Organized Breast Cancer Screening in British Columbia: The Screening Mammography Program of British Columbia

Purpose: Half of US states mandate women be notified if they have dense breasts on their mammogram, yet guidelines and data on supplemental screening modalities are limited. Breast density (BD) refers to the extent that breast tissue appears radiographically dense on mammograms. High BD reduces the sensitivity of screening mammography and increases breast cancer risk. The aim of this study was to determine the potential impact of California’s 2013 BD notification legislation on breast cancer screening patterns. Methods: We conducted a cohort study of women aged 40 to 74 years who were members of a large Northern California integrated health plan (approximately 3.9 million members) in 2011-2015. We calculated pre- and post-legislation rates of screening mammography and magnetic resonance imaging (MRI). We also examined whether women with dense breasts (defined as BI-RADS density c or d) had higher MRI rates than women with nondense breasts (defined as BI-RADS density a or b). Results: After adjustment for race/ethnicity, age, body mass index, medical facility, neighborhood median income, and cancer history, there was a relative 6.6% decrease (relative risk [RR] 0.934, confidence interval [CI] 0.92-0.95) in the rate of screening mammography, largely driven by a decrease among women <50 years. While infrequent, there was a relative 16% increase (RR 1.16, CI 1.07-1.25) in the rate of screening MRI, with the greatest increase among the youngest women. In the postlegislation period, women with extremely dense breasts (BI-RADS d) had 2.77 times (CI 1.93-3.95) the odds of a MRI within 9 months of a screening mammogram compared with women with nondense breasts (BI-RADS b). Conclusions: In this setting, MRI rates increased in the postlegislation period. In addition, women with higher BD were more likely to have supplementary MRI. The decrease in mammography rates seen primarily among younger women may have been due to changes in national screening guidelines.

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Analysis of Participant Factors That Affect the Diagnostic Performance of Screening Mammography: A Report of the Alliance for Breast Cancer Screening in Korea

Korean Journal of Radiology ◽

10.3348/kjr.2017.18.4.624 ◽

2017 ◽

Vol 18 (4) ◽

pp. 624 ◽

Cited By ~ 5

Author(s):

Young Joong Kim ◽

Eun Hye Lee ◽

Jae Kwan Jun ◽

Dong-Rock Shin ◽

Young Mi Park ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Diagnostic Performance ◽

Screening Mammography

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CT Findings of Axillary Tuberculosis Lymphadenitis: A Case Detected by Breast Cancer Screening Examination

Case Reports in Radiology ◽

10.1155/2016/9016517 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5

Author(s):

Hiroko Shojaku ◽

Kyo Noguchi ◽

Tetsuya Kamei ◽

Yasuko Tanada ◽

Kouichi Yoshida ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Screening Mammography ◽

Tuberculous Lymphadenitis ◽

Screening Examination ◽

Ct Findings ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Axillary Region

We report the first description of CT findings of axillary tuberculous lymphadenitis confirmed by the pathological specimen. The breast cancer screening examination is one of the prime methods of detection of axillary tuberculous lymphadenitis. The most common site of axillary tuberculous lymphadenitis is the deep axilla. Screening mammography often fails to cover the whole axilla. The presence on the contrast-enhanced CT of unilateral multiple circumscribed dense nodes, some of which have large and dotted calcifications, might suggest tuberculous lymphadenitis in axillary region.

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Breast Cancer Screening in Average-Risk Women

10.1093/med/9780190223700.003.0038 ◽

2016 ◽

Author(s):

Christoph I. Lee

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Meta Analysis ◽

Screening Mammography ◽

Average Risk ◽

Additional Information ◽

Additional Imaging ◽

Study Methodology ◽

Benign Biopsy

This chapter, found in the cancer screening and management section of the book, provides a succinct synopsis of a key meta-analysis regarding the efficacy of mammography for breast cancer screening among younger and older average-risk women. This summary outlines study methodology and design, major results, limitations and criticisms, related studies and additional information, and clinical implications. Meta-analysis of available trial data demonstrates a 15% mortality reduction among women aged 39 to 49 years with routine screening mammography. This age group has the highest rates of additional imaging but lowest rates of benign biopsy. In addition to outlining the most salient features of the analysis, a clinical vignette and imaging example are included in order to provide relevant clinical context.

