Perceptions of surveillance with magnetic resonance imaging among women with a hereditary risk of breast cancer-A phenomenographic study.

AIM: To explore perceptions of annual surveillance with magnetic resonance imaging and perceptions of care during the examination among women with a hereditary risk of breast cancer. DESIGN: Phenomenography. METHODS: Fourteen face-to-face interviews using a semi-structured interview guide were conducted among women undergoing surveillance in the southern region of Sweden. A seven-step phenomenographic analysis with investigator triangulation was performed. RESULTS: 'Considering own risk of developing breast cancer', 'Entrusting oneself to surveillance' and 'Living in a cycle' represented descriptive categories of perceptions. Family narratives introduced comprehension of own risk of breast cancer, followed by appraisal of own benefits of participating in surveillance. Entrusting oneself to surveillance included handing over management of diagnostic examinations and dealing with practical issues and diverse emotions related to surveillance. Planning life based around surveillance, struggling with fluctuating emotions, also between the examinations and questioning own identity implied the perception of living in a cycle. CONCLUSION: Surveillance for hereditary breast cancer implies living in a cycle of dealing with fluctuating emotions and planning life based around surveillance. Comprehension of one's own risk for breast cancer arises from awareness in the family. Women value the surveillance programme and trust the healthcare system. IMPLICATION FOR THE PROFESSION AND PATIENT CARE: Knowledge of women's perceptions of the surveillance programme and care is vital for supporting women in their decision-making on attendance and providing person-centred care during surveillance. IMPACT: A gap in explorative studies from the perspective of the individual woman in the context of surveillance for breast cancer and care in magnetic resonance imaging in surveillance was addressed. 'Considering own risk of developing breast cancer', 'Entrusting oneself to surveillance' and 'Living in a cycle' represented women's perceptions of surveillance and care. The study results have implications for person-centred care among women in the surveillance programme. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

A pilot study of an organised population-based testing programme for prostate cancer.

OBJECTIVE: To determine the feasibility of a digitally automated population-based programme for organised prostate cancer testing (OPT) in Southern Sweden. PATIENTS AND METHODS: A pilot project for a regional OPT was conducted between September 2020 and February 2021, inviting 999 randomly selected men aged 50, 56, or 62 years. Risk stratification was based on prostate-specific antigen (PSA) level, PSA density (PSAD), and bi-parametric prostate magnetic resonance imaging (MRI). Men with a PSA level of 3-99 ng/mL had an MRI, and men with elevated PSA level (≥3 ng/mL) had a urological check-up, including a digital rectal examination and transrectal ultrasonography (TRUS). Indications for targeted and/or systematic transrectal prostate biopsies were suspicious lesions on MRI (Prostate Imaging-Reporting and Data System [PI-RADS] 4-5) and/or PSAD > 0.15 ng/mL/mL. Additional indications for prostate biopsies were palpable tumours, PSA ratio < 0.1, or cancer suspicion on TRUS. Patient selection, mail correspondence, data collection, and algorithm processing were performed by an automated digital management system. Feasibility is reported descriptively. RESULTS: A total of 418 men had a PSA test (42%), with increasing participation rates by age (50 years, 38%; 56 years, 44%; and 62 years, 45%). Among these, 35 men (8%) had elevated PSA levels (≥3 ng/mL: one of 139, aged 50 years; 10/143, aged 56 years; and 24/146, aged 62 years). On MRI, 16 men (48%) had a negative scan (PI-RADS < 3), seven men (21%) had PI-RADS 3, nine men (27%) had PI-RADS 4, and one man (3%) had PI-RADS 5. All men with PI-RADS 4 or 5 underwent prostate biopsies, as well as two men with PI-RADS 3 due to PSAD > 0.15 ng/mL/mL or a suspicious finding on TRUS. Prostate cancer was diagnosed in 10 men. Six men underwent active treatment, whereas four men were assigned to active surveillance. CONCLUSION: Our OPT model is feasible from an operational point of view, but due to the limited scale of this study no conclusions can be made regarding the efficacy of the diagnostic model or outcome.

