Psychological considerations when attending for mammography screening

The pandemic led to a pause in routine breast screening in the UK, with up to one million not being offered appointments (Breast Cancer Now, Almost one million women in UK miss vital breast screening due to COVID-19, 2022). However, according to a Nuffield report, even before this, breast cancer screening in the UK had yet to reach its 'optimal performance standard of 80%' (Nuffield, Cancer screening-quality watch, 2022). In usual times, this has meant that with screening rates in excess of 70%, over two million women have been screened annually in the UK. However, breast cancer is also the most common cancer in women in the UK (Office for National Statistics, Cancer registration statistics, 2017), with 85% survival 5 years after diagnosis (Office for National Statistics, Cancer survival in England - adults diagnosed 2019) and it remains clear that screening can help reduce breast cancer mortality (Office for National Statistics, Cancer registration statistics, 2017). So why would 25% or more fail to accept an invitation for a routine mammogram which may ultimately help save their lives? This chapter considers a range of psychological factors relevant to understanding this phenomenon and hopefully bring about a positive change. © Springer Nature Switzerland AG 2015, 2022. All rights reserved.

Breast Cancer and SARS-Cov2: Lessons from a Pandemic.

BACKGROUND/AIM: The COVID-19 pandemic introduced drastic containment measures, which had a direct impact on breast cancer management. During the first wave, a delay in care and a decrease in new consultation numbers was observed. It would be interesting to study the resulting long-term consequences on breast cancer presentation and time to first treatment. PATIENTS AND METHODS: This retrospective cohort study was conducted at the surgery Department of the Anti-Cancer Center of Nice, France. Two periods of 6 months were compared: a pandemic period from June to December 2020 (after the end of the first wave), and a control period one year earlier. The primary endpoint was to measure the time to care access. The patients and cancer characteristics and the management type were also compared. RESULTS: A total of 268 patients underwent diagnosis for breast cancer in each period. The time from biopsy to consultation was shortened after the containment was lifted (16 days vs. 18 days, p=0.024). The time between first consultation and treatment was unchanged between the two periods. The tumor size was larger in the pandemic period (21 mm vs. 18 mm, p=0.028). The clinical presentation was different: 59.8% of patients consulted for a palpable mass in the pandemic period, vs. 49.6% in the control period (p=0.023). There was no significant change in therapeutic management. The use of genomic testing was significantly increased. The number of breast cancer cases diagnosed decreased by 30% during the first COVID-19 lockdown. Even though a rebound was expected after the first wave, the number of consultations for breast cancer remained constant. This finding shows the fragility of screening adherence. CONCLUSION: It is necessary to reinforce education in the face of crises that may be repeated. Management of breast cancer did not change, which is a reassuring aspect regarding the care pathway in anticancer centers.

Did the use of open invitations in place of timed appointment invitations reduce the uptake of breast screening in the London region during the COVID-19 recovery?

OBJECTIVE: The Covid-19 pandemic created a backlog of women awaiting an invitation for breast screening in the UK. To recover in a timely fashion, the National Health Service programme opted to issue open invitations (OI) to women rather than the standard pre-booked timed appointments (TA). Historically, OIs have been shown to result in lower uptake. The aim of this study was to make use of a natural experiment to compare uptake in groups sent an OI with those sent a TA during a period when both invitation methods were in use. METHODS: Women invited for routine screening at one of the six London breast screening services from September 2020 to March 2021 were included and grouped according to the type of invitation they had received (TA or OI). The outcome was attendance within 6 months of opening the screening episode. Data were analysed by logistic regression. RESULTS: During the period of the study, 78,192 (32.5%) women received a TA and 162,680 (67.5%) received an OI. In the TA group, 47,391 (60.6%) attended within six months of offered appointment and in the OI group 86,430 (53.1%) attended. This difference was significant (p < 0.001). The odds ratio (95% CI) for the attended outcome was 1.44 (1.33-1.55) adjusted for differences in deprivation and for invitation category (first invitation or subsequent invitation). CONCLUSIONS: This study supports the view that TA delivers a higher uptake than OI. It suggests that during this period over 12,000 women in London, who would have been expected to attend if given the standard TA, did not attend their appointment having received an OI.

Leadership in breast screening and the importance of appropriate communication during the early onset of the COVID-19 pandemic.

