Optimizing Radiological Education: The Role of Learning Spacing via Test sets in Enhancing Diagnostic Proficiency in Breast Screening Readers.

RATIONALE AND OBJECTIVES: Integrating learning spacing in medicine has shown promise in enhancing knowledge retention and diagnostic proficiency. While studies demonstrate the effectiveness of spaced learning in various fields, limited research exists on its application in radiological training. This study aims to investigate the impact of intervals in spaced training on radiologists' and trainees' diagnostic performance via mammogram test sets. METHODS: 54 radiologists and 101 radiology trainees completed 207 and 458 first-time readings of 9 mammogram test sets between 2019 and 2023. Each test set comprised of 60 mammograms (20 cancer and 40 normal), sourced retrospectively from BreastScreen Australia. Each radiologist evaluated mammograms using the BIRADS lexicon. Readers' performance was compared with truth data and evaluated in terms of specificity, case sensitivity, lesion sensitivity, ROC AUC and JAFROC FOM. The progress of readers' performances in following test sets after the first one was analyzed using Wilcoxon Signed Rank test. The association of participants' performances and the intervals among test sets' completions was investigated using Pearson's test. RESULTS: Significant positive correlations were found between intervals and radiologists' improvement in specificity and JAFROC FOM (P < 0.05). The separation of 4 to 10 days showed the most improvement among radiologists across all metrics, while intervals exceeding 90 days related to highest increase in case sensitivity (5.15%), lesion sensitivity (6.55%), ROC AUC (3.05%) and JAFROC FOM (6.3%). Trainees completing test sets in one day showed positive correlations with their ROC AUC (R=0.45; P = 0.008) and JAFROC FOM (R=0.43; P = 0.02), while those taking a longer time to complete showed negative impacts on case sensitivity (P = 0.009) and ROC AUC (P = 0.02). Remarkable progress in trainees was found in case sensitivity (6.15%), lesion sensitivity (11.6%), ROC AUC (3.5%) and JAFROC FOM (4.35%) with test set intervals of 31-90 days. CONCLUSIONS: Radiologists demonstrated superior performance when the training test sets were spaced over longer intervals, whereas trainees exhibited proficiency with shorter time separations. By optimizing the spacing of reviewing and practicing radiological concepts, mammogram readers can bolster memory retention and diagnostic decision-making skills.

Perceptions and Behaviors Regarding Early Screening and Breast-Related Complaints Among Saudi Women.

Background Breast cancer (BC) is a global public health issue, contributing to a significant death toll among women. Breast cancer is the most common type among Saudi women, accounting for over a quarter of all new cancer cases. The current approaches for detecting BC include mammography, clinical breast exams, and breast self-examination (BSE). Early diagnosis of BC is crucial for reducing mortality and morbidity. This study aims to investigate attitudes and behaviors regarding early screening and self-examination of breast cancer in Saudi Arabia. Materials and method This cross-sectional study was conducted over eight months. The sample size calculation with a 95% confidence interval and 0.05 precision rate is 600 of the total targeted group. The study included Saudi females aged 30 and above. Data were collected via an online questionnaire. The questionnaire evaluated various aspects, including information regarding sociodemographics, barriers, and attitudes toward breast cancer screening. Results The majority of participants were aged 41-50 (40.7%) and married (76.2%). Over a third (31.9%) had been diagnosed with benign breast tumors, with MRI being the most common examination method (39.2%). Regarding screening practices, 55.7% had been screened previously, with a high intention for future screening (76.8%). Attitudes toward screening were positive, with 83.4% willing to undergo testing if free, painless, and conducted by a female provider. Barriers to screening included fear of examination (30.2%) and shame about exposing the body (25.6%). Conclusion The study provides valuable insights into the demographic characteristics, prevalence of benign breast tumors, screening practices, and attitudes toward breast cancer screening among Saudi women aged 30 and above. Factors such as age, marital status, income, occupation, and geographical residency influence screening behavior and intentions. Efforts to promote awareness, reduce barriers, and improve access to screening services are essential for enhancing breast cancer detection and prevention within this population.