Malmö Breast ImaginG database: objectives and development.

Purpose: We describe the design and implementation of the Malmö Breast ImaginG (M-BIG) database, which will support research projects investigating various aspects of current and future breast cancer screening programs. Specifically, M-BIG will provide clinical data to:1.investigate the effect of breast cancer screening on breast cancer prognosis and mortality;2.develop and validate the use of artificial intelligence and machine learning in breast image interpretation; and3.develop and validate image-based radiological breast cancer risk profiles. Approach: The M-BIG database is intended to include a wide range of digital mammography (DM) and digital breast tomosynthesis (DBT) examinations performed on women at the Mammography Clinic in Malmö, Sweden, from the introduction of DM in 2004 through 2020. Subjects may be included multiple times and for diverse reasons. The image data are linked to extensive clinical, diagnostic, and demographic data from several registries. Results: To date, the database contains a total of 451,054 examinations from 104,791 women. During the inclusion period, 95,258 unique women were screened. A total of 19,968 examinations were performed using DBT, whereas the rest used DM. Conclusions: We describe the design and implementation of the M-BIG database as a representative and accessible medical image database linked to various types of medical data. Work is ongoing to add features and curate the existing data.

Surveillance of indeterminate pulmonary nodules detected with CT in a Swedish population-based study (SCAPIS): psychosocial consequences and impact on health-related quality of life-a multicentre prospective cross-sectional study.

OBJECTIVES: To investigate whether surveillance of pulmonary nodules detected with low-dose CT (LDCT) impacted health-related quality of life and psychosocial consequences in the Swedish population-based study, Swedish CArdioPulmonary bioImage Study (SCAPIS). DESIGN: A prospective cross-sectional study. SETTINGS AND PARTICIPANTS: This multicentre (five sites) observational study, which included a cohort from SCAPIS, consisted of 632 participants with indeterminate pulmonary nodules detected with LDCT. These participants continued surveillance for up to 36 months, during which lung cancer was not detected (surveillance group). Additionally, 972 participants with a negative pulmonary LDCT scan were included as a control group. Matching criteria were LDCT date (±2 weeks), gender and site. OUTCOME MEASURES: All participants completed a health-related quality of life questionnaire (RAND-36) and the Consequences of Screening (COS) questionnaire, an average of 3 years after LDCT was conducted at entry into SCAPIS. RESULTS: Participants were 51-70 years old at study commencement. Overall, the two groups did not differ in demographic or psychosocial variables, smoking habits or pulmonary medical history. Individuals from countries other than Sweden and those with low socioeconomic status were less likely to participate (p<0.001). No effects on health-related quality of life were observed via RAND-36. In COS, the surveillance group demonstrated a higher OR for anxiety about lung cancer (OR 3.96, 95% CI 2.35 to 6.66, p<0.001), experiencing a sense of dejection (OR 1.35, 95% CI 1.06 to 1.72, p=0.015) and thoughts about existential values (OR 1.30, 95% CI 1.04 to 1.60, p=0.018). CONCLUSIONS: Lung surveillance with LDCT contributed to significant experiences of sense of dejection, anxiety about lung cancer and development of thoughts about existential values among participants in the surveillance group compared with the controls. The risk of side effects should be communicated for informed decision-making about (non-)attendance in lung cancer screening.

Validation of a candidate instrument to assess image quality in digital mammography using ROC analysis.

