarding breast and cervical cancer and screening methods among women living western Turkey.
METHODS: A questionnaire survey was administered to women aged ≥21 years. Data were collected using a 12-item questionnaire measuring women's knowledge, attitudes, and practice levels, including among participants who were health workers.
RESULTS: A total 668 women were included in the study. The average age was 37.48 ± 11.85 years. Most women had a primary-level education (43.4%) and most (50.3%) were homemakers; 27.1% of participants were health care workers. The differences in age, education, and occupation among participants were evaluated according to whether participants perform breast self-examination and have undergone Pap testing. The distribution of women according to age group showed that with increased age, the frequency of performing these two behaviors decreased, with women over 55 years old accounting for a significantly higher proportion than other age groups.
CONCLUSIONS: In our study, the level of knowledge and attitudes regarding breast and cervical cancers among women was similar to that in previous studies and was higher than expected, especially among women who were health workers. However, all women had inadequate frequency of performing screening tests.

McLean K, Darcey E, Cadby G, et al.
The distribution and determinants of mammographic density measures in Western Australian aboriginal women.
Breast Cancer Res. 2019; 21(1):33 [PubMed] Article available free on PMC after 01/07/2020 Related Publications
BACKGROUND: Mammographic density (MD) is an established risk factor for breast cancer. There are significant ethnic differences in MD measures which are consistent with those for corresponding breast cancer risk. This is the first study investigating the distribution and determinants of MD measures within Aboriginal women of Western Australia (WA).
METHODS: Epidemiological data and mammographic images were obtained from 628 Aboriginal women and 624 age-, year of screen-, and screening location-matched non-Aboriginal women randomly selected from the BreastScreen Western Australia database. Women were cancer free at the time of their mammogram between 1989 and 2014. MD was measured using the Cumulus software. Kolmogorov-Smirnov tests were used to compare distributions of absolute dense area (DA), precent dense area (PDA), non-dense area (NDA) and total breast area between Aboriginal and non-Aboriginal women. General linear regression was used to estimate the determinants of MD, adjusting for age, NDA, hormone therapy use, family history, measures of socio-economic status and remoteness of residence for Aboriginal and non-Aboriginal women separately.
RESULTS: Aboriginal women were found to have lower DA and PDA and higher NDA than non-Aboriginal women. Age (p <  0.001) was negatively associated and several socio-economic indices (p <  0.001) were positively associated with DA and PDA in Aboriginal and non-Aboriginal women. Remoteness of residence was associated with both mammographic measures but for non-Aboriginal women only.
CONCLUSIONS: Aboriginal women have, on average, less MD than non-Aboriginal women but the factors associated with MD are similar for both sample populations. Since reduced MD is associated with improved sensitivity of mammography, this study suggests that mammographic screening is a particularly good test for Australian Indigenous women, a population that suffers from high breast cancer mortality.

Yuan C, Jin F, Guo X, et al.
Correlation Analysis of Breast Cancer DWI Combined with DCE-MRI Imaging Features with Molecular Subtypes and Prognostic Factors.
J Med Syst. 2019; 43(4):83 [PubMed] Related Publications
This study aimed to deeply analyze the application of DWI and DCE-MRI imaging in breast cancer, the correlation between the imaging characteristics of DWI and DCE-MRI and the molecular subtypes and prognostic factors of breast cancer was studied. Firstly, DWI and DCE-MRI scans of all patients before interventional therapy were performed, and relevant information of the subjects was introduced in turn. Secondly, molecular subtypes were determined according to immunohistochemical results and gene amplification. Siemens 3.0 T post-processing workstation was used for image post-processing. The time signal curve (TIC), early enhancement rate (EER) and ADC values were measured, morphological characteristics were recorded, and the correlation between each image feature and molecular subtypes, prognostic factors (tumor size, pathological grade, lymph node metastasis, ER, PR, HER2, Ki67) was analyzed. The results showed that parameters such as ADC value, EER, lobulation sign, burr sign, enhancement way and TIC type were correlated with prognostic factors and molecular subtypes. And Bayesian model discriminant analysis showed that the above imaging parameters couldn't well predict the expression of immunohistochemical factors and molecular subtypes. However, the above characteristics had a good effect on the prediction of pathological grade, with a false diagnosis rate of 9.69%.

