Conclusions for mammography screening after 25-year follow-up of the Canadian National Breast Cancer Screening Study (CNBSS)

ObjectivesArgentina is a low and middle-income country (LMIC) with a highly fragmented healthcare system that conflicts with access to healthcare stated by the country’s Universal Health Coverage plan. A tele-mammography network could improve access to breast cancer screening decreasing its mortality. This research aims to conduct an economic evaluation of the implementation of a tele-mammography program to improve access to healthcare.MethodsA cost-utility analysis was performed to explore the incremental benefit of annual tele-mammography screening for at-risk Argentinian women over 40 years old. A Markov model was developed to simulate annual mammography or tele-mammography screening in two hypothetical population-based cohorts of asymptomatic women. Parameter uncertainty was evaluated through deterministic and probabilistic sensitivity analysis. Model structure uncertainty was also explored to test the robustness of the results.ResultsIt was estimated that 31 out of 100 new cases of breast cancer would be detected by mammography and 39/100 by tele-mammography. The model returned an incremental cost-effectiveness ratio (ICER) of £26 051/quality-adjusted life-year (QALY) which is lower than the WHO-recommended threshold of £26 288/QALY for Argentina. Deterministic sensitivity analysis showed the ICER is most sensitive to the uptake and sensitivity of the screening tests. Probabilistic sensitivity analysis showed tele-mammography is cost-effective in 59% of simulations.DiscussionTele-mammography should be considered for adoption as it could improve access to expertise in underserved areas where adherence to screening protocols is poor. Disaggregated data by province is needed for a better- informed policy decision. Telemedicine could also be beneficial in ensuring the continuity of care when health systems are under stress like in the current COVID-19 pandemic.ConclusionThere is a 59% chance that tele-mammography is cost-effective compared to mammography for at-risk Argentinian women over 40- years old, and should be adopted to improve access to healthcare in underserved areas of the country.

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Psychological predictors of intention and avoidance of attending organized mammography screening in Norway: applying the Extended Parallel Process Model

BMC Women s Health ◽

10.1186/s12905-021-01201-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anna Ivanova ◽

Ingela Lundin Kvalem

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Mammography Screening ◽

Psychological Factors ◽

Process Model ◽

Parallel Process ◽

Extended Parallel Process Model ◽

Screening Programs ◽

Response Efficacy

Abstract Background Mammography screening is the main method for early detection of breast cancer in Norway. Few studies have focused on psychological determinants of both attendance and non-attendance of publicly available mammography screening programs. The aim of the current study, guided by the Extended Parallel Process Model, was to examine how psychological factors influence defensive avoidance of breast cancer screening and intention to attend mammography. Methods Cross-sectional survey data from a community sample of women living in Norway aged ≥ 18 (N = 270), and without a history of breast cancer, was collected from September 2018 to June 2019 and used to investigate the relationships between the Extended Parallel Process Model (EPPM) constructs and two outcomes: defensive avoidance of breast cancer screening and intention to attend mammography within the next two years. After adjusting for confounding factors, the hierarchical multiple linear regression analyses was conducted to assess the ability of the independent variables based on the EPPM to predict the two outcome variables. Significance level was chosen at p < 0.05. Results Multivariate analyses showed that defensive avoidance of breast cancer screening was predicted by lower perceived susceptibility to breast cancer (β = − 0.22, p = 0.001), lower response efficacy of mammography screening (β = − 0.33, p = 0.001), higher breast cancer fear (β = 0.15, p = 0.014), and checking breasts for lumps (β = − 0.23, p = 0.001). Intention to attend mammography within the next two years was predicted by higher response efficacy of mammography screening (β = 0.13, p = 0.032), having a lower educational level (β = − 0.10, p = 0.041), and regular previous mammography attendance compared to never attending (β = 0.49, p = 0.001). Conclusions The study revealed that defensive avoidance of breast cancer screening and intention to attend mammography were not predicted by the same pattern of psychological factors. Our findings suggest future health promotion campaigns need to focus not only on the psychological factors that encourage women’s decision to attend the screening, but also to counter factors that contribute to women’s decision to avoid it.

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National breast cancer screening program in France: Results for 2013-2014

European Journal of Cancer ◽

10.1016/s0959-8049(17)30590-7 ◽

2017 ◽

Vol 72 ◽

pp. S158-S159

Author(s):

A. Rogel ◽

Q. Cécile ◽

E. Chatignoux ◽

F. Hamers ◽

N. Beltzer

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Screening Program ◽

Breast Cancer Screening Program ◽

National Breast ◽

Cancer Screening Program

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Novel Mapping Methods to Describe Utilization of Free Breast Cancer Screening from a State Program

10.20944/preprints202010.0463.v1 ◽

2020 ◽

Author(s):

Kelly Hughes ◽

David Haynes ◽

Anne Joseph

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Adaptive Filters ◽

Mapping Technique ◽

Cancer Early Detection ◽

Spatially Adaptive ◽

National Breast ◽

Detection Program ◽

Early Detection Program

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) of Minnesota, “Sage”, provides breast cancer screening to uninsured women. We introduce a novel mapping technique, spatially adaptive filters (SAFs), to estimate utilization of Sage screening in Minnesota. Sage screenings (N = 74,712) were geocoded. The eligible population was modeled with the RTI synthetic population dataset. Between 2011 and 2015, 36,979 women a year were Sage eligible. Utilization was highly variable across Minnesota (M = 37.2%, range 0% - 131%, SD = 18.7%). This replicable approach modeled utilization rates to the neighborhood-level, allowing Sage to prioritize locations and engage communities.

