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The associations of certain factors, such as age and menopausal hormone therapy, with breast cancer risk are known to differ for interval and screen‐detected cancers. However, the extent to which associations of other established breast cancer risk factors differ by mode of detection is unclear. We investigated associations of a wide range of risk factors using data from a large UK cohort with linkage to the National Health Service Breast Screening Programme, cancer registration, and other health records. We used Cox regression to estimate adjusted relative risks (RRs) and 95% confidence intervals (CIs) for associations between risk factors and breast cancer risk. A total of 9421 screen‐detected and 5166 interval cancers were diagnosed in 517,555 women who were followed for an average of 9.72 years. We observed the following differences in risk factor associations by mode of detection: greater body mass index (BMI) was associated with a smaller increased risk of interval (RR per 5 unit increase 1.07, 95% CI 1.03–1.11) than screen‐detected cancer (RR 1.27, 1.23–1.30); having a first‐degree family history was associated with a greater increased risk of interval (RR 1.81, 1.68–1.95) than screen‐detected cancer (RR 1.52, 1.43–1.61); and having had previous breast surgery was associated with a greater increased risk of interval (RR 1.85, 1.72–1.99) than screen‐detected cancer (RR 1.34, 1.26–1.42). As these differences in associations were relatively unchanged after adjustment for tumour grade, and are in line with the effects of these factors on mammographic density, they are likely to reflect the effects of these risk factors on screening sensitivity. [ABSTRACT FROM AUTHOR]

Primary breast lymphoma (PBL) is a rare malignant lymphoid neoplasm limited to the breast, accounting for about 0.15% of all malignant breast tumors and 1.7% to 2.2% of extra-nodal lymphomas. PBL must be distinguished from conventional breast carcinomas due to different therapeutic approaches. A 25-year-old female presented with a left breast mass. Histopathology and immunohistochemical tests confirmed the diagnosis of diffuse large B-cell lymphoma (DLBCL). She had no similar lesions elsewhere in the body. She received 1 cycle of R-CHOP chemotherapy but absconded from the treatment and succumbed afterward while at home. Recent developments in DLBCL treatment have greatly improved patient outcomes by incorporating targeted medicines like rituximab, increased chemotherapy regimens, new drugs, and individualized treatment techniques. PBL appears to have a worse prognosis; thus, delay or abscondment from treatment is of serious concern when it comes to improving the prognosis of patients with PBL. [ABSTRACT FROM AUTHOR]

Background: Although DBT is the standard initial imaging modality for women with focal breast symptoms, the importance of ultrasound has grown rapidly in the past decades. Therefore, the Breast UltraSound Trial (BUST) focused on assessing the diagnostic value of ultrasound and digital breast tomosynthesis (DBT) for the evaluation of breast symptoms by reversing the order of breast imaging; first performing ultrasound followed by DBT. This side-study of the BUST evaluates patients' perceptions of ultrasound and DBT in a reversed setting. Methods: After imaging, 1181/1276 BUST participants completed a survey consisting of open and closed questions regarding both exams (mean age 47.2, ±11.74). Additionally, a different subset of BUST participants (n = 29) participated in six focus group interviews 18–24 months after imaging to analyze their imaging experiences in depth. Results: A total of 55.3% of women reported reluctance to undergoing DBT, primarily due of pain, while the vast majority also find bilateral DBT reassuring (87.3%). Thematic analysis identified themes related to 1) imaging reluctance (pain/burden, result, and breast harm) and 2) ultrasound and DBT perceptions. Regarding the latter, the theme comfort underscores DBT as burdensome and painful, while ultrasound is largely perceived as non-burdensome. Ultrasound is also particularly valued for its interactive nature, as highlighted in the theme interaction. Perceived effectiveness reflects women's interest in bilateral breast evaluation with DBT and the visibility of lesions, while they express more uncertainty about the reliability of ultrasound. Emotional impact portrays DBT as reassuring for many women, whereas opinions on the reassurance provided by ultrasound are more diverse. Additional themes include costs, protocols and privacy. Conclusions: Ultrasound is highly tolerated, and particularly valued is the interaction with the radiologist. Nearly half of women express reluctance towards DBT; nevertheless, a large portion report feeling more confident after undergoing bilateral DBT, reassuring them of the absence of abnormalities. Understanding patients' perceptions of breast imaging examinations is of great value when optimizing diagnostic pathways. [ABSTRACT FROM AUTHOR]

Background: Several image-based diagnostic methods have been developed to examine the features of breast lesions among women, while the value of combining palpation imaging and ultrasound by a bimodal breast examination system is still unknown. Methods: A real-world study was conducted among 424 patients who visited Fujian Maternal and Child Health Hospital and Fujian Obstetrics and Gynecology Hospital, and used the Bimodal Breast Exam (BBE) systems which combines palpation imaging and ultrasound imaging. Among them, 97 patients had additional ultrasound, mammogram, or pathological examination. These patients were used to evaluate the consistency and efficacy of the BBE in interpreting the features of breast lesions as compared to results of ultrasound, mammogram, and pathological examinations. Results: The BBE system detected 1517 lesions with palpation imaging, 1126 lesions with ultrasound examination (950 solid lesions and 176 cysts), and 391 non mass lesions. Among them, 404 patients were diagnosed as benign and 20 were diagnosed as malignant tumor. However, 12, 9 and 4 cases were diagnosed as malignant tumors by ultrasound, mammogram and pathological examination, respectively. Compared with the integrative results of ultrasound, mammogram and pathology, the sensitivity of BBE is 55.6%, and the specificity is 90.9%, with a kappa coefficient of 0.387 (0.110, 0.665), indicating moderate consistency. Conclusions: In clinical practice, BBE can be used to evaluate features of breast lesions with a high specificity. The diagnostic efficacy is comparable to the integrative results of ultrasound, mammography, and pathological examination. [ABSTRACT FROM AUTHOR]

Patients use the internet to learn more about health conditions. Non-English–speaking patients may face additional challenges. The quality of online breast cancer information, the most common cancer in women, is uncertain. This study aims to examine the quality of online breast cancer information for English and non-English–speaking patients. Three search engines were queried using the terms: "how to do a breast examination," "when do I need a mammogram," and "what are the treatment options for breast cancer" in English, Spanish, and Chinese. For each language, 60 unique websites were included and classified by type and information source. Two language-fluent reviewers evaluated website quality using the Journal of American Medical Association benchmark criteria (0-4) and the DISCERN tool (1-5), with higher scores representing higher quality. Scores were averaged for each language. Health On the Net code presence was noted. Inter-rater reliability between reviewers was assessed. English and Spanish websites most commonly originated from US sources (92% and 80%, respectively) compared to Chinese websites (33%, P < 0.001). The most common website type was hospital-affiliated for English (43%) and foundation/advocacy for Spanish and Chinese (43% and 45%, respectively). English websites had the highest and Chinese websites the lowest mean the Journal of American Medical Association (2.2 ± 1.4 versus 1.0 ± 0.8, P = 0.002) and DISCERN scores (3.5 ± 0.9 versus 2.3 ± 0.6, P < 0.001). Health On the Net code was present on 16 (8.9%) websites. Inter-rater reliability ranged from moderate to substantial agreement. The quality of online information on breast cancer across all three languages is poor. Information quality was poorest for Chinese websites. Improvements to enhance the reliability of breast cancer information across languages are needed. [ABSTRACT FROM AUTHOR]

Objective: Although breast magnetic resonance imaging (MRI) is a valuable screening tool, breast MRI testing burden was associated with cancer worry and quality of life. We aimed to develop and validate the MRI‐related distress scale (MRI‐DS) to assess comprehensive distress specifically related to breast MRI. Methods: We enrolled women aged above 18 years, diagnosed breast cancer, had MRI examination at least one time, and who could speak and read Korean in phase I and enrolled women aged above 18 years, visited outpatient clinic of breast general surgery, had undergone MRI examination at least once, and could speak and read Korean in phase II. We excluded patients who had any physical or psychiatric conditions in both phases. We recruited from a tertiary university‐based hospital in South Korea between April and August 2023. Results: All 18 items had acceptable levels of item correlation (≥0.30) in the explanatory factor analysis with a four‐factor solution. The fit indices for the four‐factor solution model were good. The discriminant validity of the MRI‐DS had a moderate correlation with general anxiety or quality of life. In the known‐group analysis, those who reported MRI as the most burden breast examination had higher total scores. Conclusion: The validity of the MRI‐DS has been confirmed as a scale for measuring the specific distress caused by breast MRI. The MRI‐DS is recommended to health professional to communicate with patients with MRI. Clinical Implications: It can be used to assess the distress associated with MRI screening in breast cancer patients. Physician could use MRI‐DS to discuss the reasons for distress caused by breast MRI screening and to address specific sources of discomfort associated with it. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess ethnic inequalities in the coverage and utilization of cancer screening services among women in Peru. Methods: Data from the 2017–2023 Demographic and Family Health Survey in Peru were analyzed to evaluate ethnic disparities in screening coverage for breast and cervical cancer, including clinical breast examination (CBE), Pap smear test (PST), and mammography. Measures such as the GINI coefficient and Slope Index of Inequality (SII) were used to quantify coverage and utilization disparities among ethnic groups. Results: The study included 70,454 women aged 30–69. Among women aged 40–69, 48.31% underwent CBE, 84.06% received PST, and 41.69% underwent mammography. It was found inequalities in coverage for any cancer screening (GINI: 0.10), mammography (GINI: 0.21), CBE (GINI: 0.19), and PST (GINI: 0.06), in 25 Peruvian regions. These inequalities were more pronounced in regions with larger populations of Quechua, Aymara, and Afro-Peruvian women. In rural areas, Quechua or Aymara women (SII: -0.83, -0.95, and − 0.69, respectively) and Afro-Peruvian women (SII: -0.80, -0.92, and − 0.58, respectively) experienced heightened inequalities in the uptake of CBE, mammography, and PST, respectively. Like Quechua or Aymara women (SII: -0.50, SII: -0.52, and SII: -0.50, respectively) and Afro-Peruvian women (SII: -0.50, SII: -0.58, and SII: -0.44, respectively) with only a primary education. Conclusion: Ethnic inequalities affect breast and cervical cancer screening coverage across regions in Peru. In Quechua, Aymara, and Afro-Peruvian women the uptake of mammography, CBE, and PST was less frequently than their white or mestizo counterparts. These inequalities are attributed to sociodemographic conditions such as lower education levels and residence in rural or non-capital areas. [ABSTRACT FROM AUTHOR]