Steponaviciene L, Briediene R, Vanseviciute R, Smailyte G
Trends in Breast Cancer Incidence and Stage Distribution Before and During the Introduction of the Mammography Screening Program in Lithuania.
Cancer Control. 2019 Jan-Dec; 26(1):1073274818821096 [PubMed] Article available free on PMC after 01/07/2020 Related Publications
BACKGROUND:: The aim of this study was to analyze the incidence trends of localized and advanced breast cancer (BC) before and during the implementation of the mammography screening program (MSP) in Lithuania.
METHODS:: The study period was divided into 2 intervals: the prescreening period (1998-2005) and implementation period (2006-2012). Analysis was performed for 3 age-groups: 0 to 49 years, 50 to 69 (target population), and older than 70.
RESULTS:: In all age-groups, the incidence of localized BC has shown a steady increase, while the incidence of advanced stage BC has decreased. In the target population, during the study period, the stage I BC incidence increased statistically significantly by 10.3% per year (from 3.3 per 100 000 in 1998 to 12.2 per 100 000 in 2012). The increase in localized BC was faster in the period before the implementation of the MSP than during the implementation in 2006 to 2012 (10.3% and 5.7%). A slightly statistically significant decrease was observed for advanced BC during the study period (-1.1% per year), while during the implementation of the MSP, significant changes were not seen.
CONCLUSIONS:: The results of our study indicate that the implementation of the MSP in Lithuania did not significantly influence trends of localized and advanced BC. Changes observed during the study period, including the prescreening and screening introduction periods, may reflect the general trends in the awareness of BC and improvements in diagnostics.

Grosse Frie K, Kamaté B, Traoré CB, et al.
Health system organisation and patient pathways: breast care patients' trajectories and medical doctors' practice in Mali.
BMC Public Health. 2019; 19(1):204 [PubMed] Article available free on PMC after 01/07/2020 Related Publications
BACKGROUND: Information on pathways of women seeking diagnostic services due to breast- related symptoms can help highlight challenges related to the healthcare system in improving early diagnosis of breast cancer.
METHODS: We retrospectively analysed the entire patient pathway, from first symptom recognition via initial healthcare visit up to final diagnosis at the pathology service in Mali. Data from questionnaire-based structured patient interviews (n = 124) were used to calculate time to first healthcare visit (median 91 days) and consecutive time to diagnosis (median 21 days) and to extract information on type of initially visited healthcare facility (community healthcare centre, referral hospital, tertiary hospital, private clinic). Median time to first healthcare visit and time to diagnosis and type of initially-visited healthcare facility were cross-tabulated with patient characteristics. An additional survey among (n = 30) medical doctors in the community healthcare centres and referral hospitals in Bamako was conducted to understand current knowledge and referral practice with respect to female patients with breast-related symptoms.
RESULTS: Patients who initially visited private clinics had the shortest time to first healthcare visit (median 44 days), but the longest time to diagnosis (median 170 days). Patients visiting community healthcare centres and referral hospitals took longest for a first healthcare visit (median 153 and 206 days, respectively), but the time to diagnosis was shorter (median 95 and 7 days, respectively). The majority of patients (45%) initially visited a tertiary hospital; these patients had shortest total time to diagnosis (median 56 days health seeking and 8 days diagnostic time), but did not follow the recommended pathway for patients in the pyramidal healthcare system in Mali. The doctors' survey showed lower breast cancer knowledge in the community healthcare centres than in the referral hospitals. However, most doctors felt able to recognise suspected cases of cancer and referred patients directly to a hospital.
CONCLUSIONS: The role of different healthcare facilities in ensuring triage of patients with breast-related symptoms needs to be defined before any early detection initiatives are implemented. Especially at the entry level of the healthcare system, the access and quality of health services need to be strengthened.

Marmarà D, Marmarà V, Hubbard G
Predicting reattendance to the second round of the Maltese national breast screening programme: an analytical descriptive study.
BMC Public Health. 2019; 19(1):189 [PubMed] Article available free on PMC after 01/07/2020 Related Publications
BACKGROUND: A range of barriers influence women's uptake to a first breast screening invitation. Few studies however, have examined factors associated with second screening uptake. This study follows Maltese women to explore predictors and behaviours to re-attendance, and to determine if uptake of first invitation to the Maltese Breast Screening Programme (MBSP) is a significant predictor of second screening uptake.
METHODS: A prospective study was conducted to determine factors associated with re-attendance for 100 women invited to the second MBSP round. Records of women's second attendance to the MBSP were extracted in January 2016 from the MBSP database. Data were analyzed using chi-square tests, Independent Samples t-test, Mann Whitney test, Shapiro Wilk test and logistic regression.
RESULTS: There were no significant associations for sociodemographic or health status variables with second screening uptake (p > 0.05), except breast condition (Fisher's exact test, p = 0.046). Non-attendees at second screening were most unsure of screening frequency recommendations (χ2 = 9.580, p = 0.048). Attendees were more likely to perceive their susceptibility to breast cancer (p = 0.041), believed breast cancer to be life changing (p = 0.011) and considered cues to action to aid attendance (p = 0.028). Non-attendees were in stronger agreement on mammography pain (p = 0.008) and were less likely to consider cues to action (15.4% non-attendees vs 1.4% attendees) (p = 0.017 respectively). 'Perceived barriers', 'breast cancer identity', 'causes' and 'consequences' were found to be significant predictors of second screening uptake, with 'perceived barriers' being the strongest. The inclusion of illness perception items improved the regression model's accuracy in predicting non-attendance to the second screening round (84.6% vs 30.8%). First screening uptake was found to be a significant predictor of subsequent uptake (OR = 0.102; 95% CI = 0.037, 0.283; p = 0.000).
CONCLUSIONS: Interventions to increase uptake should target first invitees since attending for the first time is a strong predictor of uptake to the second cycle. Further research is required given the small sample. Particular attention should be paid to women who did not respond to their first invite or are unsure or reluctant participants initially.

