Perspectives of African American women about barriers to breast cancer prevention and screening practices: A qualitative study

Breast cancer is a severe illness that often has fatal consequences. Adherence to the recommendations for breast cancer surveillance is poorly practiced among African American women. The study aimed to identify barriers to preventative screening for breast cancer among African American women (AAW) using a qualitative research design. We explored the influence of personal barriers,stereotypes, socioeconomic status, culture, attitudes, and beliefs on African American women's behavior regarding breast cancer screening. Fourteen African American women were interviewed. Data analysis was completed with Interpretative Phenomenology Approach (IPA). This study's findings demonstrated that African American women perceived the barriers to breast cancer screening include lack of information about available resources, belief that screening cannot change genetic predisposition, embarrassment from exposing the breast for a mammogram, fear of mammograms, and fear of a positive result. These findings may be used to develop interventions to increase AAW's participation in breast cancer screening. (Afr J Reprod Health 2022; 26[7]: 22-28).

BREAST CANCER SCREENING: UPDATED RECOMMENDATIONS OF THE BRAZILIAN COLLEGE OF RADIOLOGY AND DIAGNOSTIC IMAGING, BRAZILIAN BREAST DISEASE SOCIETY, AND BRAZILIAN FEDERATION OF GYNECOLOGICAL AND OBSTETRICAL ASSOCIATIONS / Recomendações do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, da Sociedade Brasileira de Mastologia e da Federação Brasileira das Associações de Ginecologia e Obstetrícia para o rastreamento do câncer de mama

Objective: To present the current breast cancer screening guidelines in Brazil, as devised by the Brazilian College of Radiology and Diagnostic Imaging (CBR), the Brazilian Society for Breast Disease (SBM) and the Brazilian Federation of Gynecological and Obstetrical Associations (FEBRASGO). Methods: We analyzed scientific studies available in Medline and Lilacs databases. In the absence of evidence, the guidelines reflected the consensus opinion of an expert panel. Guidelines: Annual mammography screening is recommended for women aged 40­74 years. Among women aged 75 years or older, annual mammography screening should be reserved for those with an expected survival of 7 years or more. Complementary ultrasound should be considered for women with dense breasts. Complementary magnetic resonance imaging is recommended for women at high risk. When available, an advanced form of mammography known as tomosynthesis can be considered as a means of screening for breast cancer.

Objetivo: Apresentar as recomendações do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), da Sociedade Brasileira de Mastologia (SBM) e da Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO) para o rastreamento por imagem do câncer de mama no Brasil. Métodos: Foram analisados os estudos disponíveis nas bases científicas Medline e Lilacs. Na ausência de dados probatórios, as recomendações refletiram o consenso da comissão de especialistas. Recomendações: O rastreamento mamográfico anual é recomendado para as mulheres entre 40 e 74 anos. Acima de 75 anos deve ser reservado para as mulheres que tenham expectativa de vida maior que 7 anos. O rastreamento complementar com ultrassonografia deve ser considerado para as mulheres com mamas densas. O rastreamento complementar com ressonância magnética é recomendado para as mulheres com alto risco. A tomossíntese é uma forma de mamografia que pode ser considerada para o rastreamento do câncer de mama, quando disponível.

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

OBJECTIVE: To analyze participant factors that affect the diagnostic performance of screening mammography. MATERIALS AND METHODS: We enrolled 128756 cases from 10 hospitals between 2005 and 2010. We analyzed recall rate, cancer detection rate (CDR) per 1000 examinations, positive predictive value (PPV), sensitivity, specificity, false positive rate (FPR), and interval cancer rate (ICR) per 1000 negative examinations according to participant factors including age, breast density, and number of visit to the same institution, and adjusted for confounding variables. RESULTS: Increasing age improved recall rates (27.4% in 40's, 17.5% in 50's, 11.1% in 60's, and 8.6% in 70's), CDR (2.7, 3.2, 2.0, and 2.4), PPV (1.0, 1.8, 1.8, and 2.8%), sensitivity (81.3, 88.8, 90.3, and 94.7%), specificity (72.7, 82.7, 89.0, and 91.7%), and FPR (27.3, 17.3, 11.0, and 8.4%) (p < 0.05). Higher breast density impaired recall rates (4.0% in P1, 9.0% in P2, 28.9% in P3, and 27.8% in P4), PPV (3.3, 2.3, 1.2, and 1.3%), specificity (96.1, 91.2, 71.4, and 72.5%), and FPR (3.9, 8.9, 28.6, and 27.6%) (p < 0.001). It also increased CDR (1.3, 2.1, 3.3, and 3.6) and ICR (0.2, 0.3, 0.6, and 1.6) (p < 0.05). Successive visits to the same institution improved recall rates (20.9% for one visit, 10.7% for two visits, 7.7% for more than three visits), PPV (1.6, 2.8, and 2.7%), specificity (79.4, 89.6, and 92.5%), and FPR (20.6, 10.4, and 7.5%) (p < 0.001). CONCLUSION: Young age and dense breasts negatively affected diagnostic performance in mammography screening, whereas successive visits to the same institution had a positive effect. Examinee education for successive visits to the same institution would improve the diagnostic performance.