This pilot-study aims to assess, whether quantitatively assessed enhancing breast tissue as a percentage of the entire breast volume can serve as an indicator of breast cancer at breast MRI and whether the contrast-agent employed affects diagnostic efficacy. This retrospective IRB-approved study, included 39 consecutive patients, that underwent two subsequent breast MRI exams for suspicious findings at conventional imaging with 0.1 mmol/kg gadobenic and gadoteric acid. Two independent readers, blinded to the histopathological outcome, assessed unenhanced and early post-contrast images using computer-assisted software (Brevis, Siemens Healthcare). Diagnostic performance was statistically determined for percentage of ipsilateral voxel volume enhancement and for percentage of contralateral enhancing voxel volume subtracted from ipsilateral enhancing voxel volume after crosstabulation with the dichotomized histological outcome (benign/malignant). Ipsilateral enhancing voxel volume versus histopathological outcome resulted in an AUC of 0.707 and 0.687 for gadobenic acid, reader 1 and 2, respectively and in an AUC of 0.778 and 0.773 for gadoteric acid, reader 1 and 2, respectively. Accounting for background parenchymal enhancement by subtracting contralateral enhancing volume from ipsilateral enhancing voxel volume versus histolopathological outcome resulted in an AUC of 0.793 and 0.843 for gadobenic acid, reader 1 and 2, respectively and in an AUC of 0.692 and 0.662 for gadoteric acid, reader 1 and 2, respectively. Pairwise testing yielded no statistically significant difference both between readers and between contrast agents employed (p > 0.05). Our proposed CAD algorithm, which quantitatively assesses enhancing breast tissue as a percentage of the entire breast volume, allows indicating the presence of breast cancer. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate whether artifacts on contrast-enhanced (CE) breast MRI maximum intensity projections (MIPs) might already be forecast before gadolinium-based contrast agent (GBCA) administration during an ongoing examination by analyzing the unenhanced T1-weighted images acquired before the GBCA injection. Materials and methods: This IRB-approved retrospective analysis consisted of n = 2884 breast CE MRI examinations after intravenous administration of GBCA, acquired with n = 4 different MRI devices at different field strengths (1.5 T/3 T) during clinical routine. CE-derived subtraction MIPs were used to conduct a multi-class multi-reader evaluation of the presence and severity of artifacts with three independent readers. An ensemble classifier (EC) of five DenseNet models was used to predict artifacts for the post-contrast subtraction MIPs, giving as the input source only the pre-contrast T1-weighted sequence. Thus, the acquisition directly preceded the GBCA injection. The area under ROC (AuROC) and diagnostics accuracy scores were used to assess the performance of the neural network in an independent holdout test set (n = 285). Results: After majority voting, potentially significant artifacts were detected in 53.6% (n = 1521) of all breast MRI examinations (age 49.6 ± 12.6 years). In the holdout test set (mean age 49.7 ± 11.8 years), at a specificity level of 89%, the EC could forecast around one-third of artifacts (sensitivity 31%) before GBCA administration, with an AuROC = 0.66. Conclusion: This study demonstrates the capability of a neural network to forecast the occurrence of artifacts on CE subtraction data before the GBCA administration. If confirmed in larger studies, this might enable a workflow-blended approach to prevent breast MRI artifacts by implementing in-scan personalized predictive algorithms. Clinical relevance statement: Some artifacts in contrast-enhanced breast MRI maximum intensity projections might be predictable before gadolinium-based contrast agent injection using a neural network. Key Points: • Potentially significant artifacts can be observed in a relevant proportion of breast MRI subtraction sequences after gadolinium-based contrast agent administration (GBCA). • Forecasting the occurrence of such artifacts in subtraction maximum intensity projections before GBCA administration for individual patients was feasible at 89% specificity, which allowed correctly predicting one in three future artifacts. • Further research is necessary to investigate the clinical value of such smart personalized imaging approaches. [ABSTRACT FROM AUTHOR]

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Breast cancer care is a costly global health issue where effective management depends on early detection and treatment. A breast cancer diagnosis can result in financial catastrophe especially in low- and middle-income countries (LMIC). Large inequities in breast cancer care are observed and represent a global challenge to caregivers and patients. Strategies to improve early diagnosis include awareness and clinical breast examination in LMIC, and screening in high-income countries (HIC). The use of clinical guidelines for the management of breast cancer is needed. Adapted guidelines from HIC can address disparities in populations with limited resources. Locally developed strategies still provide effective guidance in improving survival. Integrated practice units (IPU) with timely multidisciplinary breast care conferences and patient navigators are required to achieve high-value, personalized breast cancer management in HIC as well as LMIC. Breast cancer patient care should include a quality of life evaluation using ideally patient-reported outcomes (PROM) and experience measurements (PREM). Evaluation of breast cancer outcomes must include the financial cost of delivered care. The resulting value perspective should guide resource allocation and program priorities. The value of care must be improved by translating the findings of social and economic research into practice and resolving systemic inequity in clinical breast cancer research. Cancer survivorship programs must be put in place everywhere. The treatment of patients with metastatic breast cancer must require more attention in the future, especially in LMIC. [ABSTRACT FROM AUTHOR]

Background: This study aimed to indirectly examine whether the implementation of clinical breast examination‐based screening program in Morocco has been successful in downstaging and improving survival rates. Breast cancer patients detected through the screening pathway were compared with those detected through self‐referral over the same period in terms of cancer stage at diagnosis, tumor characteristics, care delays, and survival. Methods: A prospective observational study was conducted between April 2019 and August 2020 at two major public oncology centers. Results: A total of 896 women with confirmed breast cancer were recruited (483 were program‐referred and 413 were self‐referred). The authors did not report any significant difference between the two groups in terms of stage at diagnosis, molecular profile, or histopathological grade. Early‐stage cancer (stage I‐II) was detected in 55.7% of self‐referred participants compared to 55.5% of program‐referred participants. Median intervals between symptom recognition, pathological diagnosis, and treatment initiation were not significantly different between the two groups. Similarly, survival after treatment showed no significant difference between patients screened by the program and self‐referred patients. The 3‐year survival rate after treatment was 94.5% for patients referred through the program and 88.6% for patients not referred through the program (p =.16). Conclusions: This study highlights the importance of equitable and timely access to high‐quality diagnosis and treatment facilities, leading to substantial downstaging and enhanced survival rates. Continued efforts to improve quality and expand coverage to include asymptomatic women will consolidate the health infrastructure gains achieved by the Moroccan breast cancer screening program. There were no significant differences between breast cancer patients detected through the clinical breast examination‐based screening pathway and those who self‐referred in terms of cancer stage at diagnosis, tumor characteristics, treatment modality, care delays, and survival. However, this study highlights the importance of equitable and timely access to high‐quality diagnosis and treatment facilities, resulting in significant downstaging and improved survival. [ABSTRACT FROM AUTHOR]

Objective: In this study, it was aimed for third-year medical school students to improve their knowledge, examination skills and attitudes about breast cancer, and to experience the skills of taking a disease history, communicating effectively and giving bad news. Methods: The present study was carried out with 406 3rd-year medical faculty students from Akdeniz University and a semi-experimental method was employed. The content of implementation consists of improving the students' skills in receiving disease history from the patient and "clinical breast examination" on breast model, as well as informing the patient about the examination findings. Before the application, all students were given theoretical information about the subject and practiced with a learning guide on clinical breast examination. The pretest-posttest results of surveys received from the participating students and the standardized patient practice feedback form were analyzed. Results: Examining the surveys conducted before and after the implementation with 406 students, it was found that the students learned what the risk factors related with breast cancer are and they could question them while receiving the patient history (p<0.05). Their ability to perform breast examination was improved and they could detect the lump in breast (p<0.05). They gained experience about informing the patients and referring them to the departments related with preliminary diagnosis of breast cancer, as well as giving bad news (p<0.05). Conclusions: With a suitable scenario and planned educations, "Standardized Patient Practice" can be successfully used in preclinical educations. [ABSTRACT FROM AUTHOR]

