scholarly journals Investigating the Effectiveness of Breast Cancer Supplemental Screening Considering Radiologists’ Bias

2020 ◽  
Author(s):  
Sevda Molani ◽  
Mahboubeh Madadi ◽  
Donna L. Williams
Keyword(s):  
Breast Cancer ◽  
Health Outcomes ◽  
Breast Density ◽  
Healthcare Providers ◽  
Screening Tests ◽  
Early States ◽  
Patient’S Outcome ◽  
Screening Sensitivity ◽  
Partially Observable ◽  
The Impact

AbstractBreast density is known to increase breast cancer risk and decrease mammography screening sensitivity. Breast density notification laws (enacted in 38 states as of September 2020), require physicians to inform women with high breast density of these potential risks. The laws usually require healthcare providers to notify patients of the possibility of using more sensitive supplemental screening tests (e.g., ultrasound). Since the enactment of the laws, there have been controversial debates over i) their implementations due to the potential radiologists bias in breast density classification of mammogram images and ii) the necessity of supplemental screenings for all patients with high breast density. In this study, we formulate a finite-horizon, discrete-time partially observable Markov chain (POMC) to investigate the effectiveness of supplemental screening and the impact of radiologists’ bias on patients’ outcomes. We consider the conditional probability of eventually detecting breast cancer in early states given that the patient develops breast cancer in her lifetime as the primary and the expected number of supplemental tests as the secondary patient’s outcome. Our results indicate that referring patients to a supplemental test solely based on their breast density may not necessarily improve their health outcomes and other risk factors need to be considered when making such referrals. Additionally, average-skilled radiologists’ performances are shown to be comparable with the performance of a perfect radiologist (i.e., 100% accuracy in breast density classification). However, a significant bias in breast density classification (i.e., consistent upgrading or downgrading of breast density classes) can negatively impact a patient’s health outcomes.

The Impact of Breast Density on Breast Cancer Detection

2021 ◽  
Vol 19 (01) ◽  
pp. 109-116
Author(s):  
NORHASHIMAH MOHD NORSUDDIN ◽  
NURFADHILAH IDRIS
Keyword(s):  
Breast Cancer ◽  
Breast Density ◽  
Cancer Detection ◽  
Breast Cancer Detection ◽  
The Impact

OBJEKTIF: Kajian ini dilakukan untuk mengenalpasti kategori densiti payudara yang mempunyai kebarangkalian tinggi untuk menyebabkan kanser payudara tidak dikesan atau disalah diagnosis. METODOLOGI: Kelulusan etika menjalankan penyelidikan telah diperolehi daripada Jawatankuasa Etika Penyelidikan Universiti Kebangsaan Malaysia. Sebanyak 495 kes mamografi telah dipilih dari Jabatan Radiologi, Pusat Perubatan Universiti Kebangsaan Malaysia. Semua kes mamografi telah diasingkan kepada 4 kumpulan diagnosis iaitu negative benar, positif benar, positif palsu dan negatif palsu. Kemudian, setiap kes mamografi dibahagikan mengikut empat kategori densiti payudara BI-RADS (I, II, III, IV). Analisis kebarangkalian risiko (odd ratio) setiap kategori densiti payudara dengan keputusan positif palsu dan negatif palsu dilakukan dengan menggunakan ujian regresi logistik. HASIL KAJIAN: Kebarangkalian imej mamografi dalam kategori densiti BI-RAD IV didiagnosis sebagai positif palsu adalah emapt kali ganda berbanding imej mamografi dalam kategori densiti BI-RAD I (odd ratio [OR], 4.27; 95% CI,0.88- 20.67). Manakala, imej mamografi yang mempunyai densiti BI-RAD II dan BI-RAD III mempunyai hampir dua kali ganda kemungkinan didiagnosis sebagai negatif palsu berbanding wanita berdensiti BI-RAD I (odd ratio [OR], 1.59, 1.32; 95% CI, 0.29-8.77, 0.25-7.01). KESIMPULAN: Densiti payudara dalam mamografi mempengaruhi keputusan diagnosis pakar radiologi dalam pengesanan kanser payudara. Kes mamografi yang mempunyai densiti BI-RAD IV lebih cenderung disalah diagnosis. Manakala pengesanan kanser dalam payudara berdensiti BI-RAD II dan BI-RAD III lebih berisiko untuk tidak dikesan. Penelitian yang lebih perlu diberikan dalam mentafsir imej mamografi berdensiti BI-RAD II, III dan IV bagi mengelakkan kanser disalah diagnosis atau tidak dikesan di peringkat awal. Pengesanan awal kanser payudara dapat meningkatkan kemandirian pesakit kanser.

