Reducing Barriers and Strategies to Improve Appropriate Screening Mammogram Attendance in Women 75 Years and Older.

Although breast cancer death rates have persistently declined over the last 3 decades, older women have not experienced the same degree in mortality reduction as younger women despite having more favorable breast cancer phenotypes. This occurrence can be partially attributed to less robust mammographic screening in older women, the propensity to undertreat with advancing age, and the presence of underlying comorbidities. With recent revisions to breast cancer screening guidelines, there has been a constructive shift toward more agreement in the need for routine mammographic screening to commence at age 40. Unfortunately, this shift in agreement has not occurred for cutoff guidelines, wherein the recommendations are blurred and open to interpretation. With increasing life expectancy and an aging population who is healthier now than any other time in history, it is important to revisit mammographic screening with advanced age and understand why older women who should undergo screening are not being screened as well as offer suggestions on how to improve screening mammogram attendance in this population.

Discussion and Optimization of the Male Breast Cancer Patient Experience.

Breast cancer in men is rare and often overlooked as there is a misconception that it is a gendered disease that affects women only. The feminization, or "pinkification," of the disease has been socially constructed to raise awareness, improve screening, and empower women but has not addressed the occurrence of the illness in men. Men may therefore experience unique psychosocial difficulties when faced with a disease that predominantly affects women, including feelings of disbelief and embarrassment that impact their sense of self and challenge their masculinity. The lack of mammographic screening in men, lack of public awareness, and the shame that develops during the time of diagnosis can result in treatment avoidant behaviors, a delayed presentation, and worse prognosis in men. Although male breast cancer (MBC) is uncommon, the incidence is increasing; therefore, efforts should be made to enhance education for health care professionals and the general public in order to lessen the stigma, with the goal of improving outcomes. Furthermore, special attention to the unique medical needs and hurdles encountered by transgender males can break down health care barriers in this marginalized patient population. This article offers male perceptions on breast cancer, the psychosocial implications of being diagnosed with a gendered disease, and suggestions on how to improve the MBC experience.

Changes in the Utilization of the BI-RADS Category 3 Assessment in Recalled Patients Before and After the Implementation of Screening Digital Breast Tomosynthesis.

RATIONALE AND OBJECTIVES: The purpose of this study was to compare the utilization of the Breast Imaging Reporting and Data System (BI-RADS) category 3 assessment in patients recalled from screening before and after the implementation of digital breast tomosynthesis (DBT). MATERIALS AND METHODS: This was a retrospective review of 11,478 digital mammography (DM) screening exams and 9350 DM+DBT screening exams. Lesions assigned a BI-RADS category 3 at diagnostic exam were classified as architectural distortions, asymmetries, calcifications, masses, and "other" and followed for a minimum of 2 years. RESULTS: The addition of DBT to screening DM resulted in a 30.4% relative reduction (10.3 women per 1000) in the utilization of BI-RADS category 3 compared to screening DM alone (3.4% for DM versus 2.4% for DM+DBT; p < 0.0001). There was a statistically significant change in the distribution of category 3 findings with DM+DBT characterized by an increase in calcifications and architectural distortions and a decrease in asymmetries. There was no change in category 3 assessment for masses. Although both cohorts had delayed cancer detection rates that exceeded the recommended 2% benchmark (2.3% for DM and 3.6% for DM+DBT), when limited to invasive malignancies, the delayed cancer detection rates were below the 2% benchmark (1.5% for DM and 0.9% for DM+DBT). Screening DM+DBT resulted in a 9.2% relative reduction in recall rate compared to DM (13.0% for DM versus 11.8% for DM+ DBT, p = 0.012). CONCLUSION: Implementation of DBT in the screening population decreased the overall number of patients assigned to short-term follow-up by 10.3 per 1000 women while maintaining comparable rates of delayed cancer detection.

Utilizing the Hub-and-Spoke Model to Deliver Quality Breast Imaging in a Large Health System.

Healthcare systems are constantly expanding and gaining new territories. This growth is met with challenges in the organization and delivery of quality health care services to a large geographical area. The need for provider and staff coverage at the new sites often outpaces the rate at which additional providers and staff are hired. The need for new technology, equipment, and administrative support to oversee the new sites may also lag. The overall result could compromise patient experience at these outlying locations. The breast imaging division at University Hospitals Cleveland Medical Center (UHCMC) instituted many changes to support UHCMC's continual growth while focusing on consistent quality of care and optimal patient experience. Changes included adoption of the hub-and-spoke organization-design model and incorporation of the integrated practice unit (IPU) concept. In the hub-and-spoke organization-design model, full services are offered at a central hub, with additional limited services provided at the peripheral spoke sites. The IPU is a dedicated team of clinical and nonclinical personnel providing the full care cycle centered on a specific medical condition such as breast health. The breast imaging hubs and spokes are incorporated into the breast health IPUs to provide uniform quality care across a large health system. The purpose of this article is to describe how the breast imaging division, functioning as members of the breast care IPU, utilized the hub-and-spoke concept to provide quality breast imaging services throughout the expanding health system.

Comparing cancer detection rates of patients undergoing short term follow-up vs routine follow-up after benign breast biopsies, is follow-up needed?

PURPOSE: To compare cancer rates after benign breast biopsies between patients with short term imaging follow-up (STFU) and those with routine follow-up (RFU). MATERIALS & METHODS: Retrospective review of benign stereotactic, US or DCE-MRI breast biopsies. RESULTS: Of 580 lesions, 192 (33%) had STFU, and 388 (67%) had RFU. For US and mammographic detected lesions, there is no difference in cancer rates between the STFU (1 cancer, n=148) and the RFU group (0 cancer, n=365) (p=0.29). There were 2 cancers in the STFU group versus 0 in the RFU DCE-MRI group (p=0.54). CONCLUSION: Our results support RFU after benign ultrasound and stereotactic breast biopsies.