Begum SA, Mahmud T, Rahman T, et al.
Knowledge, Attitude and Practice of Bangladeshi Women towards Breast Cancer: A Cross Sectional Study.
Mymensingh Med J. 2019; 28(1):96-104 [PubMed] Related Publications
In Bangladesh incidence rate of breast cancer was about 22.5 per 100000 females. Breast cancer has been reported as the highest prevalence rate (19.3 per 100,000) among Bangladeshi women between 15 and 44 years of age. For this prevailing situation a cross-sectional study was designed to assess the knowledge, attitude and practices of community-dwelling women in Bangladesh towards breast cancer at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2013 to June 2014. All female participants attending at outpatient department of BSMMU having age more than 20 years and education at least JSC, purposively selected until the sample size achieved 500. Only applying simple cost free method like self breast examination (SBE) and clinical breast examination (CBE) one can asses her breast. Thereby awareness develops regarding her breast so any mass newly appear can be assessed by the lady herself. Early diagnosis of the breast cancer will reduce the burden of treatment cost, mortality & morbidity. Research and development strategy of the project is to enhance the awareness of the community people about breast cancer prevention. Mean age of the study population was 36.16 years. Regarding education nearly 30% (n=150) of them studied up to Junior School, 16% (n=80) respondents completed masters and above remaining in between. Regarding occupation, almost 60% (n=300) were house wife, 32% (n=160) were service holder and only 8% (n=40) of them were students. Knowledge about common female cancer 60% (n=300) were aware about the cervical cancer, 24% (n=120) mentioned breast cancer, 4% (n=20) mentioned ovarian cancer, and 12% (n=60) don't know anything regarding common women cancer. Knowledge about early symptoms of breast cancer, majority of the respondents 66% (n=330) were aware that mass in the breast is the main symptom, 2% (n=10) mentioned pain in breast, 32% (n=160) mentioned that they don't know anything regarding the early symptoms. About the cause of breast cancer 60% (n=300) mentioned that, they don't know anything regarding the cause of breast cancer, 36% (n=180) were aware that non lactation is a cause of breast cancer. About 4% (n=20) of the study population mentioned others, like due to some ones bad did cancer occur as punishment. Knowledge about risk factor of breast cancer, 65% (n=325) have no idea about the risk of breast cancer, 32% (n=160) mentioned few risk factors which have relation with breast cancer and 3% (n=15) did not mention anything. Regarding diagnosis of cancer breast 72% (n=360) mentioned they don't know anything, 16% (n=80) by doing ultra sonogram of breast, 6% (n=30) mentioned about Mammography and 6% (n=30) MRI & others. Regarding screening for prevention of breast cancer 60% (n=300) mentioned that they don't know anything regarding screening. Thirty percent (n=150) were aware that there is screening method but they are not aware specifically regarding this method and they also not aware that breast cancer is a preventable disease. 10% (n=50) were fully aware about screening method like CBE & SBE. About the cause of not seeking medical advice for prevention of Breast cancer, majority of the respondents 40% (n=200) mentioned expenditure problems, 32% (n=160) they don't have any knowledge about this type of medical advice, 8% (n=40) mentioned communication problems and 20% (n=100) others. Regarding Practice of CBE & SBE 68% (n=340) never practice CBE & SBE, 30% (n=150) occasionally practiced CBE & SBE. Only 2% (n=10) mentioned that they were regularly practicing CBE & SBE.