Risk-Adapted Breast Screening for Women at Low Predicted Risk of Breast Cancer: An Online Discrete Choice Experiment.

BACKGROUND: A risk-stratified breast screening program could offer low-risk women less screening than is currently offered by the National Health Service. The acceptability of this approach may be enhanced if it corresponds to UK women's screening preferences and values. OBJECTIVES: To elicit and quantify preferences for low-risk screening options. METHODS: Women aged 40 to 70 y with no history of breast cancer took part in an online discrete choice experiment. We generated 32 hypothetical low-risk screening programs defined by 5 attributes (start age, end age, screening interval, risk of dying from breast cancer, and risk of overdiagnosis), the levels of which were systematically varied between the programs. Respondents were presented with 8 choice sets and asked to choose between 2 screening alternatives or no screening. Preference data were analyzed using conditional logit regression models. The relative importance of attributes and the mean predicted probability of choosing each program were estimated. RESULTS: Participants (N = 502) preferred all screening programs over no screening. An older starting age of screening, younger end age of screening, longer intervals between screening, and increased risk of dying had a negative impact on support for screening programs (P < 0.01). Although the risk of overdiagnosis was of low relative importance, a decreased risk of this harm had a small positive impact on screening choices. The mean predicted probabilities that risk-adapted screening programs would be supported relative to current guidelines were low (range, 0.18 to 0.52). CONCLUSIONS: A deintensified screening pathway for women at low risk of breast cancer, especially one that recommends a later screening start age, would run counter to women's breast screening preferences. Further research is needed to enhance the acceptability of offering less screening to those at low risk of breast cancer. HIGHLIGHTS: Risk-based breast screening may involve the deintensification of screening for women at low risk of breast cancer.Low-risk screening pathways run counter to women's screening preferences and values.Longer screening intervals may be preferable to a later start age.Work is needed to enhance the acceptability of a low-risk screening pathway.

Lessons Learnt from Imaging Review of Interval Breast Cancers in a Single Center in the UK National Breast Screening Program.

False-negative mammograms are a part of any screening program and the National Breast Screening Program in the United Kingdom is no exception. Every year, 2.5 million women have screening mammograms in the United Kingdom. Around 8 per 1,000 women screened are diagnosed with a breast cancer and 3 per 1,000 women will present with an interval breast cancer following a negative screening mammogram and before their next mammogram. Robust quality standards have to be adhered to at every stage in the screening pathway in order to maintain the fine balance between detecting cancers early and avoiding unnecessary false-positive results. As part of this process, there is a mandatory requirement for screening units to review all breast cancers. We present a pictorial illustration of the lessons learnt from such a review in this essay. The cases described here are from one large breast screening unit in the North of England. In this unit, 30,000 to 40,000 women have a screening mammogram each year and these are all double read by human readers. All cases requiring recall and those where there is a disagreement between the first and second human reader go through a consensus/arbitration process involving a minimum of two human readers. Interval cancers are identified through a consistent process outlined by the screening program and are then subjected to a review by a minimum of two reviewers. In this process, the reviewers have access to the false-negative mammograms along with all priors that were available at the time of initial read. The reviewers make a decision on whether the initial mammogram is normal or abnormal without seeing the diagnostic mammogram with the interval cancer. They also categorize the density of the breast and describe the mammographic abnormality if there is any on a standardized interval cancer data collection form. Finally, they categorize the interval cancer into one of three types-"satisfactory," "satisfactory with learning points," or "unsatisfactory."

A Prospective Analysis of Screen-Detected Cancers Recalled and Not Recalled by Artificial Intelligence.