Breast cancer-related lymphedema and quality of life: A qualitative analysis over years of survivorship

2019 ◽  
pp. 174239531987279
Author(s):  
Allison B Anbari ◽  
Ausanee Wanchai ◽  
Jane M Armer
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Healthcare Providers ◽  
Breast Cancer Diagnosis ◽  
Data Saturation ◽  
Breast Cancer Related Lymphedema ◽  
Reported Data ◽  
The Impact

Objectives The study purpose was to examine perspectives of women with newly diagnosed breast cancer-related lymphedema (BCRL) regarding their quality of life over seven years. Method Data were collected over seven years using the Lymphedema and Breast Cancer Questionnaire (LBCQ). Participants with BCRL answered open-ended questions corresponding to changes in mood and lifestyle from post-op through annual interviews and surveys. Self-reported data from 97 participants with BCRL were analyzed using in vivo coding and template-style content analysis to elicit the impact of BCRL on quality of life domains. Results Data saturation was achieved as participants neared 30 to 36 months post- breast cancer diagnosis. Three major themes were identified related to BCRL’s impact on: physical function; daily living and social function; and psychological function. Discussion Findings suggest that BCRL impacts quality of life not only soon after diagnosis, but also throughout survivorship years. Healthcare providers should develop programs to enhance quality of life for survivors with BCRL.

Screening Sensitivity According to Breast Cancer Location

2019 ◽  
Vol 70 (2) ◽  
pp. 186-192 ◽  
Author(s):  
Isabelle Théberge ◽  
Marie-Hélène Guertin ◽  
Nathalie Vandal ◽  
Gary Côté ◽  
Michel-Pierre Dufresne ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Density ◽  
Central Area ◽  
Lower Sensitivity ◽  
Interval Cancers ◽  
Experienced Radiologist ◽  
Sensitivity Ratio ◽  
Screening Mammograms ◽  
Screening Sensitivity ◽  
Adjusted Sensitivity

Purpose To examine the relation between breast cancer location and screening mammogram sensitivity, and assess whether this association is modified by body mass index (BMI) or breast density. Methods This study is based on all interval cancers (n = 481) and a random sample of screen-detected cancers (n = 481) diagnosed in Quebec Breast Cancer Screening Program participants in 2007. Film-screening mammograms, diagnostic mammograms, and ultrasound reports (when available) were requested for these cases. The breast cancer was then localised in mediolateral oblique (MLO) and craniocaudal (CC) projections of the breast by 1 experienced radiologist. The association between cancer location and screening sensitivity was assessed by logistic regression. Adjusted sensitivity and sensitivity ratios were obtained by marginal standardisation. Results A total of 369 screen-detected and 268 interval cancers could be localised in MLO and/or CC projections. The 2-year sensitivity reached 68%. Overall, sensitivity was not statistically associated with location of the cancer. However, sensitivity seems lower in MLO posterior inferior area for women with BMI ≥ 25 kg/m2 compared to sensitivity in central area for women with lower BMI (adjusted sensitivity ratio: 0.58, 95% confidence interval [CI]: 0.17–0.98). Lower sensitivity was also observed in subareolar areas for women with breast density ≥ 50% compared to the central areas for women with lower breast density (for MLO and CC projections, adjusted sensitivity ratio and 95% CI of, respectively, 0.54 [0.13–0.96] and 0.46 [0.01–0.93]). Conclusions Screening sensitivity seems lower in MLO posterior inferior area in women with higher BMI and in subareolar areas in women with higher breast density. When interpreting screening mammograms, radiologists need to pay special attention to these areas.

scholarly journals Effect on nurse and patient experience: overnight use of blue-depleted illumination

2019 ◽  
Vol 8 (3) ◽  
pp. e000692 ◽  
Author(s):  
Lorenzo Albala ◽  
Timothy Bober ◽  
Graham Hale ◽  
Benjamin Warfield ◽  
Micaela Langille Collins ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Patient Experience ◽  
Financial Incentives ◽  
Healthcare Providers ◽  
Depression Scale ◽  
Poor Sleep ◽  
Patient Anxiety ◽  
Night Time ◽  
Task Lighting ◽  
The Impact

