Artificial intelligence in mammography: a systematic review of the external validation.

Objective: To conduct a systematic review of external validation studies on the use of different Artificial Intelligence algorithms in breast cancer screening with mammography. Data source: Our systematic review was conducted and reported following the PRISMA statement, using the PubMed, EMBASE, and Cochrane databases with the search terms "Artificial Intelligence," "Mammography," and their respective MeSH terms. We filtered publications from the past ten years (2014 - 2024) and in English. Study selection: A total of 1,878 articles were found in the databases used in the research. After removing duplicates (373) and excluding those that did not address our PICO question (1,475), 30 studies were included in this work. Data collection: The data from the studies were collected independently by five authors, and it was subsequently synthesized based on sample data, location, year, and their main results in terms of AUC, sensitivity, and specificity. Data synthesis: It was demonstrated that the Area Under the ROC Curve (AUC) and sensitivity were similar to those of radiologists when using independent Artificial Intelligence. When used in conjunction with radiologists, statistically higher accuracy in mammogram evaluation was reported compared to the assessment by radiologists alone. Conclusion: AI algorithms have emerged as a means to complement and enhance the performance and accuracy of radiologists. They also assist less experienced professionals in detecting possible lesions. Furthermore, this tool can be used to complement and improve the analyses conducted by medical professionals.

Impact of Covid-19 on Breast Cancer Screening.

OBJECTIVE: To assess the influence of the COVID-19 pandemic on breast cancer screening. METHODS: This was a cross-sectional and retrospective study, which used data extracted from "TABNET" between 2014 to 2020.  Statistical analysis was carried out using the ANOVA model. RESULT: In 2019, a total of 3,068,776 mammograms were conducted, which significantly decreased to 1,808,765 in 2020.  Since the onset of the pandemic in Brazil in March 2020, there has been a reduction in the number of mammograms performed.  Mammography coverage increased from 0.11 to 0.18 between 2014 and 2019 but sharply declined from 0.18 to 0.10 between 2019 and 2020. CONCLUSION: The COVID-19 pandemic has had a detrimental impact on breast cancer screening efforts, especially in detecting the disease in early stages.  Health services shifted their focus towards caring for COVID-19 patients, therefore neglecting routine screening programs and interventions. Additionally, the population's fear of contagion contributed to a decrease in demand for screening tests.

Relationship between Screening, Diagnostic Mammograms, Hospital Admissions, and Mortality Rates from Breast Cancer.

BACKGROUND: Breast cancer is the most common type of cancer worldwide. If diagnosed and treated early, it has a high chance of cure, and for this, screening tests are necessary, namely mammograms, which are the most commonly used. The objective of this study was to analyze the association between the number of screening and diagnostic mammograms and the number of hospitalizations and deaths from breast cancer. METHODS: This is a cross-sectional, analytical, retrospective study with secondary data made available by the Ministry of Health. Pearson correlation analysis was employed to assess whether the number of mammograms is associated with the number of deaths and hospitalizations, Poisson regression was used to assess whether an increase in the number of mammograms and hospitalizations is related to the number of deaths, and the Cox-Stuart test was used to analyze the temporal trend of the variables under study and the projection of time series. RESULTS: There was a strong positive correlation for all age groups when relating the variables hospitalizations and deaths, a moderate-to-strong correlation for the variables mammography and hospitalization, and a weak correlation for the variables mammography and death. There was no statistical significance in the relationship between the number of mammograms and deaths, whereas the hospitalization variable had a significant impact in relation to death, increasing the chance by 0.015%. There has also been a significant growth trend in the variables deaths and hospitalizations in Brazil over the years. CONCLUSIONS: A growing trend was identified from 2013 to 2021, both in hospitalizations and deaths, thus suggesting that strategies aimed at reformulating public health policies are necessary for earlier diagnosis in order to improve the treatment of breast cancer and the prognosis of the disease.

[BIRADS 0 patient reclassification in a first-level of care unit]. / Reclasificación de pacientes BIRADS 0 en una unidad de primer nivel de atención.