OBJECTIVE: The use of artificial intelligence has potential in assisting many aspects of imaging interpretation. We undertook a prospective service evaluation from March to October 2022 of Mammography Intelligent Assessment (MIA) operating "silently" within our Breast Screening Service, with a view to establishing its performance in the local population and setting. This evaluation addressed the performance of standalone MIA vs conventional double human reading of mammograms. METHODS: MIA analyzed 8779 screening events over an 8-month period. The MIA outcome did not influence the decisions made on the clinical pathway. Cases were reviewed approximately 6 weeks after the screen reading decision when human reading and/or MIA indicated a recall. RESULTS: There were 146 women with positive concordance between human reading and MIA (human reader and MIA recalled) in whom 58 breast cancers were detected. There were 270 women with negative discordance (MIA no recall, human reader recall) for whom 19 breast cancers and 1 breast lymphoma were detected, with 1 cancer being an incidental finding at assessment. Six hundred and four women had positive discordance (MIA recall, human reader no recall) in whom 2 breast cancers were detected at review. The breast cancers demonstrated a wide spectrum of mammographic features, sites, sizes, and pathologies, with no statistically significant difference in features between the negative discordant and positive concordant cases. CONCLUSION: Of 79 breast cancers identified by human readers, 18 were not identified by MIA, and these had no specific features or site to suggest a systematic error for MIA analysis of 2D screening mammograms.

Auditing Abbreviated Breast MR Imaging: Clinical Considerations and Implications.

Abbreviated breast MR (AB-MR) imaging is a relatively new breast imaging tool, which maintains diagnostic accuracy while reducing image times compared with full-protocol breast MR (FP-MR) imaging. Breast imaging audits involve calculating individual and organizational metrics, which can be compared with established benchmarks, providing a standard against which performance can be measured. Unlike FP-MR imaging, there are no established benchmarks for AB-MR imaging but studies demonstrate comparable performance for cancer detection rate, positive predictive value 3, sensitivity, and specificity with T2. We review the basics of performing an audit, including strategies to implement if benchmarks are not being met.

Clinical Integration of Artificial Intelligence for Breast Imaging.

This article describes an approach to planning and implementing artificial intelligence products in a breast screening service. It highlights the importance of an in-depth understanding of the end-to-end workflow and effective project planning by a multidisciplinary team. It discusses the need for monitoring to ensure that performance is stable and meets expectations, as well as focusing on the potential for inadvertantly generating inequality. New cross-discipline roles and expertise will be needed to enhance service delivery.

Dataset of breast thermography images for the detection of benign and malignant masses.

Thermographic image analysis is a subfield of diagnostic image processing aimed at detecting breast abnormalities in women at an early stage. It is a developing field of research and its effectiveness and scope require scientific assessment to be determined. An open-access dataset has been created for the scientific community to test and develop techniques for computational detection of normal and abnormal breast conditions from thermograms. This dataset is a valuable resource for researchers due to the scarcity of publicly available datasets of breast thermographic images. It includes thermographic images of the female chest area in three capture positions: anterior, left oblique and right oblique. The data set comes from 119 women ranging from 18 to 81 years of age. A table is attached to the dataset with the diagnosis of breast pathology, showing that 84 patients had benign pathology and 35 patients had malignant pathology. The diagnoses of women with healthy breast pathology are not included.

Imaging the dense breast.

The sensitivity of mammography reduces as breast density increases, which impacts breast screening and locoregional staging in breast cancer. Supplementary imaging with other modalities can offer improved cancer detection, but this often comes at the cost of more false positives. Magnetic resonance imaging and contrast-enhanced mammography, which assess tumour enhancement following contrast administration, are more sensitive than digital breast tomosynthesis and ultrasound, which predominantly rely on the assessment of tumour morphology.

Emotion constructs and outcome measures following false positive breast screening test results: A systematic review of reporting clarity and selection rationale.