Objective: This study sought to discern the differential impacts of communicating individualized breast cancer risk versus disseminating generic breast cancer information on women's proclivity towards breast cancer screenings. Method: A structured experimental design was used, including 300 female volunteers aged between 40-69, who had not previously been diagnosed with breast cancer, in Erzincan. Data collection entailed a face-to-face administration of a 22-item questionnaire complemented by the ASSISTS scale. Participants were randomized into two conditions: one receiving a standardized briefing on breast cancer screening modalities, and the other being apprised of their lifetime risk of breast cancer development based on the modified Gail model. Results: Post-intervention, 55.8% (n=72) of the risk-informed cohort and 40.5% (n=41) of the generic information cohort expressed a willingness to undergo screening (p=0.022). Notably, the group informed of their personalized risk exhibited a more pronounced uptick in requests for breast self-examination, clinical breast examination, and mammography screening compared to their counterparts. Conclusions: The communication of personalized breast cancer risk proves to be a more efficacious and time-efficient strategy than generic information dissemination in bolstering screening participation rates. [ABSTRACT FROM AUTHOR]

Breast diseases are on the rise throughout the world. It is essential to learn correct technique of "clinical breast examination" to ascertain the appropriate diagnostic workup in the most efficient manner. The ABCD rule is proposed by three highly skilled clinicians in the field of breast care trained in the famous Cardiff Breast Unit of Prof LE Hughes, Prof David JT Webster and Prof Robert E Mansel. The ABCD rule will allow early detection of breast cancer and other diseases with timely management of patients. It will help both the medical and nursing students as well as the field health workers in learning about diagnosis of breast diseases and in screening for breast cancer. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is a significant health issue affecting women worldwide, including Malaysia, where the incidence of breast cancer is increasing. Early detection of breast cancer plays a crucial role in improving treatment outcomes and reducing mortality rates. Aims and Objectives: This study examines the impact of adjunctive breast ultrasound (BUS) on screening for Malaysian women, offering evidence to enhance future protocols and decisions in the early detection. Materials and Methods: This study involved 5807 women aged 40 and above undergoing breast screening at Beacon Hospital from January to December 2022. Data collected included mammography and BUS results, categorized by breast imaging reporting and data system (BI-RADS) and diagnostic criteria. Suspicious cases on both modalities had histopathology examination (HPE) for confirmation. A subset of 1690 cases underwent both mammography and BUS screening and was compared to those who only had mammography using BI-RADS scores. Results: This study revealed that the majority of mammograms, 94.69% (5499 cases), were categorized as BI-RADS category 0, 1, 2, and 3, while 5.3% (307 cases) were classified as BI-RADS 4 and 5. Among the cases that underwent ultrasound (1688 cases), 23.43% of them were categorized as BI-RADS 4-5. Using ultrasound in addition to mammography increased the number of cases (BI-RADS 4-5) by 33.48%, resulting in a total of 460 cases identified compared to 307 cases, detected by mammography alone. Significantly, 39% (74 cases) of the 190 cases with confirmed malignancies (BI-RADS 6) by HPE were initially classified as negative mammography (BI-RADS 0-3) but were later identified as BI-RADS 5 on ultrasound. Conclusion: Ultrasound as a supplementary screening method holds the potential for boosting breast cancer detection sensitivity and reducing false negatives, thereby aiding in early detection and better treatment outcomes. [ABSTRACT FROM AUTHOR]

To determine the usefulness of combining two methodologies (OSCE and escape room) in a scenario simulation to evaluate a subject, and determine the evaluation of the students of this experience. An observational cross-sectional study was carried out with students enrolled in a sexual and reproductive health-care course as a part of their nursing degree. The students had to solve four clinical cases based on the contents of the teaching practices of the subject by solving clues that led them to carry out procedures and techniques and provide care in scenario simulators. Students evaluated the experience using the GAMEX (Gameful Experience in Gamification) scale. Mean differences were estimated with their respective 95% confidence intervals. A total of 124 students participated. Of these, 63.7% (79) solved the clinical cases with their knowledge and skills. Most (80.6%, 100) students stated that they completely remembered and applied the knowledge of the topic during the game. Almost all (98.4%, 122) would recommend this experience. The dimensions with the best rating on the GAMEX scale were "fun", with an average score of 4.7 points (0.49), followed by "critical thinking", with 4.2 (0.59). Women presented statistically better scores than men (mean difference: 1.58; 95% CI: 0.55, 2.61). The OSCE combined with an escape room using scenario simulations may be a useful tool to evaluate the subject. In addition, the students were satisfied, had fun, and recommended the experience. This study was not registered. [ABSTRACT FROM AUTHOR]

Background: Automated Breast Ultrasound (AB US) has shown good application value and prospects in breast disease screening and diagnosis. The aim of the study was to explore the ability of AB US to detect and diagnose mammographically Breast Imaging Reporting and Data System (BI-RADS) category 4 microcalcifications. Methods: 575 pathologically confirmed mammographically BI-RADS category 4 microcalcifications from January 2017 to June 2021 were included. All patients also completed AB US examinations. Based on the final pathological results, analyzed and summarized the AB US image features, and compared the evaluation results with mammography, to explore the detection and diagnostic ability of AB US for these suspicious microcalcifications. Results: 250 were finally confirmed as malignant and 325 were benign. Mammographic findings including microcalcifications morphology (61/80 with amorphous, coarse heterogeneous and fine pleomorphic, 13/14 with fine-linear or branching), calcification distribution (189/346 with grouped, 40/67 with linear and segmental), associated features (70/96 with asymmetric shadow), higher BI-RADS category with 4B (88/120) and 4 C (73/38) showed higher incidence in malignant lesions, and were the independent factors associated with malignant microcalcifications. 477 (477/575, 83.0%) microcalcifications were detected by AB US, including 223 malignant and 254 benign, with a significantly higher detection rate for malignant lesions (x2 = 12.20, P < 0.001). Logistic regression analysis showed microcalcifications with architectural distortion (odds ratio [OR] = 0.30, P = 0.014), with amorphous, coarse heterogeneous and fine pleomorphic morphology (OR = 3.15, P = 0.037), grouped (OR = 1.90, P = 0.017), liner and segmental distribution (OR = 8.93, P = 0.004) were the independent factors which could affect the detectability of AB US for microcalcifications. In AB US, malignant calcification was more frequent in a mass (104/154) or intraductal (20/32), and with ductal changes (30/41) or architectural distortion (58/68), especially with the both (12/12). BI-RADS category results also showed that AB US had higher sensitivity to malignant calcification than mammography (64.8% vs. 46.8%). Conclusions: AB US has good detectability for mammographically BI-RADS category 4 microcalcifications, especially for malignant lesions. Malignant calcification is more common in a mass and intraductal in AB US, and tend to associated with architectural distortion or duct changes. Also, AB US has higher sensitivity than mammography to malignant microcalcification, which is expected to become an effective supplementary examination method for breast microcalcifications, especially in dense breasts. [ABSTRACT FROM AUTHOR]

Objective: In physical health examinations, breast sonography is a commonly used imaging method, but it can lead to repeated exams and unnecessary biopsy due to discrepancies among radiologists and health centers. This study explores the role of off-the-shelf artificial intelligence (AI) software in assisting radiologists to classify incidentally found breast masses in two health centers. Methods: Female patients undergoing breast ultrasound examinations with incidentally discovered breast masses were categorized according to the 5th edition of the Breast Imaging Reporting and Data System (BI-RADS), with categories 3 to 5 included in this study. The examinations were conducted at two municipal health centers from May 2021 to May 2023. The final pathological results from surgical resection or biopsy served as the gold standard for comparison. Ultrasonographic images were obtained in longitudinal and transverse sections, and two junior radiologists and one senior radiologist independently assessed the images without knowing the pathological findings. The BI-RADS classification was adjusted following AI assistance, and diagnostic performance was compared using receiver operating characteristic curves. Results: A total of 196 patients with 202 breast masses were included in the study, with pathological results confirming 107 benign and 95 malignant masses. The receiver operating characteristic curve showed that experienced breast radiologists had higher diagnostic performance in BI-RADS classification than junior radiologists, similar to AI classification (AUC = 0.936, 0.806, 0.896, and 0.950, p < 0.05). The AI software improved the accuracy, sensitivity, and negative predictive value of the adjusted BI-RADS classification for the junior radiologists' group (p< 0.05), while no difference was observed in the senior radiologist group. Furthermore, AI increased the negative predictive value for BI-RADS 4a masses and the positive predictive value for 4b masses among radiologists (p < 0.05). AI enhances the sensitivity of invasive breast cancer detection more effectively than ductal carcinoma in situ and rare subtypes of breast cancer. Conclusions: The AI software enhances diagnostic efficiency for breast masses, reducing the performance gap between junior and senior radiologists, particularly for BI-RADS 4a and 4b masses. This improvement reduces unnecessary repeat examinations and biopsies, optimizing medical resource utilization and enhancing overall diagnostic effectiveness. [ABSTRACT FROM AUTHOR]