Background: In Mexico and the world, breast cancer is the cancer type with the highest incidence and mortality for women. Its incidence has increased due to a higher life expectancy and a higher exposure to risk factors. Screening is done by mammography using the BIRADS (Breast Imaging Reporting and Data System) system, the standard for mammography screening report which classifies lesions assigning recommendations for patient follow-up. The system goes from 0 (not conclusive) to 6 (demonstrated malignancy), being of interest for this study the BIRADS 0 category. Objective: To describe patients classified as BIRADS 0 by mammography and their reclassification in a first-level hospital during 2021. Material and methods: Retrospective, descriptive, cross-sectional, observational study. Women over 40 years with a BIRADS 0 result were studied. The following databases were used: Institutional Cancer Registry, Family Medicine Information System, Electronic Clinical File, and the mammography and patient list from preventive medicine. Results: Reclassification by ultrasound (US) was achieved in 100% of patients, in all of the BIRADS US categories. In 3.8% of BIRADS 0 patients, ductal adenocarcinoma was found and confirmed by histological testing. Conclusion: All of the reassessed lesions with US were adequately reclassified.

Introducción: en México y el mundo, el cáncer de mama causa la mayor mortalidad por cáncer en mujeres. Su incidencia ha incrementado por una mayor esperanza de vida y exposición a factores de riesgo. El tamizaje de esta enfermedad se hace mediante mastografía, y para la estratificación de las lesiones se utiliza el sistema BIRADS (Breast Imaging Reporting and Data System), que estandariza el informe, categoriza las lesiones según el grado de sospecha y asigna recomendaciones a seguir. Dicho sistema va desde 0 (no concluyente) hasta 6 (lesión con malignidad demostrada) y es de interés para este estudio la categoría 0. Objetivo: describir la reclasificación de pacientes con reporte BIRADS 0 por mastografía durante 2021 en una unidad de primer nivel de atención. Material y métodos: estudio retrospectivo, descriptivo, transversal, observacional. Se estudiaron mujeres mayores de 40 años con resultado BIRADS 0. Se utilizaron las siguientes bases de datos: Registro Institucional de Cáncer, Sistema de Información de Medicina Familiar, Expediente Clínico Electrónico y lista nominal de mastografías y censo de pacientes sospechosos de medicina preventiva. Resultados: la reclasificación con ultrasonido (US) se logró en el 100% de pacientes, en todas las categorías de BIRADS US. En el 3.8% se confirmó carcinoma ductal por histología en las pacientes inicialmente categorizadas como BIRADS 0. Conclusiones: la totalidad de lesiones reevaluadas con US fueron reclasificadas satisfactoriamente.

[Analysis of the effect of mammography allocation on women's health indicators]. / Análise do efeito da alocação de mamógrafo sobre indicadores de saúde da mulher.

The early detection of breast cancer enables more effective forms of treatment. However, widespread access to its main screening tool, mammography, remains a challenge for the Brazilian public health system. This study aimed to analyze the effect of allocating mammography equipment on women's health indicators. In 2013, of the 4,557 municipalities that lacked the equipment, 260 received it up to 2019. The main hypothesis of this study suggests that receiving the mammography device would show a heterogeneous effect between locations and that such receival would depend on observable (propensity score matching) and non-observable variables (fixed effects model). Results indicate that the Brazilian municipalities that had mammography equipment in use from 2014 onward increased their number of exams without short-term effects to diagnoses and deaths due to malignant breast neoplasia. In addition to equipment, a more complex structure involving other factors (such as access to consultations, qualified professionals, waiting time, etc.) is important to improve women's health indicators in the analyzed municipalities.

A detecção precoce de câncer de mama permite formas de tratamentos mais eficazes. Entretanto, o acesso generalizado à principal ferramenta de rastreamento, a mamografia, ainda é um desafio para o sistema público de saúde brasileiro. Este estudo tem o objetivo de analisar o efeito da alocação de mamógrafos sobre indicadores de saúde da mulher. Em 2013, dentre os 4.557 municípios que não tinham o equipamento, 260 receberam até 2019. A principal hipótese é que o efeito de receber o mamógrafo seja heterogêneo entre as localidades e que receber o equipamento dependa de variáveis observáveis (pareamento por escore de propensão) e não observáveis (modelo de efeitos fixos). Os resultados indicam que os municípios brasileiros que tiveram mamógrafo em uso a partir de 2014 obtiveram aumentos na realização de exames, porém sem efeitos de curto prazo para diagnósticos e óbitos por neoplasia maligna da mama. Além de equipamentos, uma estrutura mais complexa que envolve outros fatores como acesso a consultas, profissionais qualificados, tempo de espera etc. são importantes para melhorar os indicadores de saúde femininos no recorte de municípios analisados.