Iotti V, Giorgi Rossi P, Nitrosi A, et al.
Comparing two visualization protocols for tomosynthesis in screening: specificity and sensitivity of slabs versus planes plus slabs.
Eur Radiol. 2019; 29(7):3802-3811 [PubMed] Related Publications
OBJECTIVES: Tomosynthesis (DBT) has proven to be more sensitive than digital mammography, but it requires longer reading time. We retrospectively compared accuracy and reading times of a simplified protocol with 1-cm-thick slabs versus a standard protocol of slabs + 1-mm-spaced planes, both integrated with synthetic 2D.
METHODS: We randomly selected 894 DBTs (including 12 cancers) from the experimental arm of the RETomo trial. DBTs were read by two radiologists to estimate specificity. A second set of 24 cancers (8 also present in the first set) mixed within 276 negative DBTs was read by two radiologists. In total, 28 cancers with 64 readings were used to estimate sensitivity. Radiologists read with both protocols separated by a 3-month washout. Only women that were positive at the screening reading were assessed. Variance was estimated taking into account repeated measures.
RESULTS: Sensitivity was 82.8% (53/64, 95% confidence interval (95% CI) 67.2-92.2) and 90.6% (95% CI 80.2-95.8) with simplified and standard protocols, respectively. In the random screening setting, specificity was 97.9% (1727/1764, 95% CI 97.1-98.5) and 96.3% (95% CI 95.3-97.1), respectively. Inter-reader agreement was 0.68 and 0.54 with simplified and standard protocols, respectively. Median reading times with simplified protocol were 20% to 30% shorter than with standard protocol.
CONCLUSIONS: A simplified protocol reduced reading time and false positives but may have a negative impact on sensitivity.
KEY POINTS: • The adoption of digital breast tomosynthesis (DBT) in screening, more sensitive than mammography, could be limited by its potential effect on the radiologists' workload, i.e., increased reading time and fatigue. • A DBT simplified protocol with slab only, compared to a standard protocol (slab plus planes) both integrated with synthetic 2D, reduced time and false positives but had a negative impact on sensitivity.

Deniz S, Coskun F, Oztas D, Kurt AO
Knowledge, attitudes and behaviors of breast and cervical cancers and screenings of women working in primary health care services.
J BUON. 2018; 23(7):44-52 [PubMed] Related Publications
PURPOSE: Determination of information attitudes, behaviors and related factors on breast and cervical cancer screenings of primary health care workers.
METHODS: The population of the study consisted of 1,130 female health workers working in health facilities (Community Health Centers, Family Health Centers) that provided primary health care services in the province of Mersin. The fieldwork was carried out in October 2017-February 2018 period. There were 62 questions in the survey form. There were questions about socio-demographic and living conditions in the first 19 questions and breast and cervical cancer in the next 43 questions.
RESULTS: In the study, 87.8% of the target group could be reached, 84.8% of the physicians and 88.2% of the non-physician health professionals. The mean age was 38.93 ± 7.89. Of the group 14% were physicians and the rest were health workers such as midwives, nurses, health officers and medical secretaries, while 47.7% of the group had at least 1 relative who was diagnosed with cancer. More than 90% of the group said that breast and cervical cancer could be diagnosed early and treated if diagnosed early. Of the group 95.3% knew how to do breast self-examination (BSE) and 90.1% of those who knew were doing BSE. The most common response to the question of what should be done for early recognition of breast cancer was BSE and Pap smear test in cervical cancer. The physician group was more advantageous than the other staff in knowing and practicing BSE and in what period it should be done. The most common symptom of breast cancer was the presence of a mass or swelling in the breast. Of the subjects in the target age group, 21.9% of those who think they are at risk had never had a Pap smear test and 14.3% have not had a gynecological examination.
CONCLUSIONS: Although these findings indicate that health care professionals are more knowledgable in terms of breast and cervical cancer screening than non-health care workers, it is necessary to motivate healthcare professionals to increase their level of knowledge and practice on cancer screening. The most important means of achieving this is to ensure that in-service trainings, cancer screenings and the risks to be taken in case of non-screening are mentioned seriously.

Tina Shih YC, Dong W, Xu Y, Shen Y
Assessing the Cost-Effectiveness of Updated Breast Cancer Screening Guidelines for Average-Risk Women.
Value Health. 2019; 22(2):185-193 [PubMed] Related Publications
BACKGROUND: Several specialty societies have recently updated their breast cancer screening guidelines in late 2015/early 2016.
OBJECTIVES: To evaluate the cost-effectiveness of US-based mammography screening guidelines.
METHODS: We developed a microsimulation model to generate the natural history of invasive breast cancer and capture how screening and treatment modified the natural course of the disease. We used the model to assess the cost-effectiveness of screening strategies, including annual screening starting at the age of 40 years, biennial screening starting at the age of 50 years, and a hybrid strategy that begins screening at the age of 45 years and transitions to biennial screening at the age of 55 years, combined with three cessation ages: 75 years, 80 years, and no upper age limit. Findings were summarized as incremental cost-effectiveness ratio (cost per quality-adjusted life-year [QALY]) and cost-effectiveness acceptability frontier.
RESULTS: The screening strategy that starts annual mammography at the age of 45 years and switches to biennial screening between the ages of 55 and 75 years was the most cost-effective, yielding an incremental cost-effectiveness ratio of $40,135/QALY. Probabilistic analysis showed that the hybrid strategy had the highest probability of being optimal when the societal willingness to pay was between $44,000/QALY and $103,500/QALY. Within the range of commonly accepted societal willingness to pay, no optimal strategy involved screening with a cessation age of 80 years or older.
CONCLUSIONS: The screening strategy built on a hybrid design is the most cost-effective for average-risk women. By considering the balance between benefits and harms in forming its recommendations, this hybrid screening strategy has the potential to optimize the health care system's investment in the early detection and treatment of breast cancer.