INTRODUCTION: In England, the NHS National Breast Screening Programme (NHSBSP) offers routine breast screening to all women, some trans men and non-bionary people, between the ages of 50 years and up to their 71 st birthday, every 3 years. The unfolding Covid-19 pandemic in early 2020 was understandably a time of great anxiety and concern. Culturally we were seeing strong behavioural shifts such as social distancing and a general change in all our daily life patterns. Conceptually, and as leaders, we understood the vulnerability we observed, but felt that we did not have the 'right language' and in fact lacked the relevant experience of how to address and communicate with staff and clients during this crisis. METHODS: A semiotic, observational research project was utilised that aimed at providing insight how cultural behaviour was being shaped and expressed during the early onset of the Covid-19 pandemic in England. The recommendations of the project were then integrated and implemented into an action plan and subsequent practice. RESULTS: Semiotic analysis revealed that several factors (positive and negative) impacted on peoples' confidence and had practical and emotional implications. Eleven main codes which are belief systems about oneself and others were identified and expressed in a multitude of different ways revealing three main themes or needs i.e. Reassurance, Trust and Clarity. An action plan was developed in response to the project findings and recommendation were implemented. CONCLUSIONS: Effective leadership relies on situational awareness. Our semiotic project enabled us to find the 'right' language and communication style so that we could connect with staff at the time of crisis. Using our own expert staff, we empowered them by providing the correct, easily digestible resources to facilitate confidence across the service teams which in turn supported the delivery of high-quality breast screening at a time of great uncertainty. IMPLICATION FOR PRACTICE: We must learn to be agile and adaptive, both in our operational delivery and our communication styles.

COVID-19 Vaccine-Associated Lymphadenopathy in Breast Imaging Recipients: A Review of Literature.

The unpredictability of the coronavirus disease 2019 (COVID-19) pandemic has created an ongoing global healthcare crisis. Implementation of a mass vaccination program to accelerate disease control remains in progress. Although injection site soreness, fatigue, and fever are the most common adverse reactions reported after a COVID-19 vaccination, ipsilateral lymph node enlargement has increasingly been observed. In patients undergoing routine screening and surveillance for breast cancer, interpreting lymphadenopathy (LAP) is challenging in the setting of a recent COVID-19 vaccination. With a growing proportion of the population receiving the vaccine, a multifaceted approach is necessary to avoid unnecessary and costly workup. In this comprehensive review, we summarize the existing literature on COVID-19 vaccine-associated LAP in breast imaging patients.

Phone-Based Breasts Self-Examination as an Intervention in Breast Cancer Control During the COVID-19 Pandemic.

Importance: Exploring methods to mitigate the effect of COVID-19 pandemic on routine cancer screening activities among women. Objective: To investigate the effectiveness of telephone-based outreach as a substitute for physical screening for breast among screened women, during COVID-19 lockdown. Design/Setting/Subjects: Asymptomatic women aged 30-59 years were screened for breast and cervix cancers in the Chennai region, between January 2017 and March 2020 and are due for screening follow-up. A database from the population-based cancer screening program organized by the Cancer Institute during the above period was used for the study. Outcome data were obtained through the period from October 2020 to March 2021. Intervention: Phone-based breast self-examination awareness, inquiry about breast cancer symptoms, and guiding clinical management. Outcome Measure: Compliance to BSE protocol after 8-16 weeks, presence of significant symptoms, and incidence of early breast cancer. Results: Among 12,242 screened women, 6716 (56.8%) responded to a phone-based BSE intervention and 53 women had breast-related symptoms. Thirty-two (60.4%) women reported for further evaluation, and five invasive breast cancers were identified. Conclusion and Relevance: In a low-resource setting where there are no existent screening programs, simple interventions like teaching breast self-examination of women through tele-counseling can result in early detection of breast cancers.

Recovery of the breast screening programme following pandemic-related delays: Should we focus on round length or uptake?

OBJECTIVES: The NHS Breast Screening programme is recovering from the hiatus in screening in 2020 due to the COVID-19 pandemic. Currently, open rather than timed invitations are issued, which leads to lower uptake but more rapid coverage of the eligible population by invitation and therefore closer adherence to a round length of 3 years. We aimed to estimate the likely effect on numbers of cancers detected at incident screens of a range of round lengths and uptake rates. METHODS: We assumed exponential distributions of time to incidence of preclinical screen-detectable cancer and of time to progression thereafter to symptomatic clinical disease. We derived numerical values of these, along with screening sensitivity, from published research results and statistics from the NHS Breast Screening programme. These were used to calculate numbers of cancers detected at incident screens at ages 51-70 by round length and uptake rates. RESULTS: We found that in a homogeneous population of cancers, a 4-year round length with uptake of 62%, as observed with timed appointments in London before the pandemic, would result in 295 cancers screen detected per 10,000 invited, compared to 222 cancers with a 3-year round and uptake of 46%, as observed in London during the recovery period. Similar results were found when we posited two populations, one of rapidly progressing and one of slowly progressing cancers. CONCLUSIONS: It may be more productive in terms of early detection to focus on uptake rather than round length in the programme's recovery from the pandemic.

The COVID-19 BreastScreen Department - beyond the pandemic.

The first wave of the COVID-19 pandemic in Australia forced a temporary closure of BreastScreen Australia services. Now reopened, the BreastScreen experience has been redefined for both staff and clients and the journey to the 'new BreastScreen normal' is continually evolving in response to the ongoing threat of COVID-19 and government directives on health policy. Many changes mirror those undertaken in the wider community and emphasise wellness to attend, hygiene and social distancing. Importantly, radiographers have been identified as having a high-risk role and have had to modify positioning techniques and cleaning regimes accordingly. Beyond the pandemic, the 'new normal' needs to be one which enables well women to continue screening with a visible sense of reassurance that all that can be done is being done to ensure the safe and continued early detection of breast cancer.