PURPOSE: To validate a candidate instrument, to be used by different professionals to assess image quality in digital mammography (DM), against detection performance results. METHODS: A receiver operating characteristics (ROC) study was conducted to assess the detection performance in DM images with four different image quality levels due to different quality issues. Fourteen expert breast radiologists from five countries assessed a set of 80 DM cases, containing 60 lesions (40 cancers, 20 benign findings) and 20 normal cases. A visual grading analysis (VGA) study using a previously-described candidate instrument was conducted to evaluate a subset of 25 of the images used in the ROC study. Eight radiologists that had participated in the ROC study, and seven expert breast-imaging physicists, evaluated this subset. The VGA score (VGAS) and the ROC and visual grading characteristics (VGC) areas under the curve (AUCROC and AUCVGC) were compared. RESULTS: No large differences in image quality among the four levels were detected by either ROC or VGA studies. However, the ranking of the four levels was consistent: level 1 (partial AUCROC: 0.070, VGAS: 6.77) performed better than levels 2 (0.066, 6.15), 3 (0.061, 5.82), and 4 (0.062, 5.37). Similarity between radiologists' and physicists' assessments was found (average VGAS difference of 10 %). CONCLUSIONS: The results from the candidate instrument were found to correlate with those from ROC analysis, when used by either observer group. Therefore, it may be used by different professionals, such as radiologists, radiographers, and physicists, to assess clinically-relevant image quality variations in DM.

How does image quality affect radiologists' perceived ability for image interpretation and lesion detection in digital mammography?

OBJECTIVES: To study how radiologists' perceived ability to interpret digital mammography (DM) images is affected by decreases in image quality. METHODS: One view from 45 DM cases (including 30 cancers) was degraded to six levels each of two acquisition-related issues (lower spatial resolution and increased quantum noise) and three post-processing-related issues (lower and higher contrast and increased correlated noise) seen during clinical evaluation of DM systems. The images were shown to fifteen breast screening radiologists from five countries. Aware of lesion location, the radiologists selected the most-degraded mammogram (indexed from 1 (reference) to 7 (most degraded)) they still felt was acceptable for interpretation. The median selected index, per degradation type, was calculated separately for calcification and soft tissue (including normal) cases. Using the two-sided, non-parametric Mann-Whitney test, the median indices for each case and degradation type were compared. RESULTS: Radiologists were not tolerant to increases (medians: 1.5 (calcifications) and 2 (soft tissue)) or decreases (median: 2, for both types) in contrast, but were more tolerant to correlated noise (median: 3, for both types). Increases in quantum noise were tolerated more for calcifications than for soft tissue cases (medians: 3 vs. 4, p = 0.02). Spatial resolution losses were considered less acceptable for calcification detection than for soft tissue cases (medians: 3.5 vs. 5, p = 0.001). CONCLUSIONS: Perceived ability of radiologists for image interpretation in DM was affected not only by image acquisition-related issues but also by image post-processing issues, and some of those issues affected calcification cases more than soft tissue cases. KEY POINTS: • Lower spatial resolution and increased quantum noise affected the radiologists' perceived ability to interpret calcification cases more than soft tissue lesion or normal cases. • Post-acquisition image processing-related effects, not only image acquisition-related effects, also impact the perceived ability of radiologists to interpret images and detect lesions. • In addition to current practices, post-acquisition image processing-related effects need to also be considered during the testing and evaluation of digital mammography systems.

Intra- and inter-rater reliability of compressed breast thickness, applied force, and pressure distribution in screening mammography.

BACKGROUND: Ensuring equivalent and reproducible breast compression between mammographic screening rounds is important for the diagnostic performance of mammography, yet the extent to which screening mammography positioning and compression is reproducible for the individual woman is unknown. PURPOSE: To investigate the intra- and inter-rater reliability of breast compression in screening mammography. MATERIALS AND METHODS: Eleven breast-healthy women participated in the study. Two experienced radiographers independently positioned and compressed the breasts of each participant in two projections-right craniocaudal and left mediolateral oblique-and at two time points. The spatial pressure distribution on the compressed breast was measured using a pressure sensor matrix. Applied force, compressed breast thickness, force in field of view, contact area, mean pressure, and center of mass (anterio-posterior and mediolateral axes) were measured. The reliabilities of the measures between the time points for each radiographer (intra-rater reliability) and between the radiographers (inter-rater reliability) were analyzed using the intraclass correlation coefficient (ICC). RESULTS: Intra- and inter-rater reliabilities from both projections demonstrated good to excellent ICCs (≥0.82) for compressed breast thickness, contact area, and anterio-posterior center of mass. The other measures produced ICCs that varied from poor (≤0.42) to excellent (≥0.93) between time points and between radiographers. CONCLUSION: Intra- and inter-rater reliability of breast compression was consistently high for compressed breast thickness, contact area, and anterio-posterior center of mass but low for mediolateral center of mass and applied force. Further research is needed to establish objective and clinically useful parameters for the standardization of breast compression.