BackgroundTypical hospital lighting is rich in blue-wavelength emission, which can create unwanted circadian disruption in patients when exposed at night. Despite a growing body of evidence regarding the effects of poor sleep on health outcomes, physiologically neutral technologies have not been widely implemented in the US healthcare system.ObjectiveThe authors sought to determine if rechargeable, proximity-sensing, blue-depleted lighting pods that provide wireless task lighting can make overnight hospital care more efficient for providers and less disruptive to patients.DesignNon-randomised, controlled interventional trial in an intermediate-acuity unit at a large urban medical centre.MethodsNight-time healthcare providers abstained from turning on overhead patient room lighting in favour of a physiologically neutral lighting device. 33 nurses caring for patients on that unit were surveyed after each shift. 21 patients were evaluated after two nights with standard-of-care light and after two nights with lighting intervention.ResultsProviders reported a satisfaction score of 8 out of 10, with 82% responding that the lighting pods provided adequate lighting for overnight care tasks. Among patients, a median 2-point improvement on the Hospital Anxiety and Depression Scale was reported.Conclusion and relevanceThe authors noted improved caregiver satisfaction and decreased patient anxiety by using a blue-depleted automated task-lighting alternative to overhead room lights. Larger studies are needed to determine the impact of these lighting devices on sleep measures and patient health outcomes like delirium. With the shift to patient-centred financial incentives and emphasis on patient experience, this study points to the feasibility of a physiologically targeted solution for overnight task lighting in healthcare environments.

Breast Cancer Treatment in Older Women: Does Getting What You Want Improve Your Long-Term Body Image and Mental Health?

2004 ◽  
Vol 22 (19) ◽  
pp. 4002-4009 ◽  
Author(s):  
Melissa I. Figueiredo ◽  
Jennifer Cullen ◽  
Yi-Ting Hwang ◽  
Julia H. Rowland ◽  
Jeanne S. Mandelblatt
Keyword(s):  
Breast Cancer ◽  
Mental Health ◽  
Body Image ◽  
Health Outcomes ◽  
Older Women ◽  
Evaluation System ◽  
Short Form ◽  
Breast Conservation ◽  
The Impact

Purpose Little is known about the impact of surgical treatment on body image and health outcomes in older breast cancer patients. The purpose of this article is to evaluate whether concordance between treatment received and treatment preferences predicts posttreatment body image and whether body image, in turn, affects mental health in older women with breast cancer 2 years after treatment. Patients and Methods A longitudinal cohort of 563 women who were 67 years old or older and who had stages I and II breast cancer were surveyed by telephone at 3, 12, and 24 months after surgery. All women were clinically eligible for breast conservation. Body image was measured using questions adapted from the Cancer Rehabilitation Evaluation System–Short Form, and mental health was evaluated using a Medical Outcomes Study subscale. Results Body image was an important factor in treatment decisions for 31% of women. Women who received breast conservation had better body image 2 years after treatment than women who had mastectomies (P < .0001). Women who preferred breast conservation but received mastectomy had the poorest body image. Using generalized estimating equations, we found that body image, in turn, predicted 2-year mental health. Conclusion Body image is important for many older women, and receiving treatment consistent with preferences about appearance was important in long-term mental health outcomes. Health professionals should elicit preferences about appearance from women and provide treatment choices in concordance with these preferences. Enhancing shared decision making has the potential to improve mental health in older breast cancer survivors.

scholarly journals The Impact of Breast Density Information or Notification on Women's Cognitive, Psychological, and Behavioral Outcomes: A Systematic Review

2021 ◽  
Author(s):  
Brooke Nickel ◽  
Tessa Copp ◽  
Meagan Brennan ◽  
Rachel Farber ◽  
Kirsten McCaffery ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Breast Density ◽  
Controlled Trial ◽  
Behavioral Outcomes ◽  
The United States ◽  
Disadvantaged Communities ◽  
Study Team ◽  
Randomised Controlled ◽  
The Impact

Abstract Background Breast density (BD) is an independent risk factor for breast cancer and reduces the sensitivity of mammography. This systematic review aims to synthesize evidence from existing studies to understand the impact of BD information and/or notification on women's cognitive, psychological and behavioral outcomes. Methods Studies were identified via relevant database searches up to March 2020. Two authors evaluated the eligibility of studies with verification from the study team, extracted and crosschecked data, and assessed the risk of bias. Results Of the 1134 titles identified, 29 studies were included. Twenty-three studies were quantitative, including only 1 randomised controlled trial of women receiving BD information, and 6 were qualitative. Twenty-seven studies were conducted in the United States, with 19 conducted post-BD legislation. The overall results in terms of BD awareness, knowledge, attitudes, perceptions and intentions were heterogeneous across included studies, with the strongest consistency demonstrated regarding the importance of communication with and involvement of healthcare professionals. Together the studies did however highlight that there is still limited awareness of BD in the community, especially in more socio-economic disadvantaged communities, and limited knowledge about what BD means and the implications for women. Importantly, BD information in the context of overall breast cancer risk has not yet been studied. Conclusions There are important gaps in the understanding of the impact of BD information or notification on women and how best to communicate BD information to women. More high-quality evidence to inform both current and future practice related to BD is still needed.