Breast pain is extremely common, occurring in 70% to 80% of women. Most cases of breast pain are from physiologic or benign causes, and patients should be reassured and offered treatment strategies to alleviate symptoms, often without diagnostic imaging. A complete clinical history and physical examination is key for distinguishing intrinsic breast pain from extramammary pain. Breast pain without other suspicious symptoms and with a negative history and physical examination result is rarely associated with malignancy, although it is a common reason for women to undergo diagnostic imaging. When breast imaging is indicated, guidelines according to the American College of Radiology Appropriateness Criteria should be followed as to whether mammography, US, or both are recommended. This review article summarizes the initial clinical evaluation of breast pain and evidence-based guidelines for imaging. Additionally, the article reviews cyclical and noncyclical breast pain and provides an image-rich discussion of the imaging presentation and management of benign and malignant breast pain etiologies. [ABSTRACT FROM AUTHOR]

Background: This study challenges the prevalent belief that surgical roles demand masculine traits, potentially limiting women's suitability for such positions. Contrary to this stereotype, we explored the hypothesis that in sensitive surgical procedures, where communal traits are valued, women patients might favor women surgeons. Two experimental studies investigated women's preferences for a man versus a woman surgeon in a breast exam and breast surgery. Methods: In two studies we experimentally tested women's preferences for a man versus a woman surgeon for a breast exam (a noninvasive and non‐complicated procedure), and breast surgery (an invasive and more complicated procedure). Study 2 delved into factors influencing these preferences, including patients' age, stereotypical perceptions of women surgeons as communal/warm, past negative experiences with men and women doctors, and previous body‐related trauma. Results: Women consistently preferred a woman surgeon for both procedures and expressed increased willingness to wait for an appointment with a woman surgeon. However, this preference was less pronounced for surgery than for an exam. Study 2 identified the stereotypical perception of women surgeons as communal/warm as the strongest predictor for this preference, along with previous negative experiences with men doctors and age. Conclusions: While some gender bias persists, this study underscores a notable preference for women surgeons in intimate medical services like breast exams or surgery. This preference holds practical implications for healthcare providers encouraging women's preventive checkups and offers insights for women medical students making residency choices. [ABSTRACT FROM AUTHOR]

Asian Society of Mastology (ASOMA) is an international body of experts from disciplines of surgery, radiology, pathology, medical and radiation oncology, plastic surgery, and breast support group dedicated to improving the care of patients with breast diseases. The clinical breast assessment (CBA) of patients with a focused history and clinical breast examination (CBE) is an essential and initial component of triple assessment in the evaluation of patients presenting with breast diseases. CBE is also an affordable method of screening for breast cancer. It adds to breast imaging by providing additional information about the breast lesion and providing a sense of reassurance to the patients. CBA needs to be implemented in a systematic and uniform fashion throughout the world by all the clinicians involved in breast care. The optimal method for CBE has not yet been fully established. This article highlights the importance of CBE and discusses the studies comparing various methods of CBE on breast models and human subjects to provide the evidence to support the most valid and reliable method of CBE. [ABSTRACT FROM AUTHOR]

The purpose of this feasibility study is to investigate if latent diffusion models (LDMs) are capable to generate contrast enhanced (CE) MRI-derived subtraction maximum intensity projections (MIPs) of the breast, which are conditioned by lesions. We trained an LDM with n = 2832 CE-MIPs of breast MRI examinations of n = 1966 patients (median age: 50 years) acquired between the years 2015 and 2020. The LDM was subsequently conditioned with n = 756 segmented lesions from n = 407 examinations, indicating their location and BI-RADS scores. By applying the LDM, synthetic images were generated from the segmentations of an independent validation dataset. Lesions, anatomical correctness, and realistic impression of synthetic and real MIP images were further assessed in a multi-rater study with five independent raters, each evaluating n = 204 MIPs (50% real/50% synthetic images). The detection of synthetic MIPs by the raters was akin to random guessing with an AUC of 0.58. Interrater reliability of the lesion assessment was high both for real (Kendall's W = 0.77) and synthetic images (W = 0.85). A higher AUC was observed for the detection of suspicious lesions (BI-RADS ≥ 4) in synthetic MIPs (0.88 vs. 0.77; p = 0.051). Our results show that LDMs can generate lesion-conditioned MRI-derived CE subtraction MIPs of the breast, however, they also indicate that the LDM tended to generate rather typical or 'textbook representations' of lesions. [ABSTRACT FROM AUTHOR]

Background: Breast cancer (BCa) is the most common cause of cancer death in Pakistan. In 2019, Pakistan saw the highest global BCa-associated death rate. But do Pakistani women know about the various aspects of BCa? And how prevalent are BCa screening methods amongst Pakistani females? These questions formed the basis for our study. Methods: We conducted this review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. On September 1, 2023, we searched PubMed, Embase, Scopus, and Google Scholar, and performed a citation search to search for eligible studies published in 2010 or after, using the following terms: "breast cancer" and "Pakistan". Observational studies that evaluated BCa awareness and/or practice amongst Pakistani females who were not associated with medicine were eligible. We used the National Institutes of Health quality assessment tool to assess the risk of bias. We conducted a proportion meta-analysis to calculate pooled prevalences for variables. Results: Responses from 9766 Pakistani women across 18 included studies showed alarmingly low levels of BCa knowledge: risk factors, 42.7% (95% CI: 34.1%-51.4%); symptoms, 41.8% (95% CI: 26.2%-57.5%); diagnostic modalities, 36.3% (95% CI: 23.1%-49.4%); treatments, 46.6% (95% CI: 13.5%-79.8%). Prevalence of breast self-examination (BSE) and ever having undergone a clinical breast exam (CBE) was 28.7% (95% CI: 17.9%-39.6%) and 15.3% (95 CI: 11.2%-19.4%), respectively. BCa knowledge was significantly associated with better educational status, age, and socioeconomic status. Conclusion: On average, only two in five Pakistani women are aware of one or more risk factors, symptoms, or diagnostic modalities. Approximately one in two women know about possible BCa treatment. Less than one in three women practice regular BSE, and less than one in five women have ever undergone a CBE. [ABSTRACT FROM AUTHOR]

Objectives: To develop a deep learning–based method for contrast-enhanced breast lesion detection in ultrafast screening MRI. Materials and methods: A total of 837 breast MRI exams of 488 consecutive patients were included. Lesion's location was independently annotated in the maximum intensity projection (MIP) image of the last time-resolved angiography with stochastic trajectories (TWIST) sequence for each individual breast, resulting in 265 lesions (190 benign, 75 malignant) in 163 breasts (133 women). YOLOv5 models were fine-tuned using training sets containing the same number of MIP images with and without lesions. A long short-term memory (LSTM) network was employed to help reduce false positive predictions. The integrated system was then evaluated on test sets containing enriched uninvolved breasts during cross-validation to mimic the performance in a screening scenario. Results: In five-fold cross-validation, the YOLOv5x model showed a sensitivity of 0.95, 0.97, 0.98, and 0.99, with 0.125, 0.25, 0.5, and 1 false positive per breast, respectively. The LSTM network reduced 15.5% of the false positive prediction from the YOLO model, and the positive predictive value was increased from 0.22 to 0.25. Conclusions: A fine-tuned YOLOv5x model can detect breast lesions on ultrafast MRI with high sensitivity in a screening population, and the output of the model could be further refined by an LSTM network to reduce the amount of false positive predictions. Clinical relevance statement: The proposed integrated system would make the ultrafast MRI screening process more effective by assisting radiologists in prioritizing suspicious examinations and supporting the diagnostic workup. Key Points: • Deep convolutional neural networks could be utilized to automatically pinpoint breast lesions in screening MRI with high sensitivity. • False positive predictions significantly increased when the detection models were tested on highly unbalanced test sets with more normal scans. • Dynamic enhancement patterns of breast lesions during contrast inflow learned by the long short-term memory networks helped to reduce false positive predictions. [ABSTRACT FROM AUTHOR]