La detección temprana del cáncer de mama permite formas de tratamientos más eficaces. Sin embargo, el acceso generalizado a la principal herramienta de seguimiento, la mamografía, sigue siendo un desafío para el sistema público de salud brasileño. Este estudio tiene como objetivo analizar el efecto de la asignación de mamógrafos en los indicadores de salud de la mujer. En 2013, de los 4.557 municipios que no tenían el equipo, 260 lo recibieron hasta 2019. La hipótesis principal es que el efecto de recibir un mamógrafo es heterogéneo entre las localidades y que recibir el equipo depende de variables observables (emparejamiento por puntaje de propensión) y no observables (modelo de efectos fijos). Los resultados indican que en los municipios brasileños que han tenido mamógrafo en uso a partir de 2014 obtuvieron aumentos en la realización de exámenes, pero sin efectos a corto plazo sobre los diagnósticos y las muertes por neoplasia maligna de la mama. Además de los equipos, una estructura más compleja que involucra otros factores como el acceso a consultas, profesionales calificados, tiempo de espera, etc. son importantes para mejorar los indicadores de salud de las mujeres en el recorte de municipios analizados.

Repercussions of the COVID-19 pandemic on breast cancer actions in a Brazilian state.

Objective: To analyze whether the COVID-19 pandemic had an impact on the screening, diagnosis and treatment of breast cancer in women up to 50 years of age in the state of Pará. Methods: Retrospective, cross-sectional study with a quantitative approach, using data from the Information Technology Department of the Brazilian Unified Health System. (DATASUS). The number of exams carried out in the pre-pandemic (2018-2019) and pandemic (2020-2021) period was analyzed based on the percentage variation, application of the chi-square test and G test for the time of exams and start time of treatment. Results: During the pandemic period, there was a greater number of screening mammograms (+3.68%), cytological (+23.68%), histological (+10.7%) and a lower number of diagnostic mammograms (-38.7%). The time interval for carrying out the exams was up to 30 days for screening and diagnostic exams and more than 60 days to start treatment during the pandemic period. Conclusion: Although the results indicate an increase in the number of screening and diagnostic procedures for breast cancer during the pandemic period, with the exception of diagnostic mammography, when considering probability values, the study points out that statistically the COVID-19 pandemic did not interfere with actions of breast cancer, in women over 50 years of age, in the state of Pará. Considering the autonomy of nursing and its role in public health, it is up to the professionals who are in charge of primary care programs to implement contingency plans in periods of crisis so that the population is not left unassisted.

Time trend analysis and impacts of the COVID-19 pandemic on mammography and Papanicolaou test coverage in Brazilian state capitals.

BACKGROUND: Breast and cervical cancer are major public health issues globally. The reduction in incidence and mortality rates of these cancers is linked to effective prevention, early detection, and appropriate treatment measures. This study aims to analyze the temporal trends in the prevalence of mammography and Papanicolaou test coverage among women living in Brazilian state capitals between 2007 and 2023, and to compare the coverage of these tests before and during the Covid-19 pandemic. METHODS: A time series study was conducted using data from the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey from 2007 to 2023. The variables analyzed included mammography and Papanicolaou test coverage according to education level, age group, race/skin color, regions, and Brazilian capitals. The Prais-Winsten regression model was used to analyze the time series, and Student's t-test was employed to compare the prevalence rates between 2019 and 2023. RESULTS: Between 2007 and 2023, mammography coverage showed a stationary trend (71.1% in 2007 and 73.1% in 2023; p-value = 0.75) with a declining trend observed among women with 12 years or more of education (APC= -0.52% 95%CI -1.01%; -0.02%). Papanicolaou test coverage for all women aged between 25 and 64 exhibited a downward trend from 82% in 2007 to 76.8% in 2023 (APC= -0.45% 95%CI -0.76%; -0.13%). This decline was also noticed among those with 9 years or more of education; in the 25 to 44 age group; among women with white and mixed race; and in the Northeast, Central-West, Southeast, and South regions. When comparing coverage before and during Covid-19 pandemic, a reduction was noted for both tests. CONCLUSIONS: Over the years, there has been stability in mammography coverage and a decline in Papanicolaou test. The COVID-19 pandemic negatively impacted the number of these tests carried out among women, highlighting the importance of actions aimed at increasing coverage, especially among the most vulnerable groups.

Ethnic inequalities in coverage and use of women's cancer screening in Peru.