scholarly journals The impact of breast density notification on rescreening rates within a population-based mammographic screening program

2022 ◽  
Vol 24 (1) ◽  
Author(s):  
Sarah Pirikahu ◽  
Helen Lund ◽  
Gemma Cadby ◽  
Elizabeth Wylie ◽  
Jennifer Stone
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Breast Density ◽  
Screening Program ◽  
Population Based ◽  
Mammographic Screening ◽  
Younger Women ◽  
Screening Programs ◽  
The Impact

Abstract Background High participation in mammographic screening is essential for its effectiveness to detect breast cancers early and thereby, improve breast cancer outcomes. Breast density is a strong predictor of breast cancer risk and significantly reduces the sensitivity of mammography to detect the disease. There are increasing mandates for routine breast density notification within mammographic screening programs. It is unknown if breast density notification impacts the likelihood of women returning to screening when next due (i.e. rescreening rates). This study investigates the association between breast density notification and rescreening rates using individual-level data from BreastScreen Western Australia (WA), a population-based mammographic screening program. Methods We examined 981,705 screening events from 311,656 women aged 40+ who attended BreastScreen WA between 2008 and 2017. Mixed effect logistic regression was used to investigate the association between rescreening and breast density notification status. Results Results were stratified by age (younger, targeted, older) and screening round (first, second, third+). Targeted women screening for the first time were more likely to return to screening if notified as having dense breasts (Percentunadjusted notified vs. not-notified: 57.8% vs. 56.1%; Padjusted = 0.016). Younger women were less likely to rescreen if notified, regardless of screening round (all P < 0.001). There was no association between notification and rescreening in older women (all P > 0.72). Conclusions Breast density notification does not deter women in the targeted age range from rescreening but could potentially deter younger women from rescreening. These results suggest that all breast density notification messaging should include information regarding the importance of regular mammographic screening to manage breast cancer risk, particularly for younger women. These results will directly inform BreastScreen programs in Australia as well as other population-based screening providers outside Australia who notify women about breast density or are considering implementing breast density notification.

Impact of timeliness of breast radiotherapy on health outcomes in early breast cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6591-6591
Author(s):  
H. T. Gold ◽  
H. T. Do
Keyword(s):  
Breast Cancer ◽  
Health Outcomes ◽  
Cancer Patients ◽  
Early Breast Cancer ◽  
White Women ◽  
Disease Free Survival ◽  
Breast Cancer Patients ◽  
Post Surgery ◽  
Stage 1 ◽  
The Impact

6591 Background: The objective of this study is to understand the impact of timely radiotherapy on disease-free survival (DFS) in early breast cancer patients ages 65 and above. Methods: The study population is women diagnosed from 1991–1999 in the linked SEER-Medicare database who underwent breast-conserving surgery and radiotherapy within 6 months of diagnosis. Median followup varies from 4 years for ductal carcinoma in situ (DCIS)(n=1,185) to 5 years for Stage 1 disease (n=7,481), and ranges from 0–11 years. Descriptive and proportional hazards analysis of this longitudinal cohort were conducted. Covariates include age, race, poverty, marital status, comorbidity, rurality, radiation completion and delay, elapsed time since diagnosis, comedo necrosis histology (DCIS only), and chemotherapy receipt (Stage 1 only). Subjects were censored at end of followup (including enrolling in Medicare managed care from Medicare fee-for-service) or death. Treatment delay is defined as radiotherapy beginning 8+ weeks post-surgery without chemotherapy or 4+ weeks after chemotherapy ends; other definitions also were explored. Radiotherapy is considered complete if the patient received greater than 16/22 of expected treatments, based on scientific literature. Results: DFS is negatively associated with radiation delay (OR=1.24, p=0.003 for Stage 1; OR=1.40, p=0.054 for DCIS) and Klabunde's inpatient comorbidity index (OR=1.32, p=0.004 for Stage 1; OR=1.66, p=0.065 for DCIS). Additional analyses suggest that a longer delay of 12+ weeks post-surgery (16+ weeks post-chemotherapy) further reduces DFS (OR=4.66, p<0.0001 for Stage 1; OR=12.4, p<0.0001 for DCIS). Non-white women with Stage 1 disease are more likely to delay radiotherapy (p<0.0001), but are not more likely to have worse outcomes (p>0.3). Conclusions: Delayed initiation of radiation therapy is associated with decreased DFS following radiotherapy for early breast cancer and DCIS. Non-white race is associated with delay, but not reduced DFS. Programs targeting referring physicians and patients should be developed to promote timely receipt of radiotherapy by early breast cancer patients, thereby reducing the risk of adverse health outcomes. No significant financial relationships to disclose.

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