Purpose: Develop and test a measurement framework of mammogram facility resources, policies, and practices in Appalachia. Methods: Survey items describing 7 domains of imaging facility qualities were developed and tested in the Appalachian regions of Kentucky, Ohio, Pennsylvania, Virginia, and West Virginia. Medicare claims data (2016‐2018) were obtained on catchment area mammogram services. Construct validity was examined from associations with facility affiliation, community characteristics, mammogram screening uptake, and market reach. Analyses were performed with t‐tests and ANOVA. Results: A total of 192 (of 377) sites completed the survey. Five factors were initially selected in exploratory factor analysis (FA) and refined in confirmatory FA: capacity, outreach & marketing, operational support, radiology review (NNFI =.94, GFI = 0.93), and diagnostic services (NNFI = 1.00, GFI = 0.99). Imaging capacity and diagnostic services were associated with screening uptake, with capacity strongly associated with catchment area demographic and economic characteristics. Imaging facilities in economically affluent versus poorer areas belong to larger health systems and have significantly more resources (P <.001). Facilities in economically distressed locations in Appalachia rely more heavily on outreach activities (P <.001). Higher facility capacity was significantly associated (P <.05) with larger catchment area size (median split: 48.5 vs 51.6), mammogram market share (47.4 vs 52.7), and screening uptake (47.6 vs 52.4). Conclusions: A set of 18 items assessing breast imaging services and facility characteristics was obtained, representing policies and practices related to a facility's catchment area size, market share, and mammogram screening uptake. [ABSTRACT FROM AUTHOR]

Background: Breast cancer (BC) represents an important cause of cancer death, its incidence rate has been rising gradually in the Arab world, and in Syria, BC is the most common cancer and the leading cause of cancer death; its prognosis gets better as we detect it early in its first stages. So, it is very important to implement one or more early detection methods such as Breast Self-Examination (BSE), Clinical Breast Examination (CBE), and mammography. BSE represents an effective method to find out changes in breast structure when they happen. This study investigates the knowledge of BSE and its practice in BC patients. Methods: A quantitative cross-sectional study in Al-Bairouni hospital in Damascus-Syria was carried out using face-to-face interviews based on a structured questionnaire, which consisted of 4 sections. The data were subjected to statistical analysis using various analytical tests, including the independent t-test, one-way analysis of variance (ANOVA), and Chi-square test. Results: Five hundred patients were interviewed. Only 27.4% of patients had a good knowledge of BSE, 17.4% had average knowledge, and 55.2% had low knowledge of BSE. The factors that have an impact on the knowledge of BSE were: family breast cancer history (first and second-degree relatives), education, and the region of living (between governorates). The effect of knowledge of BSE on its practice was positive. However, only 24.8% of patients have been practicing BSE; the reasons for not practicing BSE were: no one has told the patient about it (64.8% of cases), and the patient does not have any symptoms relating to the breast (21.4%).Breast cancer was identified through breast self-examination (BSE) in 15.6% of cases. Conclusion: There is a low degree of knowledge and little practice of BSE among Syrian breast cancer patients. Family breast cancer history, governate, occupation, and level of education had a statistically significant effect on knowledge scores of BSE, unlike age and social status. So, some steps should be taken to increase awareness about BSE among Syrian females. [ABSTRACT FROM AUTHOR]

A new detailed dataset of breast ultrasound scans (BrEaST) containing images of benign and malignant lesions as well as normal tissue examples, is presented. The dataset consists of 256 breast scans collected from 256 patients. Each scan was manually annotated and labeled by a radiologist experienced in breast ultrasound examination. In particular, each tumor was identified in the image using a freehand annotation and labeled according to BIRADS features and lexicon. The histopathological classification of the tumor was also provided for patients who underwent a biopsy. The BrEaST dataset is the first breast ultrasound dataset containing patient-level labels, image-level annotations, and tumor-level labels with all cases confirmed by follow-up care or core needle biopsy result. To enable research into breast disease detection, tumor segmentation and classification, the BrEaST dataset is made publicly available with the CC-BY 4.0 license. [ABSTRACT FROM AUTHOR]

Background: Measurements of breast morphology are a determinant of the assessment of any surgical procedure, either reconstructive or cosmetic. This study aims to investigate the association between easy anthropometric measurements and values of quality of life assessed in a sample of asymptomatic women. Methodology: Healthy asymptomatic women were admitted for this study. The following measurements were assessed: height, weight, nipple to sternal notch distance, areola to infra-mammary fold distance (right vs. left), right–left nipple distance. The Breast Q questionnaire (Italian translation V.1, pre-op breast conservation surgery) in the following domains: satisfaction with breasts; psycho-social satisfaction; physical satisfaction; sexual satisfaction, which was used to assess breast-related quality of life. Results: One hundred and forty-five women responded to the breast Q questionnaire. The mean age of the sample was 44.3 years; the medium BMI was 24.1; Spearman correlation coefficients revealed that all the investigated values were negatively correlated to the "satisfaction with breasts" domain. Psychosexual satisfaction was associated with age; BMI; nipple to sternal notch distance. After normalization for age values, we observed that "satisfaction with breast" was, once again, highly correlated to BMI; nipple to sternal notch distance; areola to IMF distance. In all cases, the higher the values, the lower the scores. Conclusions: Distances between easy relevant anatomical landmarks are representative of patients' breast-related quality of life in a population of asymptomatic women. These findings allow us to identify an ideal anthropometric framework that can be used as a validated surgical endpoint for cosmetic and oncological procedures. [ABSTRACT FROM AUTHOR]

Introduction: above the age of 40, women are advised to begin breast examinations and screenings for early detection of breast cancer. The average glandular dose (AGD) provides dosimetric information about the quantity of radiation received by the mammary glands during mammographic exposures. There is, therefore, the need to analyse the radiation dose received by patients presenting for mammography examinations. Methods: a retrospective cross-sectional design was carried out on the data of 663 participants, conveniently sampled between the months of July 2021 and June 2022. Paired T-test was used to compare imaging parameters for cranio-caudal (CC), medio-lateral (ML), automatic exposure control (AEC), manual exposure control (MEC), and left and right breast. Pearson's correlation was used to test for relationship between imaging parameters and AGD. Results: the mean AGD per exposure was 1.9 ± 0.7 mGy for CC projections and 2.3 ± 1.2 mGy for ML projections. The mean AGD per examination for the study was 4.1 ± 1.4 mGy. A positive correlation was found between AGD per examination and exposure factors (tube loading and tube voltage), compressed breast thickness, and compression force. Patient age had no statistically significant relationship with the AGD per examination. Conclusion: average glandular dose (AGD) was consistent with other findings in literature studies. It was also observed that MEC yielded lower AGD per exposure values than AEC. There was no significant difference in the mean AGD per exposure for left and right breasts. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the feasibility of breast MRI exams and guided biopsies in patients with an implantable loop recorder (ILR) as well as the impact ILRs may have on image interpretation. Materials and methods: This retrospective study examined breast MRIs of patients with ILR, from April 2008 to September 2022. Radiological reports and electronic medical records were reviewed for demographic characteristics, safety concerns, and imaging findings. MR images were analyzed and compared statistically for artifact quantification on the various pulse sequences. Results: Overall, 40/82,778 (0.049%) MRIs during the study period included ILR. All MRIs were completed without early termination. No patient-related or device-related adverse events occurred. ILRs were most commonly located in the left lower-inner quadrant (64.6%). The main artifact was a signal intensity (SI) void in a dipole formation in the ILR bed with or without areas of peripheral high SI. Artifacts appeared greatest in the cranio-caudal axis (p < 0.001), followed by the anterior–posterior axis (p < 0.001), and then the right–left axis. High peripheral rim-like SI artifacts appeared on the post-contrast and subtracted T1-weighted images, mimicking suspicious enhancement. Artifacts were most prominent on diffusion-weighted (p < 0.001), followed by T2-weighted and T1-weighted images. In eight patients, suspicious findings were found on MRI, resulting in four additional malignant lesions. Of six patients with left breast cancer, the tumor was completely visible in five cases and partially obscured in one. Conclusion: Breast MRI is feasible and safe among patients with ILR and may provide a significant diagnostic value, albeit with localized, characteristic artifacts. Clinical relevance statement: Indicated breast MRI exams and guided biopsies can be safely performed in patients with implantable loop recorder. Nevertheless, radiologists should be aware of associated limitations including limited assessment of the inner left breast and pseudo-enhancement artifacts. Key Points: • Breast MRI in patients with an implantable loop recorder is an infrequent, feasible, and safe procedure. • Despite limited breast visualization of the implantable loop recorder bed and characteristic artifacts, MRI depicted additional lesions in 8/40 (20%) of cases, half of which were malignant. • Breast MRI in patients with an implantable loop recorder should be performed when indicated, taking into consideration typical associated artifacts. [ABSTRACT FROM AUTHOR]

Background: Breast Magnetic Resonance Imaging (MRI) offers the highest sensitivity in detecting breast cancer among existing clinical and imaging techniques, making it a crucial component of breast imaging protocols. This study aims to investigate MRI importance in correlation with previous imaging discordant procedures performed as echography and/or mammography to evaluate characteristics and framing in high-risk BI-RADS 4C or 5 categories based on morphological features and kinetic curves of masses found in the breasts of patients from our database. Methods: A retrospective study with related statistical analysis was performed on a group of 33 cases, selected from a total of 488 patients who underwent breast MRI examinations at SPAD Imaging International S.R.L. Craiova, between 01.01.2021 and 31.12.2023, aged between 33 and 75 years. In all patients, MRI images parameters were analysed. Results: In 33 patients, 23 had a single lesion and 10 had multiple lesions, 9 of them in the ipsilateral breast and, as a particularity, one of them, located in the contralateral breast. In 21 of the total patients with multiple or single lesions they had type III curves, which were classified in the BI-RADS 5 category, considering both criteriamorphology and type of curve, where the other previous techniques had not mentioned an increased risk, hence revealing that the situation in a percentage of 63.63 in the case of MRI investigation proved to be clearly superior. Conclusion: Combining both kinetic and morphologic criteria can enhance the diagnostic accuracy of MRI in breast lesion evaluation. [ABSTRACT FROM AUTHOR]

