Behavior of Japanese women after being informed about the benefits and disadvantages of breast cancer screening: a questionnaire survey.

BACKGROUND: The US Preventative Services Task Force assessed the efficacy of breast cancer screening according to the sum of its benefits and disadvantages. We estimate that the balance of the benefits and disadvantages varies among women depending on their demographic background. METHODS: Between March 2016 and March 2017, we conducted a questionnaire survey among Japanese women who underwent population-based or opportunistic breast cancer screening at our multicenter institutions. We investigated the behavior modification among women after being informed about the benefits and disadvantages of breast cancer screening depending on their demographic background. RESULTS: Out of 3032 questionnaires that were returned, 2936 (96.8%) were evaluated. The percentage of women with prior knowledge about the benefits and disadvantages of breast cancer screening before reading the leaflets that we created was 24%. However, 95% of the women were willing to undergo screening next time, despite knowing the disadvantages. Regarding overdiagnosis, the young women tended to choose usual treatment, and the elderly women tended to choose active surveillance. In response to the question on the significance of screening, the young women wished to avoid death by breast cancer; whereas, the elderly women wished to live a safe life. CONCLUSION: Our results indicate that the information of disadvantages does not lead to a reduction in screening rates. Additionally, we found that the balance between the benefits and disadvantages of breast cancer screening varies among women depending on their demographic background, especially age.

Patients' view of routine follow-up after breast cancer treatment.

BACKGROUND: To assess emotional distress, anxiety and stress reactions in breast cancer (BC) patients before the follow-up visits. STUDY DESIGN: Between September 2009 and December 2011 a total of 284 patients completed the BC-psychosocial assessment screening scale (PASS) and a questionnaire about their views of follow-up after treatment for BC. RESULTS: Of the patients 64% reported low level of distress on the BC-PASS. The mean scores on the physical well-being scale was 5.3, the satisfaction/sense of coherence scale 7.4, and the emotional distress scale 8.1. Women rated mammography as the most important component (71%), followed by breast ultrasound (63%) and the consultation with the physician (60%). Of the patients 94% were satisfied with the current follow-up regimen. CONCLUSIONS: In this series BC patients were satisfied with their aftercare. Mammography was thought to be the most important component of aftercare. Patient-reported outcomes should be taken into account when planning follow-up.

Knowledge of Density and Screening Ultrasound.

To determine breast density awareness and attitudes regarding supplemental breast ultrasound screening since implementation of the nation's first breast density notification law, Connecticut Public Act 09-41. A self-administered survey was distributed at a Connecticut academic breast imaging center between February 2013 and February 2014. Women with prior mammography reports describing heterogeneous or extremely dense breast tissue were invited to participate when presenting for screening mammography, screening ultrasound, or both. Data were collected on breast density awareness, history of prior ultrasounds, attitudes toward ultrasound and breast-cancer risk, and demographics. Data were collected from 950 completed surveys. The majority of surveyed women (92%) were aware of their breast density, and 77% had undergone a prior screening ultrasound. Forty-three percent of participants who were aware of their breast density also expressed increased anxiety about developing breast cancer due to having dense breast tissue. Caucasian race and higher education were significantly associated (p < 0.05) with knowledge of personal breast density (93% and 95%, respectively) and having a prior screening breast ultrasound (79% and 80%, respectively). Patients with less than a college degree (82%) were significantly more likely to rely exclusively on their provider's recommendation regarding obtaining screening ultrasound (p < 0.05). Breast density awareness is strongly associated with higher education, higher income, and Caucasian race. Non-Caucasian patients and those with less than a college education rely more heavily on their physicians' recommendations regarding screening ultrasound. Among women aware of their increased breast density, nearly half reported associated increased anxiety regarding the possibility of developing breast cancer.

Harms of Breast Cancer Screening: Systematic Review to Update the 2009 U.S. Preventive Services Task Force Recommendation.

BACKGROUND: In 2009, the U.S. Preventive Services Task Force recommended biennial mammography screening for women aged 50 to 74 years and selective screening for those aged 40 to 49 years. PURPOSE: To review studies of screening in average-risk women with mammography, magnetic resonance imaging, or ultrasonography that reported on false-positive results, overdiagnosis, anxiety, pain, and radiation exposure. DATA SOURCES: MEDLINE and Cochrane databases through December 2014. STUDY SELECTION: English-language systematic reviews, randomized trials, and observational studies of screening. DATA EXTRACTION: Investigators extracted and confirmed data from studies and dual-rated study quality. Discrepancies were resolved through consensus. DATA SYNTHESIS: Based on 2 studies of U.S. data, 10-year cumulative rates of false-positive mammography results and biopsies were higher with annual than biennial screening (61% vs. 42% and 7% vs. 5%, respectively) and for women aged 40 to 49 years, those with dense breasts, and those using combination hormone therapy. Twenty-nine studies using different methods reported overdiagnosis rates of 0% to 54%; rates from randomized trials were 11% to 22%. Women with false-positive results reported more anxiety, distress, and breast cancer-specific worry, although results varied across 80 observational studies. Thirty-nine observational studies indicated that some women reported pain during mammography (1% to 77%); of these, 11% to 46% declined future screening. Models estimated 2 to 11 screening-related deaths from radiation-induced cancer per 100,000 women using digital mammography, depending on age and screening interval. Five observational studies of tomosynthesis and mammography indicated increased biopsies but reduced recalls compared with mammography alone. LIMITATIONS: Studies of overdiagnosis were highly heterogeneous, and estimates varied depending on the analytic approach. Studies of anxiety and pain used different outcome measures. Radiation exposure was based on models. CONCLUSION: False-positive results are common and are higher for annual screening, younger women, and women with dense breasts. Although overdiagnosis, anxiety, pain, and radiation exposure may cause harm, their effects on individual women are difficult to estimate and vary widely. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.