Principios Éticos y Prevención Cuaternaria: ¿es posible no proteger el ejercicio del principio de autonomía? / Princípios Éticos e Prevenção Quaternária: é possível não proteger o exercício do princípio da autonomia? / Ethical Principles and Quaternary Prevention: is it possible not to protect the exercise of the principle of autonomy?

Este artículo tiene como objetivo discutir los principios éticos y la Prevención Cuaternaria utilizando como ejemplo la política adoptada por el gobierno Uruguayo, que a partir del año 2006 obliga a realizar tamizaje para el cáncer de mama, mediante mamografías obligatorias cada dos años, a las trabajadoras entre los 40 y 59 años de edad. Actualmente existe una controversia internacional sobre la pertinencia de los programas de detección precoz del cáncer de mama, y surgen autores e instituciones advirtiendo sobre la tensión entre el ejercicio de la autonomía individual y un contexto que promueve cada vez más la medicalización de la vida. En este contexto es fundamental que los médicos de familia utilicen un abordaje individualizado que respete la autonomía de las personas.

Este artigo tem como objetivo discutir os princípios éticos e a Prevenção Quaternária utilizando como exemplo a política adotada pelo governo uruguaio que, a partir de 2006, obriga o rastreamento para câncer de mama, por meio de mamografias obrigatórias a cada dois anos, para mulheres trabalhadoras na faixa etária entre 40 e 59 anos. Atualmente há uma controvérsia internacional sobre a pertinência dos programas de detecção precoce para câncer de mama e surgem autores e instituições alertando sobre a tensão entre o exercício individual da autonomia em um contexto que promove cada vez mais medicalização da vida. Neste contexto, é fundamental que os médicos de família utilizem uma abordagem individualizada que respeite a autonomia das pessoas.

This article aims to discuss the ethical principles and Quaternary Prevention using a policy adopted by the Uruguayan government as example. This policy, which was created in 2006, instituted mass screening for breast cancer by means of compulsory mammography every two years, for women workers aged 40 to 59 years old. However, currently there is an international controversy over the relevance of breast cancer early detection programs, and some authors and institutions are raising concerns about the exercise of individual autonomy within a context that promotes the medicalization of life. In this context, it is fundamental that family physicians use an individualized approach that respects personal autonomy.

Correlation between image quality and radiation dose on screening mammography / 中华放射医学与防护杂志

Objective To obtain the matched parameters between image quality and radiation dose by exploring the influence of the exposure parameters of screening mammography on both the image quality and radiation dose.Methods The correlation between the exposure parameters and average glandular doses to 507 patients undergoing screening mammography were retrospectively analyzed.The influence of breast compression thickness on radiation dose by exposing different thickness of PMMA was obtained.The correlation with image quality was analyzed by combined testing of contrast detail test mode ( CDMAM3.4 )and different thickness of PMMAs.Results The groups aged 30 to 49 years were the main groups in 507examined patients,up to 67.06％ of the total.The mean value of average gland doses ( AGD ) in contrastprior mode was the highest in three kinds of exposure modes,accounting for 137.5％ of standard mode.In standard mode,target material/filtration board combination was Mo/Mo,Mo/Rh and Rh/Rh,accounting for 1/3 respectively.Mo/Rh and Rh/Rh were selected in dose-prior mode,accounting for 50％ respectively.Mo/Mo was mainly selected in contrast-prior,accounting for 52％.Breast compression thickness was positively correlated with average gland doses.Image quality figure inverse (IQFinv) under three kinds of modes (STD,DOSE,CNT) was 98.32,95.41 and 107.02,respectively,and IQFinv of contrast-prior mode was the highest among them.IQFinv was in general agreement in the three kinds of exposure modes when the thickness of PMMA plates plates was greater than or equal to 5 cm.Conclusions In clinical practice,when the breast is of density type and pressed thickness is less than 4 em,the dose-prior mode should be selected.When the pressed thickness is between 4 and 6 cm,the standard exposure mode should be selected.When the pressed thickness is larger than 6 cm,the manual mode should be selected.

Sensitivity and Specificity of Screening Mammographies and Ultrasonographies Performed in Women at Seven Health Promotion Centers for One year

PURPOSE: We wanted to evaluate the sensitivity and specificity of screening mammography and ultrasonography for breast examinations and we assessed the clinical usefulness of breast ultrasound for cancer screening. MATERIALS AND METHODS: Of all the women who visited the health promotion center of seven medical institutions from Mar 2004 to Feb 2005, we compared the sensitivity and specificity between a single use of mammography and mammography with ultrasonography for the patients who underwent both mammography and ultrasonography. Here, the reference criteria were the follow-up and the histopathology, which were performed after one year. RESULTS: A total of 1123 patients underwent both mammography and ultrasonography and they could be followed up for a year. For the 1123 patients who underwent both mammography and ultrasonography, the sensitivity and specificity of a single use of mammography were 14.3% and 86.9%, respectively. The sensitivity and specificity of mammography with ultrasonography were 85.7% and 85.9%, respectively. These results showed that the sensitivity was significantly increased when mammography was combined with ultrasonography (< 0.05). CONCLUSION: The sensitivity was improved for the cases that underwent both mammography and ultrasonography.