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Preferences and Attitudes Regarding Adjunct Breast Cancer Screening Among Patients with Dense Breasts

Journal of Breast Imaging ◽

10.1093/jbi/wbz093 ◽

2020 ◽

Vol 2 (2) ◽

pp. 119-124 ◽

Cited By ~ 3

Author(s):

Matthew M Miller ◽

Kathy Repich ◽

James T Patrie ◽

Roger T Anderson ◽

Jennifer A Harvey

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Screening Mammography ◽

Contrast Administration ◽

Dense Breasts ◽

The Past ◽

Institutional Review ◽

Level Of Concern ◽

Prior Mammogram

Abstract Objective New breast screening modalities are being investigated to address the need for more sensitive breast cancer screening in women with dense breasts. We investigated the preferences and attitudes of these patients regarding adjunct screening modalities to help evaluate the acceptability of these exams. Methods In this institutional review board–approved prospective study, patients with dense breasts on their prior mammogram were invited to complete a survey. Patients were asked to estimate their personal breast cancer risk compared with peers, indicate their level of concern related to screening callbacks, radiation exposure, and intravenous (IV) contrast allergies, and identify which factors might deter them from getting adjunct screening exams. Results Five hundred eight patients with dense breasts presenting for screening mammography completed surveys. While most patients (304/508, 59.9%) felt it was likely or very likely that cancer could be missed on their mammogram, only 8.9% (45/508) had undergone adjunct screening exams in the past 3 years. The most commonly cited deterrents to adjunct screening were cost (340/508, 66.9%), pain (173/508, 34.1%), and concern that adjunct screening could lead to additional procedures (158/508, 31.1%). When asked to select among three hypothetical breast cancer screening modalities, patients strongly preferred the more sensitive examination, even if this involved greater cost (162/508, 31.9%) or IV-contrast administration (315/508, 62.0%). Conclusion Our data suggest that patients with dense breasts prefer adjunct screening exams that are both sensitive and inexpensive, although an increase in sensitivity could outweigh additional cost or even IV-line placement.

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Impact of the U.S. Preventive Services Task Force update for breast cancer screening on mammography utilization in women age 40 to 49.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.27_suppl.5 ◽

2012 ◽

Vol 30 (27_suppl) ◽

pp. 5-5

Author(s):

Amy T. Wang ◽

Jiaquan Fan ◽

Holly K. Van Houten ◽

Nilay D. Shah

Keyword(s):

Breast Cancer ◽

Time Series ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Task Force ◽

Screening Mammography ◽

Administrative Claims ◽

Post Intervention ◽

Start Date ◽

The Impact

5 Background: The 11/2009 USPSTF breast cancer screening update recommended against routine screening mammography for women age 40-49, created confusion and prompted organizations to release opposing statements. We aimed to determine if the USPSTF update for breast cancer screening impacted screening mammography utilization in women age 40-49. Methods: We conducted a time-series analysis utilizing administrative claims data from over 100 health plans. Women ages 40-64 with at least one month of enrollment from 01/2006-12/2010 were included. Medicare claims are not included and thus women ≥65 were excluded. The start date of 01/2006 was chosen to account for possible effects of the recent recession. We developed claims-based algorithms to identify the number of monthly screening mammograms. Time series models were fit using SAS PROC AUTOREG; strong seasonal fluctuations were adjusted by including an autoregressive error of order 12. Results: Over 7.9 million women were included. Prior to the intervention, the baseline monthly mammography rate was 40.9/1,000 women for the 40-49 group and 47.4/1,000 women for the 50-64 group. Based on projections from pre-intervention trends, the update was associated with a 5.72% (1.27,10.18) and 4.97% (1.11,8.84) decrease in mammography rate at 3 and 10 months post-intervention, respectively in the 40-49 group. The intervention had no effect on mammography rates in the 50-64 group. This translates to 53,969 fewer mammograms performed in the year following the update for women ages 40-49 in this dataset. Conclusions: We present the first estimates of the impact of the USPSTF breast cancer screening update using a large nationally representative database. The update was associated with a small but significant decrease in mammography rates for women ages 40-49, while no change was seen for women ages 50-64, which is consistent with the context of the guideline change. A modest effect is also in line with public backlash and the release of numerous conflicting guidelines. These findings underscore the need for further research on benefits and risks of screening mammography as it is difficult to act on numerous sources of contradictory information.

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