Estimating Distributions of Breast Cancer Onset and Growth in a Swedish Mammography Screening Cohort

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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Comment on: ‘Screening’ for Breast Cancer: Misguided Research Misinforming Public Policies, by O. S. Miettinen

Epidemiologic Methods ◽

10.1515/em-2015-0022 ◽

2015 ◽

Vol 4 (1) ◽

Author(s):

Karin Huwiler ◽

Beat Thürlimann ◽

Thomas Cerny ◽

Marcel Zwahlen

Keyword(s):

Breast Cancer ◽

Early Detection ◽

Mammography Screening ◽

Public Policies ◽

Medical Board

AbstractOur commentary of the article “‘Screening’ for Breast Cancer: Misguided Research Misinforming Public Policies” has two main parts. First we address some of the methodological points raised by Professor Miettinen. Then we review more specific aspects of the Swiss Medical Board statement on mammography screening for early detection of breast cancer.

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Mammography screening for breast cancer—the UK Age trial – Authors' reply

The Lancet Oncology ◽

10.1016/s1470-2045(20)30627-6 ◽

2020 ◽

Vol 21 (11) ◽

pp. e510

Author(s):

Stephen W Duffy ◽

Peter D Sasieni

Keyword(s):

Breast Cancer ◽

Mammography Screening ◽

The Uk

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Trends in Breast Cancer Mortality in Sweden before and after Implementation of Mammography Screening

PLoS ONE ◽

10.1371/journal.pone.0022422 ◽

2011 ◽

Vol 6 (9) ◽

pp. e22422 ◽

Cited By ~ 16

Author(s):

Jari Haukka ◽

Graham Byrnes ◽

Mathieu Boniol ◽

Philippe Autier

Keyword(s):

Breast Cancer ◽

Cancer Mortality ◽

Mammography Screening ◽

Breast Cancer Mortality ◽

Before And After

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Comparison of handheld ultrasound and automated breast ultrasound in women recalled after mammography screening

Acta Radiologica ◽

10.1177/0284185116665421 ◽

2016 ◽

Vol 58 (5) ◽

pp. 515-520 ◽

Cited By ~ 7

Author(s):

Roxanna Hellgren ◽

Paul Dickman ◽

Karin Leifland ◽

Ariel Saracco ◽

Per Hall ◽

...

Keyword(s):

Breast Cancer ◽

Mammography Screening ◽

Breast Ultrasound ◽

Breast Volume ◽

Large Area ◽

Mammographic Finding ◽

Automated Breast Volume Scanner ◽

Handheld Ultrasound ◽

Study Population ◽

Automated Breast Ultrasound

Background Automated breast volume scanner (ABVS) is an ultrasound (US) device with a wide scanner that sweeps over a large area of the breast and the acquired transverse images are sent to a workstation for reconstruction and review. Whether ABVS is as reliable as handheld US is, however, still not established. Purpose To compare the sensitivity and specificity of ABVS to handheld breast US for detection of breast cancer, in the situation of recall after mammography screening. Material and Methods A total of 113 women, five with bilateral suspicious findings, undergoing handheld breast US due to a suspicious mammographic finding in screening, underwent additional ABVS. The methods were assessed for each breast and each detected lesion separately and classified into two categories: breasts with mammographic suspicion of malignancy and breasts with a negative mammogram. Results Twenty-six cancers were found in 25 women. In the category of breasts with a suspicious mammographic finding (n = 118), the sensitivity of both handheld US and ABVS was 88% (22/25). The specificity of handheld US was 93.5% (87/93) and ABVS was 89.2% (83/93). In the category of breasts with a negative mammography (n = 103), the sensitivity of handheld US and ABVS was 100% (1/1). The specificity of handheld US was 100% (102/102) and ABVS was 94.1% (96/102). Conclusion ABVS can potentially replace handheld US in the investigation of women recalled from mammography screening due to a suspicious finding. Due to the small size of our study population, further investigation with larger study populations is necessary before the implementation of such practice.

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