OBJECTIVE: (i) To systematically identify constructs and outcome measures used to assess the emotional and mood impact of false positive breast screening test results; (ii) to appraise the reporting clarity and rationale for selecting constructs and outcome measures. METHODS: Databases (MEDLINE, CINAHL, PsycINFO) were systematically searched from 1970. Studies using standardised and non-standardised outcome measures to evaluate the emotion or mood impact of false positive breast screening test results were eligible. A 15-item coding scheme was devised to appraise articles on clarity and rationale for selected constructs and measures. RESULTS: Forty-seven articles were identified. The most investigated constructs were general anxiety and depression and disease-specific anxiety and worry. Twenty-two standardised general outcome questionnaire measures and three standardised disease-specific outcome questionnaire measures were identified. Twenty articles used non-standardised scales/items. Reporting of constructs and outcome measures was generally clear, but rationales for their selection were lacking. Anxiety was typically justified, but justification for depression was almost always absent. Practical and psychometric justification for selecting outcome measures was lacking, and theoretical rationale was absent. CONCLUSIONS: Heterogeneity in constructs and measures, coupled with unclear rationale for these, impedes a thorough understanding of why there are emotional effects of false positive screening test results. This may explain the repeated practice of investigating less relevant outcomes such as depression. There is need to develop a consensual conceptual model of and standardised approach to measuring emotional impact from cancer screening test results, to address heterogeneity and other known issues of interpreting an inconsistent evidence base.

Examining the impact of COVID-19 disruptions on population-based breast cancer screening in Ireland.

OBJECTIVE: Many population-based breast screening programmes temporarily suspended routine screening following the COVID-19 pandemic onset. This study aimed to describe screening mammography utilisation and the pattern of screen-detected breast cancer diagnoses following COVID-19-related screening disruptions in Ireland. METHODS: Using anonymous aggregate data from women invited for routine screening, three time periods were examined: (1) January-December 2019, (2) January-December 2020, and (3) January-December 2021. Descriptive statistics were conducted and comparisons between groups were performed using chi-square tests. RESULTS: In 2020, screening mammography capacity fell by 67.1% compared to 2019; recovering to 75% of mammograms performed in 2019, during 2021. Compared to 2019, for screen-detected invasive breast cancers, a reduction in Grade 1 (14.2% vs. 17.2%) and Grade 2 tumours (53.4% vs. 58.0%) and an increase in Grade 3 tumours (32.4% vs. 24.8%) was observed in 2020 (p = 0.03); whereas an increase in Grade 2 tumours (63.3% vs. 58.0%) and a reduction in Grade 3 tumours (19.6% vs. 24.8%) was found in 2021 (p = 0.02). No changes in oestrogen receptor-positive or nodal-positive diagnoses were observed; however the proportion of oestrogen/progesterone receptor-positive breast cancers significantly increased in 2020 (76.2%; p < 0.01) and 2021 (78.7%; p < 0.001) compared to 2019 (67.8%). CONCLUSION: These findings demonstrate signs of a grade change for screen-detected invasive breast cancers early in the pandemic, with recovery evident in 2021, and without an increase in nodal positivity. Future studies are needed to determine the COVID-19 impact on long-term breast cancer outcomes including mortality.

Healthcare professionals' experiences of caring for women with false-positive screening test results in the National Health Service Breast Screening Programme.

BACKGROUND: Understanding healthcare professionals' (HCPs) experiences of caring for women with false-positive screening test results in the National Health Service Breast Screening Programme (NHSBSP) is important for reducing the impact of such results. METHODS: Interviews were undertaken with 12 HCPs from a single NHSBSP unit, including advanced radiographer practitioners, breast radiographers, breast radiologists, clinical nurse specialists (CNSs), and a radiology healthcare assistant. Data were analysed thematically using Template Analysis. RESULTS: Two themes were produced: (1) Gauging and navigating women's anxiety during screening assessment was an inevitable and necessary task for all participants. CNSs were perceived as particularly adept at this, while breast radiographers reported a lack of adequate formal training. (2) Controlling the delivery of information to women (including amount, type and timing of information). HCPs reported various communication strategies to facilitate women's information processing and retention during a distressing time. CONCLUSIONS: Women's anxiety could be reduced through dedicated CNS support, but this should not replace support from other HCPs. Breast radiographers may benefit from more training to emotionally support recalled women. While HCPs emphasised taking a patient-centred communication approach, the use of other strategies (e.g., standardised scripts) and the constraints of the 'one-stop shop' model pose challenges to such an approach. PATIENT AND PUBLIC CONTRIBUTION: During the study design, two Patient and Public Involvement members (women with false-positive-breast screening test results) were consulted to gain an understanding of patient perspectives and experiences of being recalled specifically in the NHSBSP. Their feedback informed the formulations of the research aim, objectives and the direction of the interview guide.