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.

Repercussions of the COVID-19 pandemic on breast cancer actions in a Brazilian state / Repercusiones de la pandemia de COVID-19 en las acciones contra el cáncer de mama en un estado brasileira / Repercussões a pandemia da COVID-19 nas ações do câncer de mama em um Estado Brasileiro

Objective. To analyze whether the COVID-19 pandemic had an impact on the screening, diagnosis and treatment of breast cancer in women up to 50 years of age in the state of Pará. Methods. Retrospective, cross-sectional study with a quantitative approach, using data from the Information Technology Department of the Brazilian Unified Health System. (DATASUS). The number of exams carried out in the pre-pandemic (2018-2019) and pandemic (2020-2021) period was analyzed based on the percentage variation, application of the chi-square test and G test for the time of exams and start time of treatment. Results. During the pandemic period, there was a greater number of screening mammograms (+3.68%), cytological (+23.68%), histological (+10.7%) and a lower number of diagnostic mammograms (-38.7%). The time interval for carrying out the exams was up to 30 days for screening and diagnostic exams and more than 60 days to start treatment during the pandemic period. Conclusion. Although the results indicate an increase in the number of screening and diagnostic procedures for breast cancer during the pandemic period, with the exception of diagnostic mammography, when considering probability values, the study points out that statistically the COVID-19 pandemic did not interfere with actions of breast cancer, in women over 50 years of age, in the state of Pará. Considering the autonomy of nursing and its role in public health, it is up to the professionals who are in charge of primary care programs to implement contingency plans in periods of crisis so that the population is not left unassisted.

Objetivo. Analizar si la pandemia de COVID-19 tuvo impacto en el tamizaje, diagnóstico y tratamiento del cáncer de mama en mujeres de 50 años y más del Estado do Pará-Brasil. Métodos. Estudio retrospectivo, transversal, con abordaje cuantitativo, en el que se utilizaron los datos del Departamento de Informática del Sistema Único de Salud de Brasil (DATASUS). Se comparó el número de exámenes realizados y el tiempo para el inicio de tratamiento en los períodos prepandémico (2018-2019) y pandémico (2020-2021). Resultados. Se observó un mayor número de mamografías de cribado (+3.68%), citologías (+23.68%) e histologías (+10.7%) y un menor número de mamografías diagnósticas (-38.7%) en el período pandémico. El tiempo para la realización de las pruebas fue de hasta 30 días para el cribado y diagnóstico y de más de 60 días para el inicio del tratamiento durante el período pandémico. Conclusión. Aunque los resultados indican un aumento del número de procedimientos de cribado y diagnóstico del cáncer de mama en el periodo pandémico, con la excepción de la mamografía diagnóstica, cuando consideramos los valores de p) el estudio muestra que la pandemia COVID-19 estadísticamente no interfirió en las acciones preventivas contra el cáncer de mama en mujeres de 50 años y más en el estado de Pará. Teniendo en cuenta la autonomía de la enfermería y su papel en la salud pública, corresponde a los profesionales responsables de los programas de atención primaria implementar planes de contingencia en tiempos de crisis para no dejar desatendida a la población.

Objetivo. Analisar se a pandemia da COVID-19 repercutiu no rastreamento, diagnóstico e tratamento do câncer de mama em mulheres paraenses a partir de 50 anos. Métodos. Estudo retrospectivo, transversal, de abordagem quantitativa, com utilização de dados do Departamento de Informática do Sistema Único de Saúde brasileiro. (DATASUS). Analisou-se o número de exames realizados no período pré-pandemia (2018-2019) e pandêmico (2020-2021) com base na variação percentual, aplicação do teste qui quadrado e teste G para o tempo de realização de exames e tempo de início de tratamento. Resultados. Observou-se no período pandêmico maior quantitativo de mamografias de rastreamento (+3.68%), citológicos (+23.68%), histológicos (+10.7%) e menor registro de mamografias diagnósticas (-38.7%). O intervalo de tempo para realização dos exames foi de até 30 dias para os exames de rastreamento e diagnóstico e tempo maior que 60 dias para início de tratamento no período pandêmico. Conclusão. Embora os resultados indiquem aumento no quantitativo de procedimentos de rastreamento e diagnósticos para o câncer de mama no período pandêmico, com exceção da mamografia diagnóstica, ao considerarmos os valores de probabilidade, o estudo aponta que estatisticamente a pandemia da COVID-19 não interferiu nas ações do câncer de mama, em mulheres a partir de 50 anos, no Estado do Pará. Considerando a autonomia da enfermagem e sua atuação na saúde pública, cabe aos profissionais que estão à frente dos programas da atenção básica implementar planos de contingência em períodos de crise para que a população não fique desassistida.

