Breast cancer diagnosis in Inner-City African American and Hispanic women: The importance of early screening.

PURPOSE: To evaluate the diagnosis of breast cancer in inner-city African-American and Hispanic women under age 50 to support the importance of screening in this population. METHODS: This retrospective chart review included women newly diagnosed with breast cancer from 1/1/2015 to 1/1/2019 in a city hospital mainly serving minority patients. Chi-square and Fisher's exact tests were used for analysis. RESULTS: In this cohort of 108 newly diagnosed African-American (63%) and Hispanic (31%) women, 60/108 (56%) presented with a site of palpable concern for diagnostic workup, and the remaining were diagnosed via asymptomatic screening. Women ages 30-49 were significantly more likely to present with a site of palpable concern when compared to women ages 50-69 (68% vs. 44%, p = 0.045). Additionally, women ages 30-49 were more likely to have triple-negative breast cancer (TNBC) than women ages 50-69 (20% vs. 10%, p = 0.222). However, women ages 30-49 were less likely to have prior mammogram than women ages 50-69 (24% vs. 46%, p = 0.062). CONCLUSION: African-American and Hispanic women ages 30-49 were more likely to present with a site of palpable concern and TNBC than those ages 50-69. However, these young minority women ages 30-49 were less likely to have prior screening mammograms when compared to those ages 50-69. Our data highlights the importance of starting screening mammography no later than age 40 in African-American and Hispanic women. In addition, these women should have risk assessment for breast cancer no later than age 30 and be screened appropriately.

Presentation of self-detected breast mass in minority women with limited access to care: Can self-examination assist in early cancer detection?

OBJECTIVE: The United States Preventive Services Task Force recommends against breast self-examination. However, racial disparities exist in mammogram screening. We aimed to evaluate the presentation of women with newly diagnosed breast cancer in the underserved African-American and Hispanic community to provide insight regarding breast cancer screening in this population. METHODS: This retrospective cohort study included women newly diagnosed with breast cancer from 1/1/2016 to 1/1/2018 in an inner city public community hospital. Data was collected via chart review. Patients were divided based on whether they presented with self-detected breast mass. Logistic regression was used for analysis. RESULTS: 59 women were newly diagnosed with breast cancer. 34 women (58%) were African-American, 20 (34%) were Hispanic, and 5 (8%) were other race. Of 59 women, 36 (61%) presented with self-detected breast mass, and only 21 (36%) reported prior mammography. For women who presented with breast mass, the odds of having prior mammography were 78% lower (OR = 0.22, 95% CI 0.07-0.69, p = 0.009), while the odds of having invasive ductal carcinoma were 4.33 times higher (OR = 4.33, 95% CI 1.09-17.25, p = 0.037), as compared to the odds for women not presenting with breast mass. CONCLUSION: Many of our newly diagnosed breast cancer patients were African-American or Hispanic women presenting with self-detected breast mass without prior screening mammography. Further studies should evaluate whether supplemental screening methods, such as breast self-examination or clinical examination, can help with early breast cancer detection in minority women with limited access to care, and such disparities should be considered by organizations when creating screening guidelines.

A giant phyllodes tumor causing ulceration and severe breast disfigurement: case report and review of giant phyllodes.

Phyllodes tumors are rare fibroepithelial tumors that account for <1% of the breast tumors in women. These tumors are often benign unilateral lesions of the female breast (70%). Less common are malignant phyllodes, which have the potential for hematogenous spread. Phyllodes tumors can be seen in all age groups, and the median age of presentation is 45 years. Surgery is the main form of treatment. Wide excisions with margins of 1cm are suggested. While smaller and moderate size phyllodes may typically be seen, gigantic ones are very rare. These may be seen in neglected tumors. By definition, a giant phyllodes tumor is one larger than 10 cm in diameter. We report a gigantic phyllodes tumor that grew over 7 years period causing significant ulceration and disfigurement and review features of these tumors and management.

Radiology residents' on-call interpretation of chest radiographs for pneumonia.

RATIONALE AND OBJECTIVES: This study is designed to assess the performance of radiology residents in interpreting emergency department chest radiographs for pneumonia and to characterize chest radiographic findings in patients for which interpretation was amended by an attending radiologist. MATERIALS AND METHODS: We retrospectively reviewed all amended reports for chest radiographs performed on emergency department patients July 2002-June 2003. Reports preliminarily interpreted by residents and amended by a board-certified staff radiologist for the presence or absence of pneumonia were identified. A panel of three experienced radiologists, blinded to reports, jointly reviewed each chest radiograph. If the panel diagnosed pneumonia, the chest radiograph was evaluated for the projection that best showed the pneumonia, its size and location, and the presence or absence of the following features: increased opacity, air bronchograms, loss of vascular markings, silhouette sign, and linear opacities. The resident's post-graduate year (PGY) training level was noted. RESULTS: One percent (134/12,600 reports) of chest radiographic reports were amended for the presence or absence of pneumonia. One hundred chest radiographs were available and comprised the series. There were 56 females and 44 males with a mean age of 45 years (range, 1-99 years). The staff radiologist diagnosed pneumonia in 79% (79/100 radiographs). The panel agreed with the staff in 77% (kappa = 0.76) and the resident in 23% (kappa = 0.43). The panel diagnosed pneumonia in 60% (60/100 radiographs) with the following chest radiographic findings: 100% (60/60), increased opacity; 37% (22/60), air bronchograms; 72% (43/60), loss of vascular markings; 40% (24/60), silhouette sign; and 20% (12/60), linear opacities. The pneumonia was right sided in 52% (31/60), left sided in 37% (22/60), and bilateral in 11% (7/60). Right-sided pneumonias were equally distributed among the three lobes, and left-sided pneumonias had a lower-lobe predominance of 77% (17/22). Seventy-five percent (45/60) of pneumonias were segmental or smaller, and 82% (49/60) of chest radiographs showing pneumonia had both posteroanterior and lateral projections. The pneumonia was conspicuous on only one projection in 43% (21/49); the posteroanterior view in 22% (11/49), and the lateral view in 20% (10/49). Eighty-one percent (81/100) of interpreting residents were PGY-3. CONCLUSION: Interpretation of chest radiographs for pneumonia by PGY-3 residents has a low error rate. Missed pneumonias often were segmental or smaller and conspicuous on only one projection.