Minimally invasive treatment of early, good prognosis breast cancer-is this feasible?

Breast cancer screening programmes frequently detect early, good prognosis breast cancers with significant treatment burden for patients, and associated health-cost implications. Emerging evidence suggests a role for minimally invasive techniques in the management of these patients enabling many women to avoid surgical intervention. Minimally invasive techniques include vacuum-assisted excision, cryoablation, and radiofrequency ablation. We review published evidence in relation to the risks and benefits of each technique and discuss ongoing trials. Data to date are promising, and we predict a trend towards minimally invasive treatment for early, good-prognosis breast cancer as technical skills, suitability criteria, and follow-up protocols are established.

Reducing inequalities by supporting individuals to make informed decisions about accepting their breast screening invitations.

OBJECTIVES: Individuals from deprived areas are less likely to attend breast screening. Inequalities in the coverage of breast screening are associated with poorer cancer outcomes. Individuals who have a positive first experience are more likely to attend subsequent mammograms. This work evaluates the provision of an additional telephone call to individuals who have never attended breast screening, to establish whether this increases attendance. SETTING AND METHODS: 1423 patients from four general practitioner practices within socially deprived areas of National Health Service Tayside (UK) comprised the study population. In addition to their standard appointment letter, individuals were to receive a call at least 24 h prior to their appointment. The call identified barriers to screening, and offered a supportive, problem-solving approach to overcoming these barriers. Data collected included: age, Scottish Index of Multiple Deprivation, first-time invite or previous non-attender, if contactable, duration of call, number of days prior to appointment, and confirmation appointment letter was received. The primary outcome was attendance at the screening. RESULTS: Contact by phone was made with 678 (47.6%) of the study population. Of those, 483 (71.2%) attended their appointment, 122 (18%) cancelled and 73 (10.8%) did not attend (DNA), versus 344 (46.2%) attending, 34 (4.6%) cancelling and 367 (49.3%) not attending among those who were not able to be contacted. Those who received a call were more likely to attend their appointment and less likely to DNA compared to individuals not receiving the call. CONCLUSION: The intervention is simple and low cost; results indicate that the additional call may increase attendance and reduce DNA appointments at breast screening.

Users' Experience of Public Cancer Screening Services: Qualitative Research Findings and Implications for Public Health System.

Following the One Health approach, designing multidimensional strategies to orient healthcare in promoting health and preventive processes has become paramount. In particular, in the prevention domain, cancer screening attendance is still unsatisfactory in many populations and requires specific consideration. To this end, following a research-intervention logic, this study aims to investigate the experiences and meanings that users of public cancer screening services associate with prevention, particularly participation in the screenings. The experiences of 103 users (96 females; Mage = 54.0; SD = 1.24) of public cancer screening programs in the Campania region (Italy) were collected through interviews. The data collected were analysed following the Grounded Theory Methodology, supported by the software Atlas.ti 8.0. The text material was organised into eight macro-categories: Health and Body; Relationship with Cancer and Diseases; Health Facilities and Health Providers; The Affective Determinants of Cancer Screening Participation; Partners and Children; Physical Sensations and Emotions in the Course of Action; Protective Actions; Promotion and Dissemination. The core category was named Family and Familiarity. Respondents perceived prevention as an act of care for the family and themselves. Our findings support a shift from the idea of taking care of personal health as an individual matter toward considering it as a community issue, according to which resistance to act is overcome for and through the presence of loved ones. The results of this study contribute to a deeper understanding of the perspectives of southern Italian users on participation in cancer screening, and provide important insights to guide future actions to promote these public programmes based primarily on the emerging theme of family and familiarity related to screening programs.