You H, Gu H, Zhang N, et al.
Why hasn't this woman been screened for breast and cervical cancer? - Evidence from a Chinese population-based study.
Public Health. 2019; 168:83-91 [PubMed] Related Publications
OBJECTIVE: Less than half of eligible Chinese rural women have been screened for breast and cervical cancer. The objective of this study was to describe individual-level reasons for attending or not attending 'two cancers' screening using Andersen's Behavioral Model of Health Services Use.
STUDY DESIGN: Cross-sectional study.
METHODS: The study sample was from the Health Services Survey in 2013 in Jiangsu, China. A total of 6520 rural women aged 36-65 years answered the questions on 'two cancers' screening participation and were included in the final analysis, which consisted of univariate and multivariate logistic regression.
RESULTS: In the results of multivariate logistic regression, factors significantly associated with having 'two cancers' screening included educational level (odds ratio [OR] = 0.78, 95% confidence interval [CI] = 0.65-0.92), per capita household income (OR = 0.65, 95% CI = 0.58-0.73), availability of female medical faculty in township facilities (OR = 0.35, 95% CI = 0.28-0.42), quality of life (OR = 0.72, 95% CI = 0.58-0.90), being nulliparous (OR = 3.21, 95% CI = 1.96-5.26), and multiparous (OR = 1.91, 95% CI = 1.68-2.16).
CONCLUSION: To reduce inadequate screening service utilization of breast and cervical cancer in rural areas, efforts should be made not only to target the vulnerable rural women with lower income, lower educational level, and lower health conditions but also to further improve access to female primary-care providers. Strategies are also urgently needed to focus on nulliparous and multiparous women.

Jordan V, Khan M, Prill D
Breast Cancer Screening: Why Can't Everyone Agree?
Prim Care. 2019; 46(1):97-115 [PubMed] Related Publications
Screening mammography and evolving treatments have improved mortality over the last 25 years. However, breast cancer remains the second leading cause of cancer-related mortality for women in the United States. There are several contradictory recommendations regarding breast cancer screening. Familiarity with these recommendations will allow physicians to counsel their patients and ensure well-informed shared decision making.

Hinton B, Ma L, Mahmoudzadeh AP, et al.
Derived mammographic masking measures based on simulated lesions predict the risk of interval cancer after controlling for known risk factors: a case-case analysis.
Med Phys. 2019; 46(3):1309-1316 [PubMed] Article available free on PMC after 01/03/2020 Related Publications
PURPOSE: Women with radiographically dense or texturally complex breasts are at increased risk for interval cancer, defined as cancers diagnosed after a normal screening examination. The purpose of this study was to create masking measures and apply them to identify interval risk in a population of women who experienced either screen-detected or interval cancers after controlling for breast density.
METHODS: We examined full-field digital screening mammograms acquired from 2006 to 2015. Examinations associated with 182 interval cancers were matched to 173 screen-detected cancers on age, race, exam date and time since last imaging examination. Local Image Quality Factor (IQF) values were calculated and used to create IQF maps that represented mammographic masking. We used various statistics to define global masking measures of these maps. Association of these masking measures with interval cancer vs screen-detected cancer was estimated using conditional logistic regression in a univariate and adjusted model for Breast Imaging-Reporting and Data System (BI-RADS) density. Receiver operator curves were calculated in each case to compare specificity vs sensitivity, and area under those curves were generated. Proportion of screen-detected cancer was estimated for stratifications of IQF features.
RESULTS: Several masking features showed significant association with interval compared to screen-detected cancers after adjusting for BI-RADS density (up to P = 2.52E-6), and the 10th percentile of the IQF value (P = 1.72E-3) showed the strongest improvement in the area under the receiver operator curve, increasing from 0.65 using only BI-RADS density to 0.69. The highest masking group had a 32% proportion of screen-detected cancers while the low masking group had a 69% proportion.
CONCLUSIONS: We conclude that computer vision methods using model observers may improve quantifying the probability of breast cancer detection beyond using breast density alone.

