Incidental Breast Cancer on Chest CT: Is the Radiology Report Enough?

OBJECTIVE: To determine the frequency of incidental breast findings reported on chest CT for which breast imaging follow-up is recommended, the follow-up adherence rate, and the breast malignancy rate. The relationship between strength of recommendation verbiage and follow-up was also explored. METHODS: A retrospective review was conducted of chest CT reports from July 1, 2018, to June 30, 2019, to identify those with recommendation for breast imaging follow-up. Patients with recently diagnosed or prior history of breast malignancy were excluded. Medical records were reviewed to evaluate patient adherence to follow-up, subsequent BI-RADS assessment, and diagnosis (if tissue sampling performed). Adherence was defined as diagnostic breast imaging performed within 6 months of CT recommendation. Chi-square and Mann-Whitney U tests were used to determine statistical significance of categorical and continuous variables, respectively. RESULTS: A follow-up recommendation for breast imaging was included in chest CT reports of 210 patients; 23% (48/210) returned for follow-up breast imaging. All patients assessed as BI-RADS 4 or 5 underwent image-guided biopsy. Incidental breast cancer was diagnosed in 15% (7/48) of patients who underwent follow-up breast imaging as a result of a CT report recommendation and 78% (7/9) of patients undergoing biopsy. There was no significant difference in follow-up adherence when comparing report verbiage strength. CONCLUSION: It is imperative that incidental breast findings detected on chest CT undergo follow-up breast imaging to establish accurate and timely diagnosis of breast malignancy. Outreach to referring providers and patients may have greater impact on the diagnosis of previously unsuspected breast cancer.

Youth and Adult Visitation and Physical Activity Intensity at Rural and Urban Parks.

Less physical activity among rural residents may contribute to rural-urban health disparities. Parks can be ideal community resources for promoting physical activity. This study compared park visitation and activity intensity at 15 urban and 15 rural parks matched for acreage and amenities. Parks were observed in the morning, afternoon, and evening on 4 days to determine number of visitors, activity intensity, and amenity use. A total of 5486 visitors were observed with no differences in percentages of males (55.5% vs. 53.9%) and females (44.5% vs. 46.1%) or percentages of weekday (82.4% vs. 81.9%) and weekend (17.6% vs. 18.1%) visitors. The probability of visitors sitting was greater and in moderate intensity activity lower at rural parks. A greater proportion of children (25.0% vs. 14.5%) in rural parks, and teens in urban parks (8.0% vs. 69.6%), were observed on sport fields. A greater proportion of adults in urban areas (12.5% vs. 46.0%) were observed spectating sports. Greater proportions of rural children (10.9% vs. 3.5%), teens (34.1% vs. 12.4%), and adults (38.9% vs. 10.1%) were observed using shelters. Thus, when similar amenities are available, rural and urban parks are used differently, especially by youth. The urban park study results cannot be wholly applied to rural parks.

Park-like campus settings and physical activity.

OBJECTIVE: Similar to parks, college campuses may promote physical activity. The purpose of this study was to compare the physical activity of adults at urban campuses and parks. PARTICIPANTS: Participants were individuals observed on campuses and parks in April 2011. METHODS: The System for Observing Play and Recreation in Communities was used to assess physical activity at 3 campuses and parks, 3 times/day, for 4 days. RESULTS: Greater proportions of individuals (parks, campuses) were observed in vigorous (28.7%, 11.9%) and sedentary (25%, 18.3%) activities at parks than campuses and a greater proportion observed in walking (69.8%, 46.3%) intensity on campuses than parks. More men than women were observed at both parks and campuses, and paths and sport courts were most frequently used for physical activity. CONCLUSIONS: Physical activity intensities differ across college campuses and parks that provided similar physical activity amenities. Efforts should focus on increasing awareness of outdoor campus amenities that promote physical activity and understanding the outdoor amenities that of promote physical activity of women.

A microenvironment approach to reducing sedentary time and increasing physical activity of children and adults at a playground.

OBJECTIVE: Test whether a micro-environment park intervention in Grand Forks, North Dakota, movement of seating away from a playground, would increase the physical activity and length of stay of park users. METHOD: Study 1, summer 2012: physical activity of children and adults was assessed during baseline (A1) with seating in usual, standardized locations; with seating removed from the playground (B); and with seating returned to original locations (A2). Study 2, summer 2013: the study was repeated with the inclusion of a daily 2-hour assessment during which activity of each family member was recorded every 15-min and length of stay was recorded. RESULTS: For both studies, the MET (metabolic equivalent) intensity was greater (p<0.02) during condition B than during A1 and A2. For adults, the odds of being in moderate-to-vigorous physical activity than sitting during condition B were 4.1 to 22.7 greater than those during conditions A1 and A2. During the 2-hour serial observations, MET intensities during condition B were greater (p<0.005) than those during A1 and A2. The duration families stayed at the park did not differ across conditions. CONCLUSION: Adults were more active when seating was not accessible. Removal of seating did not shorten the time that adults were willing to allow children to play.