A Multireader Multicase (MRMC) Receiver Operating Characteristic (ROC) Study Evaluating Noninferiority of Quantitative Transmission (QT) Ultrasound to Digital Breast Tomosynthesis (DBT) on Detection and Recall of Breast Lesions.

RATIONALE AND OBJECTIVES: Quantitative transmission (QT) imaging is an emerging volumetric ultrasound modality for women too young for mammography. QT images tissue without overlap seen in mammography, thereby can potentially improve breast mass detection and characterization and noncancer recall. We compared radiologists' interpretation of QT vs digital breast tomosynthesis (DBT) with a multireader multicase observer performance study. MATERIALS AND METHODS: Study subjects received screening DBT and QT scans in HIPAA-compliant, institutional review board-approved prospective case-collection studies at four clinical sites. Twenty-four Mammography Quality Standards Act-qualified radiologists interpreted 177 cases (66 with cancer, atypia, or solid mass and 111 normal or with nonsolid benign abnormality), first QT, then 2 weeks later DBT synthesized 2D-views. Readers reported up to three findings per case and for each finding a recall or no recall decision and confidence of that decision. The study hypothesis was area under receiver operating characteristic curve (AUC) of QT was noninferior to DBT. Sensitivity and specificity were also compared. RESULTS: AUC of QT (0.746 ± 0.028, mean ± SD) was noninferior to DBT (0.700 ± 0.028) for AUC difference margin of -0.05 (P < .05). AUC difference was 0.046 ± 0.028 (95% CI: [-0.008, 0.101]). Sensitivity was 70.6 ± 7.2% for QT and 85.2 ± 6.4% for DBT, specificity was 60.1 ± 12.3% vs 37.2 ± 11.0%, and both differences were statistically significant. Of a total of 21 cases of cysts, readers recommended recall, on average, in 1.1 ± 1.4 cases with QT, but not with DBT, and 10.6 ± 2.2 cases with DBT, but not with QT. CONCLUSION: QT can be a potential alternative to mammography for breast cancer screening of women too young to undergo mammography.

Service and clinical impacts of reader bias in breast cancer screening: a retrospective study.

OBJECTIVES: To determine factors influencing reader agreement in breast screening and investigate the relationship between agreement level and patient outcomes. METHODS: Reader pair agreement for 83 265 sets of mammograms from the Scottish Breast Screening service (2015-2020) was evaluated using Cohen's kappa statistic. Each mammography examination was read by two readers, per routine screening practice, with the second initially blinded but able to choose to view the first reader's opinion. If the two readers disagreed, a third reader arbitrated. Variation in reader agreement was examined by: whether the reader acted as the first or second reader, reader experience, and recall, cancer detection and arbitration recall rate. RESULTS: Readers' opinions varied by whether they acted as the first or second reader. Furthermore, reader 2 was more likely to agree with reader 1 if reader 1 was more experienced than they were, and less likely to agree if they themselves were more experienced than reader 1 (P < .001). Agreement was not significantly associated with cancer detection rate, overall recall rate or arbitration recall rates (P > .05). Lower agreement between readers led to a higher arbiter workload (P < .001). CONCLUSIONS: In mammography screening, the second reader's opinion is influenced by the first reader's opinion, with the degree of influence dependent on the readers' relative experience levels. ADVANCES IN KNOWLEDGE: While less-experienced readers relied on their more experienced reading partner, no adverse impact on service outcomes was observed. Allowing access to the first reader's opinion may benefit newly qualified readers, but reduces independent evaluation, which may lower cancer detection rates.

Radiation doses received in the UK breast screening programmes 2019-2023.