Development and content validity evaluation of a candidate instrument to assess image quality in digital mammography: A mixed-method study.

PURPOSE: To develop a candidate instrument to assess image quality in digital mammography, by identifying clinically relevant features in images that are affected by lower image quality. METHODS: Interviews with fifteen expert breast radiologists from five countries were conducted and analysed by using adapted directed content analysis. During these interviews, 45 mammographic cases, containing 44 lesions (30 cancers, 14 benign findings), and 5 normal cases, were shown with varying image quality. The interviews were performed to identify the structures from breast tissue and lesions relevant for image interpretation, and to investigate how image quality affected the visibility of those structures. The interview findings were used to develop tentative items, which were evaluated in terms of wording, understandability, and ambiguity with expert breast radiologists. The relevance of the tentative items was evaluated using the content validity index (CVI) and modified kappa index (k*). RESULTS: Twelve content areas, representing the content of image quality in digital mammography, emerged from the interviews and were converted into 29 tentative items. Fourteen of these items demonstrated excellent CVI ≥ 0.78 (k* > 0.74), one showed good CVI < 0.78 (0.60 ≤ k* ≤ 0.74), while fourteen were of fair or poor CVI < 0.78 (k* ≤ 0.59). In total, nine items were deleted and five were revised or combined resulting in 18 items. CONCLUSIONS: By following a mixed-method methodology, a candidate instrument was developed that may be used to characterise the clinically-relevant impact that image quality variations can have on digital mammography.

TO USE OR NOT USE PATIENT SHIELDING ON PREGNANT WOMEN UNDERGOING CT PULMONARY ANGIOGRAPHY: A PHANTOM STUDY.

Pregnancy increases the risk of pulmonary embolism. Computed tomography pulmonary angiography (CTPA) is used for diagnosis. CT generates ionising radiation, and thus, abdominal shielding may be used. This phantom study investigated the effects of patient shielding and scan length reduction on the fetal and maternal ionising radiation dose from CTPA. The absorbed dose to the fetus was measured using thermoluminescent dosemeters. Estimated effective doses to the pregnant patient were based on the dose-length products. Shielding increased both the effective dose to the patient by 47% and the mean absorbed dose to the fetus (0.10 vs. 0.12 mGy; p < 0.001) compared with unshielded standard CTPA, as it affected the automatic exposure control. Shielded short CTPA marginally lowered only the mean fetal absorbed dose (0.03 vs. 0.02 mGy; p = 0.018). Shortening the scan reduced the fetal absorbed dose most effectively by 70% (0.10 vs. 0.03 mGy; p = 0.006), compared with the standard unshielded scan. Shielding modestly reduces fetal radiation dose but may compromise automatic exposure control, possibly increasing the maternal and fetal radiation dose. Shortening the scan is beneficial, assuming anatomical coverage is secured.

Intra- and inter-rater reliability in a comparative study of cross-sectional and spiral computed tomography pelvimetry methods.