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Age-specific accuracy of initial versus subsequent mammography screening: results from the Ghent breast cancer-screening programme

European Journal of Cancer Prevention ◽

10.1097/00008469-200204000-00006 ◽

2002 ◽

Vol 11 (2) ◽

pp. 147-151 ◽

Cited By ~ 2

Author(s):

P Van Landeghem ◽

L Bleyen ◽

G De Backer

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Mammography Screening ◽

Screening Programme ◽

Breast Cancer Screening Programme ◽

Cancer Screening Programme

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Effectiveness of diet and physical activity interventions amongst adults attending colorectal and breast cancer screening: a systematic review and meta-analysis

Cancer Causes & Control ◽

10.1007/s10552-020-01362-5 ◽

2020 ◽

Author(s):

Samuel T. Orange ◽

Kirsty M. Hicks ◽

John M. Saxton

Keyword(s):

Breast Cancer ◽

Physical Activity ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Vegetable Intake ◽

Dietary Interventions ◽

Physical Activity Interventions ◽

Mean Differences ◽

Quality Evidence

Abstract Purpose To estimate the effectiveness of tailored physical activity and dietary interventions amongst adults attending colorectal and breast cancer screening. Methods Five literature databases were systematically searched to identify randomised controlled trials (RCTs) of tailored physical activity and/or dietary interventions with follow-up support initiated through colorectal and breast cancer screening programmes. Outcomes included markers of body fatness, physical activity, and dietary intake. Mean differences (MDs) or standardised mean differences (SMDs) with 95% confidence intervals (CIs) were pooled using random effects models. Results Five RCTs met the inclusion criteria encompassing a total of 722 participants. Diet and physical activity interventions led to statistically significant reductions in body mass (MD − 1.6 kg, 95% CI − 2.7 to − 0.39 kg; I2 = 81%; low quality evidence), body mass index (MD − 0.78 kg/m2, 95% CI − 1.1 to − 0.50 kg/m2; I2 = 21%; moderate quality evidence), and waist circumference (MD − 2.9 cm, 95% CI − 3.8 to − 1.91; I2 = 0%; moderate quality evidence), accompanied by an increase in physical activity (SMD 0.31, 95% CI 0.13 to 0.50; I2 = 0%; low quality evidence) and fruit and vegetable intake (SMD 0.33, 95% CI 0.01 to 0.64; I2 = 51%; low quality evidence). Conclusion There is low quality evidence that lifestyle interventions involving follow-up support lead to modest weight loss and increased physical activity and fruit and vegetable intake. Due to the modest intervention effects, low quality of evidence and small number of studies, further rigorously designed RCTs with long-term follow-up of modifiable risk factors and embedded cost–benefit analyses are warranted (PROSPERO ref: CRD42020179960).

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Breast cancer overdiagnosis in stop-screen trials: More uncertainty than previously reported

Journal of Medical Screening ◽

10.1177/0969141320950784 ◽

2020 ◽

pp. 096914132095078

Author(s):

Stuart G Baker ◽

Philip C Prorok

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Confidence Interval ◽

Breast Cancer Screening ◽

Confidence Intervals ◽

Latent Class ◽

Screening Program ◽

Screen Interval ◽

Binomial Confidence Interval

Objective According to the Independent UK Panel on Breast Cancer Screening, the most reliable estimates of overdiagnosis for breast cancer screening come from stop-screen trials Canada 1, Canada 2, and Malmo. The screen-interval overdiagnosis fraction is the fraction of cancers in a screening program that are overdiagnosed. We used the cumulative incidence method to estimate screen-interval overdiagnosis fraction. Our goal was to derive confidence intervals for estimated screen-interval overdiagnosis fraction and adjust for refusers in these trials. Methods We first show that the UK Panel’s use of a 95% binomial confidence interval for estimated screen-interval overdiagnosis fraction was incorrect. We then derive a correct 95% binomial-Poisson confidence interval. We also use the method of latent-class instrumental variables to adjust for refusers. Results For the Canada 1 trial, the estimated screen-interval overdiagnosis fraction was 0.23 with a 95% binomial confidence interval of (0.18, 0.27) and a 95% binomial-Poisson confidence interval of (0.04, 0.41). For the Canada 2 trial, the estimated screen-interval overdiagnosis fraction was 0.16 with a 95% binomial confidence interval of (0.12, 0.19) and a 95% binomial-Poisson confidence interval of (−0.01, 0.32). For the Malmo trial, the estimated screen-interval overdiagnosis fraction was 0.19 with a 95% binomial confidence interval of (0.15, 0.22). Adjusting for refusers, the estimated screen-interval overdiagnosis fraction was 0.26 with a 95% binomial-Poisson confidence interval of (0.03, 0.50). Conclusion The correct 95% binomial-Poisson confidence interval s for the estimated screen-interval overdiagnosis fraction based on the Canada 1, Canada 2, and Malmo stop-screen trials are much wider than the previously reported incorrect 95% binomial confidence intervals. The 95% binomial-Poisson confidence intervals widen as follow-up time increases, an unappreciated downside of longer follow-up in stop-screen trials.

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