Intrinsic motivation factors based on the self-determinant theory for regular breast cancer screening.

The purpose of this study was to identify factors of intrinsic motivation that affect regular breast cancer screening and contribute to development of a program for strategies to improve effective breast cancer screening. Subjects were residing in South Korea Gangwon-Province and were female over 40 and under 69 years of age. For the investigation, the Intrinsic Motivation Inventory (IMI) was modified to the situation of cancer screening and was used to survey 905 inhabitants. Multinominal logistic regression analyses were conducted for regular breast cancer screening (RS), one-time breast cancer screening (OS) and non-breast cancer screening (NS). For statistical analysis, IBM SPSS 20.0 was utilized. The determinant factors between RS and NS were "perceived effort and choice" and "stress and strain" - internal motivations related to regular breast cancer screening. Also, determinant factors between RS and OS are "age" and "perceived effort and choice" for internal motivation related to cancer screening. To increase regular screening, strategies that address individual perceived effort and choice are recommended.

Adjunct ultrasonography for breast cancer screening in women at average risk: a systematic review.

BACKGROUND: Screening with mammography has the ability to detect breast cancer at an early stage but misses some cancers. Supporters of adjunct ultrasonography to the screening regimen argue that it might be a safe and inexpensive approach to reduce the false-negative rates of screening. Critics are concerned that adjunct ultrasonography will also increase the rate of false-positive findings and can lead to unnecessary biopsies and treatments in women at average risk. AIMS: The purpose of this review was to systematically assess the comparative benefits and harms of mammography with adjunct breast ultrasonography and mammography only in breast cancer screening. METHODS: We searched multiple electronic databases and the Cochrane Breast Cancer Group's Specialised Register (from 1995 to February 2012). To detect ongoing or unpublished studies, we searched trial registries and multiple sources of grey literature. Two researchers independently reviewed all abstracts and full-text articles against pre-defined eligibility criteria. We dually rated the risk of bias of studies and the strength of evidence based on established guidance. RESULTS: We did not detect any controlled studies that provide evidence for (or against) the use of adjunct ultrasonography for screening in women at average risk for breast cancer. Extrapolations of results from women at elevated risk for breast cancer indicate that the false-positive rates in women at average risk who were recalled because of positive ultrasonographies will exceed 98%. In women with dense or very dense breast tissue, the evidence regarding the use of adjunct ultrasonography is not conclusive. CONCLUSIONS: No methodologically sound evidence is available justifying the routine use of ultrasonography as an adjunct screening tool in women at average risk for breast cancer. IMPLICATIONS FOR PRACTICE: Clinicians should not use ultrasonography as a screening tool for breast cancer screening on a routine basis. The use should be limited to women with dense breasts for whom the accuracy of mammography is low, or for diagnostic purposes.

Who's the doctor? Patients' perceptions of the role of the breast radiologist: a lesson for all radiologists.

OBJECTIVE: The aim of this study was to explore patients' perceptions of the role of the radiologist in their care. METHODS: The questionnaire used was designed in conjunction with a psychologist who had an interest in oncology, and piloted. The final questionnaires were distributed to patients attending the breast clinic at St James's Hospital, Dublin, Ireland, from 1 March to 1 July 2011. Patients requiring imaging (mammography and/or ultrasound) were asked to complete the same questionnaire again after imaging procedures were performed. Paired t-tests were used to assess for changes in parameters, including ranking of members of the breast care team in order of perceived importance and levels of anxiety pre and post consultation with the radiologist. RESULTS: 306 patients were recruited. 76% of patients thought that radiologists were radiographers and only 14% knew that radiologists were medical doctors. Nearly 40% of patients did not consider that radiologists had a role to play in their care. There was no statistically significant difference in the ranking of team members pre and post consultation. There was a significant improvement in patient anxiety levels after consultation with the breast radiologist, which is likely to be due to the patient learning the outcome of tests performed. CONCLUSION: There is a lack of awareness amongst patients and amongst our colleagues in paramedical disciplines regarding the roles and responsibilities of the modern radiologist. ADVANCES IN KNOWLEDGE: Radiology must act to increase public awareness so that future changes in the health service will reflect the scope and importance of the speciality.