Background: Fibroadenoma, a type of fibroma, is the most common benign neoplasm found in the breast. It is predicted that around 10% of females globally may experience the development of fibroadenoma at some stage in their lives. Fibroids seldom become malignancies, about 5% of all cases. Fibroadenoma etiology is uncertain. However, levels of estrogen influence fibroadenomas. Objectives: The objectives of this study were to explore the epidemiological aspects of breast fibroadenoma. Patients and Methods: A cross-sectional study was conducted in the breast examination clinic at Al-Imamaein Al-Kadhimaein Medical City in Baghdad/Iraq. It included 260 female participants aged 15--35 years, diagnosed by specialists with breast fibroadenoma. A modified four-part questionnaire was used to obtain data from participants which includes sociodemographic, breast fibroadenoma risk factors, clinical presentation, and diagnostic intervention. Results: Participants had a mean age of 27.3 ± 6.05 years. It was found that 37.7% of participants were overweight women, 35.8% had a family history of fibroadenoma. The most common presentation was pain presented in 38.1%. Conclusions: The fibroadenomas that developed in the current study sample tended to increase in the second and third decades, notably among nulliparous and nonlactating women. Most participants were overweight with left-sided pain and lumps. [ABSTRACT FROM AUTHOR]

Sound speed reconstruction has been investigated for quantitative evaluation of tissue properties in breast examination. Full waveform inversion (FWI), a mainstream method for conventional sound speed reconstruction, is an iterative method that includes numerical simulation of wave propagation, resulting in high computational cost. In contrast, high-speed reconstruction of sound speed using a deep neural network (DNN) has been proposed in recent years. Although the generalization performance is highly dependent on the training data, how to generate data for sufficient generalization performance is still unclear. In this study, the quality and generalization performance of DNN-based sound speed reconstruction with a ring array transducer were evaluated on a natural image-derived dataset and a breast phantom dataset. The DNN trained on breast phantom data (BP-DNN) could not reconstruct the structures on natural image data with diverse structures. On the other hand, the DNN trained on natural image data (NI-DNN) successfully reconstructed the structures on both natural image and breast phantom test data. Furthermore, the NI-DNN successfully reconstructed tumour structures in the breast, while the BP-DNN overlooked them. From these results, it was demonstrated that natural image data enables DNNs to learn sound speed reconstruction with high generalization performance and high resolution. [ABSTRACT FROM AUTHOR]

Background: The benefits of mammographic screening have been shown to include a decrease in mortality due to breast cancer. Taiwan's Breast Cancer Screening Program is a national screening program that has offered biennial mammographic breast cancer screening for women aged 50–69 years since 2004 and for those aged 45–69 years since 2009, with the implementation of mobile units in 2010. The purpose of this study was to compare the performance results of the program with changes in the previous (2004–2009) and latter (2010–2020) periods. Methods: A cohort of 3,665,078 women who underwent biennial breast cancer mammography screenings from 2004 to 2020 was conducted, and data were obtained from the Health Promotion Administration, Ministry of Health and Welfare of Taiwan. We compared the participation of screened women and survival rates from breast cancer in the earlier and latter periods across national breast cancer screening programs. Results: Among 3,665,078 women who underwent 8,169,869 examinations in the study population, the screened population increased from 3.9% in 2004 to 40% in 2019. The mean cancer detection rate was 4.76 and 4.08 cancers per 1000 screening mammograms in the earlier (2004–2009) and latter (2010–2020) periods, respectively. The 10-year survival rate increased from 89.68% in the early period to 97.33% in the latter period. The mean recall rate was 9.90% (95% CI: 9.83–9.97%) in the early period and decreased to 8.15% (95%CI, 8.13–8.17%) in the latter period. Conclusions: The evolution of breast cancer screening in Taiwan has yielded favorable outcomes by increasing the screening population, increasing the 10-year survival rate, and reducing the recall rate through the participation of young women, the implementation of a mobile unit service and quality assurance program, thereby providing historical evidence to policy makers to plan future needs. [ABSTRACT FROM AUTHOR]

Introduction: Breast magnetic resonance imaging (MRI) is increasingly being used for staging of patients with breast cancer due to its high sensitivity in detecting additional cancers (ACs). However, the clinical impact of diagnosing and treating these cancers remains unclear. Methods: A retrospective study was undertaken of patients with newly diagnosed breast cancer who underwent staging MRI at The American University of Beirut Medical Centre (AUBMC) between 2012 and 2020. Pathology reports and breast MRI examinations were reviewed. Eighteen breast cancer patients with 19 pathology‐proven index cancers (ICs) and 19 pathology‐proven MRI‐detected ACs were included. Chi‐square and Fisher's exact tests for categorical variables and Wilcoxon signed rank test for numerical variables were used to compare ICs to ACs. Results: The ICs consisted of four ductal carcinoma in situ (DCIS), 13 invasive ductal carcinomas (IDC), of which five with associated DCIS, and two invasive lobular carcinomas, (ILC) of which one with associated DCIS. ACs comprised 12 DCIS, five IDC, two with associated DCIS and two ILC, one with associated DCIS. Interval cancers were more frequently invasive whereas ACs were more frequently in situ (P = 0.021). ACs were more frequently nuclear grade 2 (P = 0.009). There was no statistically significant difference between ICs and ACs in lesion type (P = 0.062), shape (P = 0.073), initial enhancement (P = 1), delayed enhancement (P = 0.732), hormonal receptor profile (P = 0.68) and Ki67 (P = 0.388). Among ACs, ten (53%) were larger than 10 mm of which five (26%) were invasive cancers, and five (26%) were larger than the ICs. Conclusions: ACs detected by breast MRI were more likely to be in situ and to show a nuclear grade 2. Although not reaching statistical significance, some ACs tend to be clinically significant by their type, size or nuclear grade. The impact on clinical management remains to be determined. [ABSTRACT FROM AUTHOR]

Background: Increased breast density augments breast cancer risk and reduces mammography sensitivity. Supplemental breast MRI screening can significantly increase cancer detection among women with dense breasts. However, few women undergo this exam, and screening is consistently lower among racially minoritized populations. Implementation strategies informed by behavioral economics ("nudges") can promote evidence-based practices by improving clinician decision-making under conditions of uncertainty. Nudges directed toward clinicians and patients may facilitate the implementation of supplemental breast MRI. Methods: Approximately 1600 patients identified as having extremely dense breasts after non-actionable mammograms, along with about 1100 clinicians involved with their care at 32 primary care or OB/GYN clinics across a racially diverse academically based health system, will be enrolled. A 2 × 2 randomized pragmatic trial will test nudges to patients, clinicians, both, or neither to promote supplemental breast MRI screening. Before implementation, rapid cycle approaches informed by clinician and patient experiences and behavioral economics and health equity frameworks guided nudge design. Clinicians will be clustered into clinic groups based on existing administrative departments and care patterns, and these clinic groups will be randomized to have the nudge activated at different times per a stepped wedge design. Clinicians will receive nudges integrated into the routine mammographic report or sent through electronic health record (EHR) in-basket messaging once their clinic group (i.e., wedge) is randomized to receive the intervention. Independently, patients will be randomized to receive text message nudges or not. The primary outcome will be defined as ordering or scheduling supplemental breast MRI. Secondary outcomes include MRI completion, cancer detection rates, and false-positive rates. Patient sociodemographic information and clinic-level variables will be examined as moderators of nudge effectiveness. Qualitative interviews conducted at the trial's conclusion will examine barriers and facilitators to implementation. Discussion: This study will add to the growing literature on the effectiveness of behavioral economics-informed implementation strategies to promote evidence-based interventions. The design will facilitate testing the relative effects of nudges to patients and clinicians and the effects of moderators of nudge effectiveness, including key indicators of health disparities. The results may inform the introduction of low-cost, scalable implementation strategies to promote early breast cancer detection. Trial registration: ClinicalTrials.gov NCT05787249. Registered on March 28, 2023. [ABSTRACT FROM AUTHOR]