BACKGROUND: Different low-dose computed tomography (CT) pelvimetry methods can be used to evaluate the size of birth canal before delivery. CT pelvimetry might generate an acceptable low fetal radiation dose but its measurement accuracy is unknown. PURPOSE: To investigate intra- and inter-rater measurement reliability of cross-sectional and two spiral CT pelvimetry methods: standard spiral and short spiral. MATERIAL AND METHODS: Ten individuals (age ≥60 years, body mass index ≥30 kg/m2) having a CT scan of the abdomen also had CT pelvimetry scans. Three radiologists made independent measurements of each pelvimetry method on two occasions and also in consensus for a reference pelvimetry computed from the standard-dose CT scan of the abdomen. Inter- and intra-rater reliability was analyzed by intraclass correlation coefficient. RESULTS: Measurements in the short spiral pelvimetry demonstrated excellent intra- and inter-rater reliability, intraclass correlation coefficient ≥0.93, and good to excellent 95% confidence interval 0.87-0.99. Corresponding results of the standard spiral and cross-sectional pelvimetry showed good to excellent intraclass correlation coefficient ≥0.85 and ≥0.76, and 95% confidence interval was least good and moderate 0.73-0.98 and 0.59-0.97, respectively. Intraclass correlation coefficient between reference pelvimetry and other CT methods showed analogous results. CONCLUSION: The short spiral pelvimetry demonstrated high and best reliability in comparison to other methods. Standard spiral method showed also good measurement reliability but the short spiral pelvimetry generates lower fetal radiation dose. This method might be suitable for measurements at narrow pelvis. Patient acceptance and attitude to CT pelvimetry should be investigated.

Prevalence, Long-term Development, and Predictors of Psychosocial Consequences of False-Positive Mammography among Women Attending Population-Based Screening.

BACKGROUND: Cancer screening aims to detect cancer at an asymptomatic stage, although side effects from screening also occur. We investigated the prevalence, longitudinal development, and predictors of psychosocial consequences of false-positive breast cancer screening. METHODS: Three hundred ninety-nine women with false-positive screening mammography responded to the Consequences of Screening-Breast Cancer (COS-BC) questionnaire immediately after a negative diagnosis (free from breast cancer) following recall examination(s) (baseline), and 6 and 12 months later. Age-matched controls (n = 499) with a negative mammogram responded to the COS-BC at the same occasions. Five COS-BC scales (Sense of dejection, Anxiety, Behavioral, Sleep, and Existential values) were used as outcome measures. RESULTS: Women with false-positive mammography had consistently higher prevalence of all five consequences compared with controls (P < 0.001). The prevalences decreased between baseline and 6 months (P < 0.001) but were stable between 6 and 12 months (P ≥ 0.136). Early recall profoundly predicted long-term consequences for all five outcomes (OR, 3.05-10.31), along with dissatisfaction with information at recall (OR, 2.28-2.56), being foreign-born (OR, 2.35-3.71), and lack of social support (OR, 1.13-1.25). CONCLUSION: This 1-year longitudinal study shows that women experience psychosocial consequences of false-positive screening mammography. Early recall should be performed cautiously, and provision of information as well as social support may reduce psychosocial consequences. IMPACT: Although delivery of population-based screening reduces breast cancer mortality, it also raises the issue of its impact on the psychosocial well-being of healthy women. Our findings identify predictors that can be targeted in future efforts to reduce the side effects of mammographic screening.

Psychometric properties of a Swedish version of the Consequences of Screening--Breast Cancer questionnaire.

AIM: To evaluate the psychometric properties of a questionnaire addressing psychosocial consequences of false-positive mammographic screening. BACKGROUND: The Consequences of Screening--Breast Cancer and Lung Cancer questionnaires target psychosocial consequences of false-positive cancer screening. The Consequences of Screening--Breast Cancer questionnaire and ten items not considered lung cancer specific from the Lung Cancer questionnaire have been adapted for use in mammographic screening in Sweden, but remain psychometrically untested. DESIGN: Instrument development paper with psychometric cross-sectional and test-retest design. METHODS: Twelve scales of a Swedish questionnaire version were tested by the Rasch model and traditional psychometric methods. Women with false-positive (Group I, n = 640) and negative (Group II, n = 802) screening mammography responded to the study questionnaire and the Nottingham Health Profile during 2009-2011. RESULTS: Iterative analyses resulted in nine scales demonstrating Rasch model fit, but all scales exhibited poor targeting with relatively large floor effects. Corrected item-total correlations exceeded the recommended criterion. Score differences between Groups I and II and correlations with Nottingham Health Profile sections followed an expected pattern. Cronbach's α and test-retest reliability was acceptable for group-level assessments for ten and seven scales, respectively. CONCLUSIONS: Five scales (Sense of dejection, Anxiety, Behavioural, Sleep and Existential values) of the Swedish questionnaire version demonstrated the best psychometric properties. Other scales should be used more cautiously. Although filling an important gap, causes of concern were identified across scales. The questionnaire should therefore be considered for group-level assessments rather than for measurement of individual degrees of psychosocial consequences.