OBJECTIVE: To report the latest UK mammography dose survey results and to compare radiation doses from digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) in UK breast screening. METHODS: Anonymized exposure factors were collected for 111 152 screening cases and 5113 assessment cases from 405 x-ray sets across the United Kingdom using an online submission system linked to a national database of mammography quality control data. Output and beam quality measurements from each set were combined with exposure data to estimate mean glandular doses (MGD). RESULTS: FFDM doses increased by ∼10% compared to the 2016-2019 national survey but compressed breast thicknesses (CBT) remained similar. DBT doses were 34%-40% higher than FFDM overall and 34% higher than FFDM for breasts 50-60 mm thick. We found a possible overestimation of PMMA breast equivalent thicknesses at low CBTs, but the evidence was not conclusive. CONCLUSION: Recent changes to the mix of x-ray models in use in UK breast screening have resulted in higher FFDM breast doses. DBT doses in the NHSBSP are on average higher than FFDM by ∼34%-40%. ADVANCES IN KNOWLEDGE: This is the first national study to report DBT and FFDM MGDs in UK breast screening.

Breast cancer screening awareness, practice, and perceived barriers: A community-based cross-sectional study among women in south-eastern Bangladesh.

Background and Aims: Breast cancer is a leading cause of mortality in Bangladesh. An early-stage screening is the best way to reduce both the morbidity and mortality burden of breast cancer. The study evaluated awareness, practice, and perceived barriers toward breast cancer screening in Bangladesh. Methods: A community-based cross-sectional study was conducted from October 2021 to December 2022 in Chattogram, Bangladesh, where 869 women (18 years or above) were randomly selected in this study. Results: Among 869 participants, 47.3% of women were recruited from urban areas and 52.7% participated from rural areas. Only 32.68% of respondents (urban vs. rural: 44.28% vs. 22.27%) were aware of breast self-examination (BSE) and 52.47% of respondents (urban vs. rural: 63.75% vs. 42.36%) had ever heard Clinical Breast Examination (CBE), respectively. Among the respondents, 27.73% (urban vs. rural: 40.15% vs. 16.59%) performed their BSE, and only 14.61% of respondents (urban vs. rural: 21.90% vs. 8.08%) had ever visited for CBE. Women residing in rural areas were approximately three times (AOR: 0.36 [95% CI: 0.25-0.52], AOR: 0.37 [95% CI: 0.23-0.58]) less likely to perform BSE and CBE, respectively, than urban dwellers. We found that higher-educated women tend to do more BSE and CBE than women with low levels of education. Perceptions of having "no symptoms" and being "risk-free" are leading barriers to breast screening among women. Conclusion: Poor awareness and practice were observed in screening among the urban and rural women in Bangladesh. Urban area dwellers had comparatively better understanding and practice than rural dwellers. We think extending health education and health promotion activities toward breast cancer screening is essential in this region.

Knowledge, attitudes, and practices related to breast cancer screening among female Jordanian university employees: A cross-sectional study.

INTRODUCTION: To improve participation in breast screening programs, the level of knowledge about BC, attitudes, and practices of women in different sections of society must be understood. This study aimed to measure the level of knowledge of BC risk factors, signs and symptoms and determine current mammography practices among female employees at Jordanian universities. METHODS: A cross-sectional descriptive study was conducted on female employees at Jordanian government universities. Data was collected using a structured questionnaire that included: sociodemographic characteristics, knowledge of BC risk factors, knowledge of BC symptoms and knowledge, attitude and practice of mammography as an early detection method. RESULTS: A total of 362 participants completed the questionnaire. Overall, 174 scored ≥50% correct answers regarding BC risk factors, while 231 scored ≥50% correct answers regarding BC signs and symptoms. Half of the participants (n = 184, 50.8%) understood mammography to be an early BC detection method. Among those participants, 95 (51.6%) were eligible for screening and 39 (21.2%) had had a previous mammogram. The main reason for not engaging in mammography was the absence of BC signs and symptoms (37.2%). Profession, educational level and family history of BC were associated with increased knowledge of BC risk factors, signs and symptoms (p = 0.01). Lecturers in medical faculties exhibited the highest level of knowledge about mammography compared to participants in other professions (p = 0.02). CONCLUSION: Only 79 participants had good to excellent knowledge about BC. Participants' profession was the major indicator for awareness of BC and mammography as an early detection method. IMPLICATIONS FOR PRACTICE: The findings of this study reinforce the importance of providing BC educational programs for university employees in Jordan to increase awareness of BC and mammography.