Accurate and automatic segmentation of fibroglandular tissue in breast MRI screening is essential for the quantification of breast density and background parenchymal enhancement. In this retrospective study, we developed and evaluated a transformer-based neural network for breast segmentation (TraBS) in multi-institutional MRI data, and compared its performance to the well established convolutional neural network nnUNet. TraBS and nnUNet were trained and tested on 200 internal and 40 external breast MRI examinations using manual segmentations generated by experienced human readers. Segmentation performance was assessed in terms of the Dice score and the average symmetric surface distance. The Dice score for nnUNet was lower than for TraBS on the internal testset (0.909 ± 0.069 versus 0.916 ± 0.067, P < 0.001) and on the external testset (0.824 ± 0.144 versus 0.864 ± 0.081, P = 0.004). Moreover, the average symmetric surface distance was higher (= worse) for nnUNet than for TraBS on the internal (0.657 ± 2.856 versus 0.548 ± 2.195, P = 0.001) and on the external testset (0.727 ± 0.620 versus 0.584 ± 0.413, P = 0.03). Our study demonstrates that transformer-based networks improve the quality of fibroglandular tissue segmentation in breast MRI compared to convolutional-based models like nnUNet. These findings might help to enhance the accuracy of breast density and parenchymal enhancement quantification in breast MRI screening. [ABSTRACT FROM AUTHOR]

Deep learning technology is useful for radiology specialists as double reading to help increase the accuracy of image interpretation results. One of the preparations for maximizing the use of this technology is using good-quality images as the source. The Automatic Exposure Control (AEC) feature, which functions to determine exposure factors automatically, is expected to help produce images with good and consistent quality so that deep learning technology can work more effectively. This research aims to determine the quality results of mammogram images taken using the AEC feature and to analyze the use of deep learning technology in evaluating mammogram images. This research method is retrospective by collecting 800 mammogram images randomly and anonymously. Three hundred images were tested, 500 were evaluated, and 250 were analyzed for image quality based on references related to applying AEC and assessing the contrast-to-noise ratio (CNR). Deep learning technology was analyzed by comparing the results of mammogram image evaluation using deep learning and the evaluation results of a radiology specialist. Deep learning technology analysis shows that 98% of mammograms have the same results as the radiology doctor's evaluation, and 2% have different results from the radiology doctor's evaluation where the image has a dense breast type. The image quality results in this research showed that 97.6% of the 250 samples taken using the AEC feature had good image quality, and 2.4% had poor image quality due to inappropriate breast positioning during the examination. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is a global public health problem with higher mortality in developing countries. The Ethiopian National Cancer Control Plan recommends clinical breast examination (CBE) for all women aged >18 years. However, there is low breast examination practice in Ethiopia. Therefore, this study aimed to describe level of intention to undergo CBE and associated factors among women visited selected rural healthcare facilities in south central Ethiopia using Theory of Planned Behavior (TPB). Methods: This study used facility-based cross-sectional study design. A total of 420 women participated in this study. Interviewer-administered structured questionnaire was adopted from previously published research works and Ajzen's TPB manual. Statistical Package for Social Sciences (SPSS), version 27, was used for analysis. Binary logistic regression model was used to determine factors associated with intention to undergo CBE. Results: In this study, nine out of ten women had never had CBE. Mean score for intention to undergo CBE was 12.55 (SD ± 3.22; min 5, max 20). Intention to undergo CBE was negatively associated with being in the second and middle wealth quantiles compared to the highest wealth quantile, and with the spouse not being able to read or write compared to having attended formal education. Positive attitude and higher subjective norm had relevant association with intention to undergo CBE. Conclusion: The high score for intention to undergo CBE should encourage primary healthcare facilities to offer CBE. Behavioral change communication interventions could address women's attitude, subjective norm, and spouse's education associated with intention to undergo CBE. [ABSTRACT FROM AUTHOR]

Introduction: Breast cancer (BC) screening uptake in Malaysia is low and a high number of cases present at a late stage. Community navigation and mobile health (mHealth) may increase screening attendance, particularly by women from rural communities. This randomized controlled study evaluated an intervention that used mHealth and community health workers to educate women about BC screening and navigate them to clinical breast examination (CBE) services in the context of the COVID-19 pandemic. Methods: Women aged 40–74 years, from Segamat, Malaysia, with a mobile phone number, who participated in the South East Asian Community Observatory health survey, (2018) were randomized to an intervention (IG) or comparison group (CG). The IG received a multi-component mHealth intervention, i.e. information about BC was provided through a website, and telephone calls and text messages from community health workers (CHWs) were used to raise BC awareness and navigate women to CBE services. The CG received no intervention other than the usual option to access opportunistic screening. Regression analyses were conducted to investigate between-group differences over time in uptake of screening and variable influences on CBE screening participation. Results: We recruited 483 women in total; 122/225 from the IG and 144/258 from the CG completed the baseline and follow-up survey. Uptake of CBE by the IG was 45.8% (103/225) whilst 3.5% (5/144) of women from the CG who completed the follow-up survey reported that they attended a CBE during the study period (adjusted OR 37.21, 95% CI 14.13; 98.00, p<0.001). All IG women with a positive CBE attended a follow-up mammogram (11/11). Attendance by IG women was lower among women with a household income ≥RM 4,850 (adjusted OR 0.48, 95% CI 0.20; 0.95, p = 0.038) compared to participants with a household income

Objective: The aim of this study was to investigate the extent of worry about breast cancer (BC) amongst a sample of women and to examine the effect of this on behavior to prevent BC. Materials and Methods: This cross-sectional study was conducted in 271 women aged 18 years and above who attended the Family Medicine Outpatient Clinic of a tertiary hospital and met the inclusion criteria. Data were collected using the following tools: Patient Information Form; Breast Cancer Worry Scale (BCWS); Breast Cancer Prevention Behaviors Identification Scale (BCPBIS); and Mammography Processes of Change Scale (MPCS). Results: When evaluated according to BCWS scores (mean 8.43 ± 3.36), the BC worry levels were found to be low. The behavior adopted for prevention was also found to be positive according to BCPBIS (mean 119 ± 15.26) and MPCS (mean 82.38 ± 12.81) scores. A significant correlation was found between the BCWS and both the BCPBIS and MPCS scores, and again between the BCPBIS and MPCS scores (p < 0.001 for all). There was a correlation with three scale scores in those who had knowledge about BC, and those who had regular clinical breast examination (BE) (p < 0.05 for all). The BCPBIS score was found to be higher in those aged between 41-65 years, those who had mammography, and performed p self-BE (p = 0.002; p < 0.001; p < 0.001, respectively). According to the MPCS score, mammography behaviors was found to be more positive in those who had regular gynecological examinations and those who had mammography (p = 0.08 and p = 0.011). Conclusion: The participants generally had low BC worry levels and had adopted positive behavior for prevention. Being informed about BC and screening and having regular BE increased BC worry. Those with high BC worry, those who had mammography before, those who had knowledge about BC and screening, and those who regularly performed BE showed more positive behaviors toward preventing BC. [ABSTRACT FROM AUTHOR]

Cryptorchidism refers to an undescended testicle, the most common genitourinary malformation in male children. It is diagnosed with history and physical examination findings, and primary care physicians play a key role in the early identification of the condition. Early surgical intervention reduces the risk of testicular cancer and preserves fertility. Patients should be referred for surgical intervention at six months of age or at the time of diagnosis if the child is older. After surgery, patients require lifelong surveillance and counseling regarding fertility implications and increased risk of testicular conditions. Patients with bilateral undescended testicles that are nonpalpable should undergo endocrinologic evaluation for sexual development disorders. Retractile testicles are a variant of cryptorchidism and should be monitored annually until puberty, when acquired ascent becomes unlikely due to greater testicular volume. Based on expert opinion, all patients with a history of cryptorchidism should undergo annual clinical examination and be taught self-examination techniques for early detection of testicular cancer. (Am Fam Physician. 2023; 108(4): 378–385. Copyright © 2023 American Academy of Family Physicians.) Cryptorchidism refers to an undescended testicle, the most common genitourinary malformation in male children. It is diagnosed with history and physical examination findings, and primary care physicians play a key role in the early identification of the condition. Early surgical intervention reduces the risk of testicular cancer and preserves fertility. Patients should be referred for surgical intervention at six months of age or at the time of diagnosis if the child is older. After surgery, patients require lifelong surveillance and counseling regarding fertility implications and increased risk of testicular conditions. Patients with bilateral undescended testicles that are nonpalpable should undergo endocrinologic evaluation for sexual development disorders. Retractile testicles are a variant of cryptorchidism and should be monitored annually until puberty, when acquired ascent becomes unlikely due to greater testicular volume. Based on expert opinion, all patients with a history of cryptorchidism should undergo annual clinical examination and be taught self-examination techniques for early detection of testicular cancer. [ABSTRACT FROM AUTHOR]