Twizeyimana L, Kim Y
Breast Cancer Screening Participation of Women with Chronic Diseases in Korea: Analysis of the 2012 Korean National Health and Nutrition Examination Survey
Asian Pac J Cancer Prev. 2019; 20(1):207-213 [PubMed] Article available free on PMC after 01/03/2020 Related Publications
Chronic disease morbidity is a concern for cancer research. Contradictory results have been reported concerning adherence to breast cancer screening among patients with chronic diseases. The study was conducted to assess the adherence to breast cancer screening among women with chronic diseases in Korea. It was a cross sectional and population based study; the data came from the Korean National Health and Nutrition Examination Survey (KNHANES) 2012. Participation in breast cancer screening was analyzed among women who had at least one of eight chronic diseases (hypertension, diabetes, cancer, dyslipidemia, stroke, depression, osteoarthritis and asthma). Pearson’s chi-squared test and multiple logistic regression analysis were performed using STATA version 14. A total 2,404 women aged 40 years or older were included in analysis. Among them, 77.3% had experienced breast cancer screening. In logistic regression model, adherence to breast cancer screening was lower in women who have ever been diagnosed as diabetes mellitus (odds ratio (OR)= 0.47, 95% confidence interval (95%CI) = 0.31-0.72), asthma (OR=0.44, 95%CI=0.24-0.82) and higher in women who have ever been diagnosed as dyslipidemia (OR= 1.85, 95%CI= 1.27-2.69), osteoarthritis (OR= 1.42, 95%CI= 1.31-2.06) and cancers (OR= 2.70, 95%CI= 1.26-5.79) compared to women without those chronic diseases. Based on treatment of chronic diseases, lower participation in breast cancer screening was observed in women who were on treatment of diabetes mellitus (OR= 0.48, 95%CI= 0.31-0.74), asthma (OR= 0.41, 95%CI= 0.15-0.92) and stroke (OR= 0.37, 95%CI= 0.14-0.97), and higher in women who were on treatment of dyslipidemia (OR= 1.37, 95%CI=1.42-2.14). In conclusion, low participation rate in breast cancer screening in women with some chronic diseases was identified. The results from this study may provide an important contribution for helping to maintain and increase participation in cancer screening of patients with chronic diseases.

Strand F, Azavedo E, Hellgren R, et al.
Localized mammographic density is associated with interval cancer and large breast cancer: a nested case-control study.
Breast Cancer Res. 2019; 21(1):8 [PubMed] Article available free on PMC after 01/03/2020 Related Publications
BACKGROUND: High mammographic density is associated with breast cancer and with delayed detection. We have examined whether localized density, at the site of the subsequent cancer, is independently associated with being diagnosed with a large-sized or interval breast cancer.
METHODS: Within a prospective cohort of 63,130 women, we examined 891 women who were diagnosed with incident breast cancer. For 386 women, retrospective localized density assessment was possible. The main outcomes were interval cancer vs. screen-detected cancer and large (> 2 cm) vs. small cancer. In negative screening mammograms, overall and localized density were classified reflecting the BI-RADS standard. Density concordance probabilities were estimated through multinomial regression. The associations between localized density and the two outcomes were modeled through logistic regression, adjusted for overall density, age, body mass index, and other characteristics.
RESULTS: The probabilities of concordant localized density were 0.35, 0.60, 0.38, and 0.32 for overall categories "A," "B," "C," and "D." Overall density was associated with large cancer, comparing density category D to A with OR 4.6 (95%CI 1.8-11.6) and with interval cancer OR 31.5 (95%CI 10.9-92) among all women. Localized density was associated with large cancer at diagnosis with OR 11.8 (95%CI 2.7-51.8) among all women and associated with first-year interval cancer with OR 6.4 (0.7 to 58.7) with a significant linear trend p = 0.027.
CONCLUSIONS: Overall density often misrepresents localized density at the site where cancer subsequently arises. High localized density is associated with interval cancer and with large cancer. Our findings support the continued effort to develop and examine computer-based measures of localized density for use in personalized breast cancer screening.