Perception of care and experience of examination in women at risk of breast cancer undergoing intensive surveillance by standard imaging with or without MRI.

OBJECTIVE: Intensive surveillance in women at breast cancer risk is currently investigated in a French prospective, non-randomized, multicenter study, in which standard imaging--mammography±ultrasound ('Mx') and standard imaging combined with magnetic resonance imaging ('MRI') are compared with regard to perception of care and examination experience. METHODS: 1561 women were invited to complete the STAI-State Anxiety Inventory and breast cancer risk perception items at baseline (T0), and MGQ (MammoGraphy Questionnaire) and MRI discomfort items within 2 days after examinations (T1). RESULTS: Baseline compliance was high (>91%). Women from the 'MRI' group were significantly younger and displayed higher education level and risk perception. MRI discomfort related to the duration, immobility, prone position or noise was experienced by more than 20% of women. In multivariate analyses, 'MRI' was associated with more favorable examination psychological experience (p≤.001), especially in women younger than 50; baseline STAI-State anxiety was associated with lower MGQ scores (p≤.001) and higher MRI discomfort (p≤.001). CONCLUSION: In spite of the discomfort experienced with MRI, perception of care and experience with this surveillance procedure was more positive than with standard imaging. PRACTICE IMPLICATIONS: Information and support may assuage some of the adverse effects of an uncomfortable examination technique.

Compliance with screening mammography and breast sonography of young Asian women.

OBJECTIVE: We evaluated compliance with mammography and breast sonography and the factors related to compliance. STUDY DESIGN: From August 2005 through July 2006, 1239 asymptomatic women, aged 40-49 years, were enrolled in the study. Compliance in the second year was calculated. Telephone interviews examined the impact of the women's experience during mammography or sonography on adherence to rescreening. RESULTS: The rates of compliance with mammography and sonography for breast cancer screening were 73.5% and 80.1%, respectively (p=0.006). More women receiving mammography (12.2%) reported unsatisfactory results (BI-RADS category 0) than those undergoing sonography (6.2%) (p<0.001). During the telephone interview, 74.9% of the women complained of pain during mammography, but none (0%) during sonography (p<0.001); 69.8% felt embarrassed during mammography and 55.6% during sonography (p<0.001). Multivariate logistic regression analysis showed that pain (OR 0.096, 95% CI 0.044-0.213) and unsatisfactory examination results (BI-RADS category 0) (OR 0.042, 95% CI 0.020-0.090) were barriers to not following up mammography. Embarrassment (OR 0.645, 95% CI 0.419-0.994) and unsatisfactory examination results (OR 0.169, 95% CI 0.085-0.336) were barriers to not following up sonography. CONCLUSIONS: For young Asian women with dense breast tissue, compliance with sonography for breast cancer screening was better than that with mammography.

Patient experiences and preferences: development of practice guidelines in a cancer imaging department.

OBJECTIVE: To improve patient management based on analysis of the results of a survey conducted during their visit to the imaging department of a cancer centre. MATERIALS AND METHODS: A questionnaire comprising 30 single-response questions on a dichotomous scale or a 3- or 4-modality scale was developed by three radiologists specialized in oncology, the head of our quality assurance department, a psycho-oncologist, a psycho-sociologist, a biostatistician and a member of our institute's Patient Committee. Questions concerned reception, information provided about the examinations, examination experiences, the relational qualities and availability of health care professionals, the interview with the radiologist and announcement of the examination results. RESULTS: The questionnaire was given to 190 patients in the waiting room before a standard radiography or ultrasound examination (33%), mammography and breast ultrasound (33%), computed tomography (CT) or magnetic resonance imaging (MRI) (34%). The return rate was 81%. This article analyses the responses to the various questions in terms of either percentages or detailed replies and suggestions. CONCLUSION: Analysis of the patients' experience and their suggestions provided objective elements concerning their real wishes in relation to each step of their management and identified changes and improvements to be made to the organization and daily functioning of the department.

European guidelines for quality assurance in breast cancer screening and diagnosis. Fourth edition--summary document.

Breast cancer is a major cause of suffering and death and is of significant concern to many women. Early detection of breast cancer by systematic mammography screening can find lesions for which treatment is more effective and generally more favourable for quality of life. The potential harm caused by mammography includes the creation of unnecessary anxiety and morbidity, inappropriate economic cost and the use of ionising radiation. It is for this reason that the strongest possible emphasis on quality control and quality assurance is required. Development of the European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis has been an initiative within the Europe Against Cancer Programme. The fourth edition of the multidisciplinary guidelines was published in 2006 and comprises approximately 400 pages divided into 12 chapters prepared by >200 authors and contributors. The multidisciplinary editorial board has prepared a summary document to provide an overview of the fundamental points and principles that should support any quality screening or diagnostic service. This document includes a summary table of key performance indicators and is presented here in order to make these principles and standards known to a wider scientific community.