The Importance of Clinical Breast Examination for Cancer Detection in Asymptomatic Women / 한국유방암학회지

Of 489 asymptomatic women who were referred to our institute from other screening clinics, 46 were eventually proven to be breast cancer patients, and this number equated to 8.1% of the 565 breast cancer patients treated in our institute during the period of January 1997 to December 1998. Among the 46 cancer patients of the initial 489 asymptomatic women, twenty-five(54.35%) were detected by mammogram alone, six(13.04%) by clinical breast examination(CBE) alone, and the remaining 15(32.61%) by both mammogram and CBE. In context with age, the mammographic sensitivity for cancer detection was 100% for women aged over 60, 91% for 50s, 78.9% for 40s, and 75% for 30s, and inversely correlated with the patient's age. Among the 25 cancers detected by mammogram alone, 18(72%) belonged to DCIS or stage|. In contrast, four(66.7%) of six cancers detected by CBE alone and nine(60%) of 15 cancers by both CBE and mammography were included in stage II a or II b. However, the total incidence of early cancers(stage 0 and I) was significantly higher in the screening group than in the symptomatic group(P<0.01). These results suggest that the role of mammography is important in the detection of cancers in their earlier stage and CBE is helpful in reducing false negative results in breast cancer screening. In conclusion, film mammography is the best tool for the detection of microcalcification and is useful for the detection of earlier lesions, but is not perfect for the detection of breast cancer particularly in young women. A careful CBE is an essential part of breast screening in order to reduce false-negative results.

Clinical breast examination for screening of asymptomatic women: the importance of clinical breast examination for breast cancer detection

Of 489 asymptomatic women who were referred to our institute from other screening clinics, 46 were eventually proven to be breast cancer patients, and this number equated to 8.1% of the 565 breast cancer patients treated in our institute during the period of January 1997 to December 1998. Among the 46 cancer patients of the initial 489 asymptomatic women, twenty-five (54.35%) were detected by mammogram alone, six (13.04%) by clinical breast examination (CBE) alone, and the remaining 15 (32.61%) by both mammogram and CBE. In context with age, the mammographic sensitivity for cancer detection was 100% for women aged over 60, 91% for 50s, 78.9% for 40s, and 75% for 30s, and inversely correlated with the patient's age. Among the 25 cancers detected by mammogram alone, 18 (72%) belonged to DCIS or stage I. In contrast, four (66.7%) of six cancers detected by CBE alone and nine (60%) of 15 cancers by both CBE and mammography were included in stage IIa or IIb. However, the total incidence of early cancers (stages 0 and I) was significantly higher in the screening group than in the symptomatic group (p < 0.01). These results suggest that the role of mammography is important in the detection of cancers in their earlier stage and CBE is helpful in reducing false negative results in breast cancer screening. In conclusion, film mammography is the best tool for the detection of microcalcification and is useful for the detection of earlier lesions, but is not perfect for the detection of breast cancer particularly in young women. A careful CBE is an essential part of breast screening in order to reduce false-negative results.

Breast Cancer Detected by Screening Mammography / 대한암학회지

PURPOSE: The early detection of breast cancer by screening mammography is important to reduce breast cancer mortality rate. The purpose of this study was to investigate the characteristics of breast cancer patients detected by screening mammography. MATERIALS AND METHODS: Surgically treated 1,265 patients at Asan Medical Center from Jul. 1989 to Dec. 1997 were evaluated. Among them, 119 patients (9.4%) were detected by screening mammography. These patients were compared with clinically detected symptomatic breast cancer group. RESULTS: The characteristics of breast cancer patients detected by screening mammography were as follows: The most common finding of mammography was microcalcifications (62.2%); The less invasive or more conservative minimal and non-destructive surgical treatments such as breast conserving surgery (21.0%), simple mastectomy (8.4%), breast reconstruction (8.4%) were performed more frequently; The median tumor size of invasive cancers was 16 mm; Node-negative cancers (83.2%) were more frequent; The early breast cancer of stage 0 and I was 70.6%; DCIS (29.4%) was highly proportionated; and The 5-year overall (95.8%) and 5-year disease-free survival rate (92.0%) were significantly higher than in clinically detected symptomatic breast cancer patients. CONCLUSION: The screening mammography was significant for detecting non-palpable, early stage breast cancer. Ultrasonography was needed as an adjunct for the accurate detection in dense breast or young women. According to early detection, the 5-year survival rate was high.