Albeshan SM, Hossain SZ, Mackey MG, et al.
Preliminary investigation of mammographic density among women in Riyadh: association with breast cancer risk factors and implications for screening practices.
Clin Imaging. 2019 Mar - Apr; 54:138-147 [PubMed] Related Publications
PURPOSE: Improved mammographic sensitivity is associated with reduced mammographic density. This study aims to: provide a preliminary report on mammographic density among women in Riyadh; identify risk factors associated with mammographic density; and consider the potential implications for screening practices.
METHODS: Based on a cross-sectional design, we examined a total of 792 women using an area-based mammographic density method (LIBRA). Spearman's correlation, Mann-Whitney U, Kruskal-Wallis and binary logistic regression were used for analyses.
RESULTS: The study population had a mean age of 49.6 years and a high proportion of participants were overweight or obese (90%). A large number of women had low mammographic density, with a mean dense breast area of 19.1 cm
CONCLUSION: Given the high proportion of women with low mammographic density, our findings suggest that women living in Riyadh may not require additional imaging strategies beyond mammography to detect breast cancers. The high proportion of obese women reported here and across Saudi Arabia suggests that mammographic density is less likely to have an adverse impact on mammographic sensitivity. Thus and to improve clinical outcomes among Saudi women, annual mammography and commencing screening at a younger age are suggested. Additional studies are required to shed further light on our findings.

Zakaria D, Shaw A
Trends in mammography, hormone replacement therapy, and breast cancer incidence and mortality in Canadian women.
Cancer Causes Control. 2019; 30(2):137-147 [PubMed] Related Publications
PURPOSE: The purpose of the study is to examine relationships between long-term trends of region- and age-specific rates of mammography, hormone replacement therapy (HRT), and breast cancer incidence and mortality in Canadian women aged 35 years and older.
METHODS: Population-based complex surveys were used to estimate mammography use in the past 2 years and ever, and HRT use in the past month. National population-based administrative data were used to estimate breast cancer incidence and mortality. Joinpoint analyses were used to estimate trends in rates and years where trend changed.
RESULTS: No consistent relationship between mammography use and breast cancer incidence was observed across age groups. Opportunistic screening occurred prior to the establishment of organized screening programs in Canada and prior to substantial declines in breast cancer mortality observed around 1990. Women aged 35-39 years demonstrated a 62.8% relative decrease in breast cancer mortality between 1950 and 2015 despite lower rates of mammography use in the past 2 years (range 9.4-15.9%) reinforcing important treatment advances. A substantial proportion of women in their 40s report mammography use in the past 2 years (range 35.8-42.2%) and regional variation exists reflecting inconsistencies in guidelines across Canada.
CONCLUSION: Rates of mammography use over time do not necessarily reflect national guideline releases or establishment of organized screening programs.

Black E, Richmond R
Improving early detection of breast cancer in sub-Saharan Africa: why mammography may not be the way forward.
Global Health. 2019; 15(1):3 [PubMed] Article available free on PMC after 01/03/2020 Related Publications
BACKGROUND AND METHODS: The prevention and control of breast cancer in sub-Saharan Africa (SSA) is an increasingly critical public health issue. Breast cancer is the most frequent female cancer in SSA and mortality rates from this disease are the highest globally. Breast cancer has traditionally been considered a disease of high-income countries, and programs for early detection have been developed and implemented in these settings. However, screening programs for breast cancer in SSA have been less effective than in high-income countries. This article reviews the literature on breast cancer in SSA, focusing on early detection practices. It then examines the case for and against mammography and other early detection approaches for breast cancer in SSA.
RESULTS: Women with breast cancer in SSA are younger compared with high-income countries. Most women present with advanced disease and because treatment options are limited, have poor prognoses. Delay between symptom onset and healthcare seeking is common. Engagement with early detection practices such as mammography and breast examination is low and contributes to late stage at diagnosis.
DISCUSSION: While early detection of breast cancer through screening has contributed to important reductions in mortality in many high-income countries, most countries in SSA have not been able to implement and sustain screening programs due to financial, logistical and sociocultural constraints. Mammography is widely used in high-income countries but has several limitations in SSA and is likely to have a higher harm-to-benefit ratio. Breast self-examination and clinical breast examination are alternative early detection methods which are more widely used by women in SSA compared with mammography, and are less resource intensive. An alternative approach to breast cancer screening programs for SSA is clinical downstaging, where the focus is on detecting breast cancer earlier in symptomatic women. Evidence demonstrates effectiveness of clinical downstaging among women presenting with late stage disease.
CONCLUSIONS: Approaches for early detection of breast cancer in SSA need to be context-specific. While screening programs with mammography have been effective in high-income countries, evidence suggests that other strategies might be equally important in reducing mortality from breast cancer, particularly in low-resource settings. There is a strong argument for further research into the feasability and acceptability of clinical downstaging for the control of breast cancer in SSA.