To determine the efficacy of abbreviated breast magnetic resonance imaging (MRI) protocols using 1.5 T MRI in the preoperative staging of newly diagnosed breast cancers. Eighty patients who underwent 1.5 T MRI between August 2014 and January 2018 for the preoperative staging of breast cancer were evaluated retrospectively. Three separate abbreviated breast MRI protocols (AP) were created from a full protocol, and the images were evaluated independently by two radiologists. AP1 included axial fat-saturated T2 weighted and diffusion-weighted (DW) images, while subtracted axial fat-saturated T1 weighted images were obtained 2 min after contrast administration in AP2. Finally, AP2 and DW images were evaluated in AP3. Lesion location, number, and size, and presence of axillary lymphadenopathy were evaluated in each protocol. Pathological data (lesion quadrant, lesion size, and presence of axillary metastases) from the 80 patients were compared with the abbreviated protocols and full diagnostic protocol. The best correlation with the full protocol for detecting the lesion quadrant, number of lesions, and presence of axillary lymphadenopathy was achieved with AP3 for both readers (κ = 0.954, 0.954 for the lesion quadrant, κ = 0.971, 0.910 for the number of lesions, and κ = 0.973, 0.865 for the axillary lymphadenopathy). The evaluation time in all abbreviated protocols was shorter than for the full protocol (p < 0.05). Comparing the abbreviated protocols with pathological data for both readers, the best correlation for detecting the lesion quadrant, number of lesions, and presence of axillary lymphadenopathy was achieved with AP3 (κ = 0.939, 0.954 for the lesion quadrant, κ = 0.941, 0.879 for the number of lesions, and κ = 0.842, 0.740 for axillary lymphadenopathy, respectively). Abbreviated breast MRI protocols can provide sufficient diagnostic accuracy in the preoperative staging of breast cancer, with shorter imaging and evaluation times. • We aimed to investigate the effectiveness of the use of abbreviated breast MRI examinations in preoperative staging. • Preoperative MRIs of biopsy-proven breast cancer patients were evaluated with abbreviated protocols and compared with the full protocol and pathology. • In this study with AP3 which include early postcontrast subtracted images and DW images, almost perfect agreement was achieved with the full protocol and pathologic comparison. • Abbreviated breast MRI protocols can provide adequate diagnostic accuracy in preoperative staging of breast cancer. [ABSTRACT FROM AUTHOR]

Objectives: To report mastectomy and reoperation rates in women who had breast MRI for screening (S-MRI subgroup) or diagnostic (D-MRI subgroup) purposes, using multivariable analysis for investigating the role of MRI referral/nonreferral and other covariates in driving surgical outcomes. Methods: The MIPA observational study enrolled women aged 18–80 years with newly diagnosed breast cancer destined to have surgery as the primary treatment, in 27 centres worldwide. Mastectomy and reoperation rates were compared using non-parametric tests and multivariable analysis. Results: A total of 5828 patients entered analysis, 2763 (47.4%) did not undergo MRI (noMRI subgroup) and 3065 underwent MRI (52.6%); of the latter, 2441/3065 (79.7%) underwent MRI with preoperative intent (P-MRI subgroup), 510/3065 (16.6%) D-MRI, and 114/3065 S-MRI (3.7%). The reoperation rate was 10.5% for S-MRI, 8.2% for D-MRI, and 8.5% for P-MRI, while it was 11.7% for noMRI (p ≤ 0.023 for comparisons with D-MRI and P-MRI). The overall mastectomy rate (first-line mastectomy plus conversions from conserving surgery to mastectomy) was 39.5% for S-MRI, 36.2% for P-MRI, 24.1% for D-MRI, and 18.0% for noMRI. At multivariable analysis, using noMRI as reference, the odds ratios for overall mastectomy were 2.4 (p < 0.001) for S-MRI, 1.0 (p = 0.957) for D-MRI, and 1.9 (p < 0.001) for P-MRI. Conclusions: Patients from the D-MRI subgroup had the lowest overall mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). This analysis offers an insight into how the initial indication for MRI affects the subsequent surgical treatment of breast cancer. Key Points: • Of 3065 breast MRI examinations, 79.7% were performed with preoperative intent (P-MRI), 16.6% were diagnostic (D-MRI), and 3.7% were screening (S-MRI) examinations. • The D-MRI subgroup had the lowest mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). • The S-MRI subgroup had the highest mastectomy rate (39.5%) which aligns with higher-than-average risk in this subgroup, with a reoperation rate (10.5%) not significantly different to that of all other subgroups. [ABSTRACT FROM AUTHOR]

Women who are at high risk of developing breast cancer warrant screening that is often initiated at younger ages than in average-risk women; this is usually with a combination of annual mammography and breast MRI. Compared to average-risk women, those at high risk are more frequently recommended to undergo screening during childbearing age and thus potentially during pregnancy and lactation. Understanding the appropriate use of screening breast imaging during pregnancy and lactation can be challenging due to limited data defining the evidence-based roles of the different imaging modalities, including mammography, US, and MRI. There have also been assumptions about the diagnostic accuracy of these modalities secondary to physiological changes. This scientific review discusses the current state of evidence- and expert-based guidelines and data for breast imaging screening of high-risk pregnant and/or lactating women, and the clinical and imaging presentations of breast cancer for these women. [ABSTRACT FROM AUTHOR]

Background: There are no consensus guidelines for supplemental breast cancer screening with whole‐breast ultrasound. However, criteria for women at high risk of mammography screening failures (interval invasive cancer or advanced cancer) have been identified. Mammography screening failure risk was evaluated among women undergoing supplemental ultrasound screening in clinical practice compared with women undergoing mammography alone. Methods: A total of 38,166 screening ultrasounds and 825,360 screening mammograms without supplemental screening were identified during 2014–2020 within three Breast Cancer Surveillance Consortium (BCSC) registries. Risk of interval invasive cancer and advanced cancer were determined using BCSC prediction models. High interval invasive breast cancer risk was defined as heterogeneously dense breasts and BCSC 5‐year breast cancer risk ≥2.5% or extremely dense breasts and BCSC 5‐year breast cancer risk ≥1.67%. Intermediate/high advanced cancer risk was defined as BCSC 6‐year advanced breast cancer risk ≥0.38%. Results: A total of 95.3% of 38,166 ultrasounds were among women with heterogeneously or extremely dense breasts, compared with 41.8% of 825,360 screening mammograms without supplemental screening (p <.0001). Among women with dense breasts, high interval invasive breast cancer risk was prevalent in 23.7% of screening ultrasounds compared with 18.5% of screening mammograms without supplemental imaging (adjusted odds ratio, 1.35; 95% CI, 1.30–1.39); intermediate/high advanced cancer risk was prevalent in 32.0% of screening ultrasounds versus 30.5% of screening mammograms without supplemental screening (adjusted odds ratio, 0.91; 95% CI, 0.89–0.94). Conclusions: Ultrasound screening was highly targeted to women with dense breasts, but only a modest proportion were at high mammography screening failure risk. A clinically significant proportion of women undergoing mammography screening alone were at high mammography screening failure risk. Whole‐breast ultrasound screening is highly targeted to women with dense breasts, but only a modest proportion are at high risk of interval or advanced breast cancer. Consideration of other breast cancer risk factors beyond breast density could facilitate identification of women at high risk of mammography screening failures who may be appropriate for supplemental ultrasound screening. [ABSTRACT FROM AUTHOR]

The "acorn cyst" sign is an imaging sign encountered on breast ultrasound exams denoting a type of benign complicated cyst. An acorn cyst is comprised of a deep anechoic fluid portion (the "acorn") and a more superficial echogenic layer of material (the "acorn cap"). Radiologists should attempt to distinguish the acorn cyst from more suspicious complex cystic and solid masses; if unable to do so, aspiration/biopsy can be performed to exclude a malignant lesion. • An acorn cyst is an example of a benign complicated cyst encountered on breast ultrasound exams. • An acorn cyst is comprised of a deep anechoic fluid portion ("acorn") and a superficial echogenic layer ("acorn cap"). • Radiologists should distinguish a benign acorn cyst from a complex cystic and solid mass which would require biopsy. [ABSTRACT FROM AUTHOR]

Background: Breast cancer mainly affects women aged >50 years; however, younger women may also have advanced breast cancer, so early detection is important. Purpose: To collect and review the imaging findings of women aged <30 years with breast cancer to find better diagnostic approaches for the early diagnosis of breast cancer in young women. Material and Methods: In this study, 45 patients aged <30 years with a diagnosis of breast cancer were evaluated. Imaging assessments were performed based on ultrasound, mammography, and magnetic resonance imaging (MRI) findings. Finally, the findings were compared with the pathological results. Results: Predominant findings in ultrasound included irregular spiculated mass in 59.4%. In mammography, irregular high-density mass (46.5%) and suspicious micro calcification (42.8%) were the most common findings. In MRI, the predominant feature was a heterogeneous enhancing mass with an irregular shape and irregular margin (81%) with a 45% plateau and 36% washout kinetic pattern. In the pathology assessment, invasive ductal carcinoma was the most common finding (84.4%). All three modalities—MRI, ultrasonography, and mammography—are valuable, with sensitivities of 100%, 93.3%, and 90%, respectively. Conclusion: Ultrasound, mammography, and MRI are highly sensitive and accurate tools for detecting breast cancer lesions in young women. Regular clinical breast examination with breast self-examination, and in suspected cases, ultrasound as the first imaging modality followed by mammography and/or MRI are the preferred diagnostic approach. [ABSTRACT FROM AUTHOR]