A roller coaster of emotions and sense--coping with the perceived psychosocial consequences of a false-positive screening mammography.

AIMS AND OBJECTIVES: To explore coping with the perceived psychosocial consequences of a false-positive screening mammography. BACKGROUND: Mammographic screening has been found effective to decrease breast cancer (BC) mortality, yet there are adverse effects. Psychosocial consequences of false-positive mammographic screening have mainly been investigated from a population-based perspective. A call for qualitative studies to further explore these consequences has thus been postulated. To date, qualitative studies have elucidated women's experiences following their recall breast examinations, but their coping with perceived psychosocial consequences of a false-positive screening mammography has not yet been explored. DESIGN: An explorative qualitative study. METHODS: Face-to-face interviews were held with a purposive heterogeneous sample of 13 Swedish-speaking women with a false-positive screening mammography. The transcripts were analysed by the use of an inductive content analysis. RESULTS: Coping with the perceived psychosocial consequences of a false-positive screening mammography implied a roller coaster of emotion and sense. Women described how they imagined the worst and were in a state of uncertainty feeling threatened by a fatal disease. Conversely, they felt protected, surrounded by their families and being professionally taken care of, which together with perceived sisterhood and self-empowerment evoked strength and hope. Being aware of family responsibility became a crucial matter. Experiencing false-positive screening raised thoughts of thankfulness and reappraisal of life, although an ounce of BC anxiety remained. Consequently, gained awareness about BC screening and values in life surfaced. CONCLUSIONS: Experiencing a false-positive screening mammography triggers agonising experiences evoking a variety of coping strategies. Provision of screening raises the issue of responsibility for an impact on psychosocial well-being among healthy women. RELEVANCE TO CLINICAL PRACTICE: Gained knowledge might provide a basis for interventions to prevent psychosocial consequences of false-positive mammographic screening and provide support for women with a potentially compromised ability to overcome such consequences.

Adaptation to Swedish and further development of the 'Consequences of Screening - Breast Cancer' questionnaire: a multimethod study.

RATIONALE: Experiencing a false-positive screening mammography can cause considerable psychosocial distress. The Consequences of Screening - Breast Cancer questionnaire (COS-BC parts 1 and 2), recently developed in Denmark, is the only condition-specific questionnaire for measuring short- and long-term psychosocial consequences of false-positive mammographic screening. Additional studies are needed to further test the COS-BC before use across cultures. Furthermore, studies have suggested that the consequences of false-positive screening results are partly common across cancer screening settings, although this hypothesis remains largely untested. OBJECTIVES: This study (i) assesses content validity of a Swedish version of the COS-BC, (ii) tests whether items expressing long-term consequences of false-positive lung cancer screening results are relevant in a breast cancer screening context and (iii) explores the usefulness of taking results from Rasch analyses of the source version as an aid in questionnaire translation and adaptation. METHODS: Following dual-panel translation, content validity was assessed through qualitative interviews with representatives of the target population and the content validity index (CVI). Item locations and Rasch model fit of the source questionnaires were considered in the translation and assessment process. RESULTS: The COS-BC items were generally found relevant and provided coverage of the target construct. Content validity was supported also for nine of 10 lung cancer screening items. Scale CVI values were ≥0.81. Previous Rasch data were useful in facilitating translation and assessing item content validity. The resulting Swedish version of the COS-BC parts 1 and 2 consists of 34 and 23 items, respectively. CONCLUSION: This study illustrates the value of methodological triangulation and use of data from previous Rasch analyses in questionnaire translation and adaptation. We found support for the hypothesis that consequences of false-positive screening are common across cancer screening settings. Psychometric properties of the Swedish COS-BC remain to be established.