Abeje S, Seme A, Tibelt A
Factors associated with breast cancer screening awareness and practices of women in Addis Ababa, Ethiopia.
BMC Womens Health. 2019; 19(1):4 [PubMed] Article available free on PMC after 01/03/2020 Related Publications
BACKGROUND: Breast cancer is a global health problem being the most common cancer of women in both developed and under-developed countries. Public and individual awareness can play a vital role in the prevention, early diagnosis and treatment of breast cancer. However evidence is sparse on awareness and practice of breast cancer screening methods used among women of reproductive age in Ethiopia. The present study was designed to determine factors associated with breast cancer screening awareness and practices of women in Addis Ababa.
METHODS: A facility based cross-sectional study was conducted among women who came for maternal and child health care services to selected public health centers. The participants were interviewed using a structured questionnaire. Following data collection, data entry and analysis was done using Epi-Info version 7and SPSS Version 21 respectively. Cross tabulation of each independent variable with the dependent variable with their 95% confidence interval was done and those variables associated at binary logistic regression with a significance level of 0.2 were entered into multiple logistic regression.
RESULTS: About half (53%) of women have heard about breast cancer and 35.5% of women are aware of at least one breast cancer screening method. Among those who are informed about breast cancer screening, 97% indicated that screening improves the chance of survival. Among the common screening methods; self-breast examination, clinical-breast examination and mammographic examination were practiced by 24.3%, 7.6% and 3.8% of respondents, respectively. Women who had high level of income were about 3 times more likely to be aware about breast cancer screening methods, [AOR = 2.5; 95%CI (1.04--5.91)], while women who attended secondary and tertiary school were 2 and 4 times more likely to practice breast cancer screening methods [AOR = 2.46; 95% CI (1.12--5.38)] and [AOR = 4.00; 95% CI(1.48--10.86)] respectively.
CONCLUSION: This study has showed that self-reported breast cancer screening coverage is low. About two-thirds of women had no information about breast cancer screening methods.

Badu-Peprah A, Adu-Sarkodie Y
Accuracy of clinical diagnosis, mammography and ultrasonography in preoperative assessment of breast cancer.
Ghana Med J. 2018; 52(3):133-139 [PubMed] Article available free on PMC after 01/03/2020 Related Publications
Background: Cancer of the breast is the most common malignancy affecting women in many parts of the world. Its early detection has, therefore, become necessary to reduce morbidity and mortality from the disease. In sub-Saharan Africa, radiological imaging, histology and management programs are associated with challenges.
Objectives: This study seeks to assess the validity of clinical diagnosis, mammography and breast ultrasonography in the preoperative assessment of suspected breast cancer patients for accurate detection of the disease to enable appropriate management.
Methods: A prospective cross-sectional study was carried out in the Radiology Department of Komfo Anokye Teaching Hospital, Kumasi, Ghana, between November 2007 and July 2008 with a sample size of 103. All patients with a clinical suspicion of breast cancer who gave informed consent were recruited, underwent bilateral mammography and whole breast ultrasonography and then biopsy for all BIRADS categories 4 or 5 lesions. The histopathology results were retrieved to complete the study.
Result: In this study the definition of malignancy was made using histology as the gold standard. A total of 103 patients were recruited for this study with mean age of 55(±15) years, out of which 52 (50.5%) had malignant lesions. The overall sensitivity of clinical diagnosis was 50.5%. While the overall sensitivity and specificity for mammogram and ultrasound were 73.0%, 80.0% and 100%, 80.4% respectively.
Conclusion: In conclusion, this study has demonstrated that clinical diagnosis, ultrasound and mammography can potentially predict breast cancer disease with considerable sensitivity and specificity.
Funding: Not declared.

Mirmoammadi A, Parsa P, Khodakarami B, Roshanaei G
Effect of Consultation on Adherence to Clinical Breast Examination and Mammography in Iranian Women: A Randomized Control Trial
Asian Pac J Cancer Prev. 2018; 19(12):3443-3449 [PubMed] Article available free on PMC after 01/03/2020 Related Publications
Background: Early diagnosis of breast cancer is directly related to success in treatment. The aim of this study was to determine the effect of consultation based on the health belief model on performance of clinical breast examination (CBE) and mammography in women. Methods: This research was a clinical trial study. Eligible women aged> 40 years attending to Hamadan health care centers in 2016 were randomly assigned to experimental and control groups (n = 75 in each group). The experimental group received 4 weekly sessions of breast cancer screening consulting based on Health Belief Model (HBM). Knowledge on breast cancer, HBM constructs, and practices were compared between two groups before, one and three months after intervention. Results: Before the intervention, no significant differences were observed in knowledge, HBM constructs and practice between experimental and control groups. While one and three months post intervention significant differences were detected between two groups on HBM constructs (except susceptibility and severity) and knowledge (p <0.05). Conclusions: The results showed the consultation promoted breast cancer screening in women.

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