Predictive value of ultrasound doppler parameters in neoadjuvant chemotherapy response of breast cancer: Prospective comparison with magnetic resonance and mammography.

BACKGROUND: Neoadjuvant chemotherapy (NACT) is a treatment option for breast cancer patients that allows for the assessment of tumor response during treatment. This information can be used to adjust treatment and improve outcomes. However, the optimal imaging modalities and parameters for assessing tumor response to NACT are not well established. METHODS: This study included 173 breast cancer patients who underwent NACT. Patients were imaged with ultrasound (US), mammography (MMG), and magnetic resonance imaging (MRI) at baseline, after two cycles of NACT, and before breast surgery. US parameters included lesion morphology, Doppler variables, and elastography measurements. MMG and MRI were evaluated for the presence of nodules and tumor dimensions. The pathological response to NACT was determined using the residual cancer burden (RCB) classification. RESULTS: The US parameter with the highest power for predicting pathological complete response (pCR) was shear wave elastography (SWE) maximum speed inside the tumor at baseline. For nonluminal tumors, the end diastolic velocity measured by US after two cycles of NACT showed the highest predictive value for pCR. Similarly, SWE maximum speed after two cycles of NACT had the highest discriminating power for predicting RCB-III in luminal tumors, while the same parameter measured at baseline was most predictive for nonluminal tumors. CONCLUSIONS: This study provides evidence that mid-treatment Doppler US and other imaging modalities can be used to predict the response to NACT in breast cancer patients. Functional parameters, such as blood flow velocities and SWE measurements, demonstrated superior predictive value for pCR, while morphological parameters had limited value. These findings have implications for personalized treatment strategies and may contribute to improved outcomes in the management of breast cancer.

An analysis of the association between breast density and body mass index with breast cancer molecular subtypes in early breast cancer: data from a Spanish population.

PURPOSE: Breast cancer is an important health problem, like obesity and dyslipidemia, with a strong association between body mass index (BMI) and breast cancer incidence and mortality. The risk of breast cancer is also high in women with high mammographic breast density (MBD). The purpose of this study was to analyze the association between BMI and MBD according to breast cancer molecular subtypes. METHODS: This transversal, descriptive, multicenter study was conducted at three Spanish breast cancer units from November 2019 to October 2020 in women with a recent diagnosis of early breast cancer. Data were collected at the time of diagnosis. RESULTS: The study included 162 women with a recent diagnosis of early breast cancer. The median age was 52 years and 49.1% were postmenopausal; 52% had normal weight, 32% overweight, and 16% obesity. There was no association between BMI and molecular subtype but, according to menopausal status, BMI was significantly higher in postmenopausal patients with luminal A (p = 0.011) and HER2-positive (p = 0.027) subtypes. There was no association between MBD and molecular subtype, but there were significant differences between BMI and MBD (p < 0.001), with lower BMI in patients with higher MBD. Patients with higher BMI had lower HDL-cholesterol (p < 0.001) and higher insulin (p < 0.001) levels, but there were no significant differences in total cholesterol or vitamin D. CONCLUSIONS: This study showed higher BMI in luminal A and HER2-positive postmenopausal patients, and higher BMI in patients with low MBD regardless of menopausal status.

Breast Imaging Reporting and Data System (BI-RADS®): a success history and particularities of its use in Brazil.

BI-RADS® is a standardization system for breast imaging reports and results created by the American College of Radiology to initially address the lack of uniformity in mammography reporting. The system consists of a lexicon of descriptors, a reporting structure with final categories and recommended management, and a structure for data collection and auditing. It is accepted worldwide by all specialties involved in the care of breast diseases. Its implementation is related to the Mammography Quality Standards Act initiative in the United States (1992) and breast cancer screening. After its initial creation in 1993, four additional editions were published in 1995, 1998, 2003 and 2013. It is adopted in several countries around the world and has been translated into 6 languages. Successful breast cancer screening programs in high-income countries can be attributed in part to the widespread use of BI-RADS®. This success led to the development of similar classification systems for other organs (e.g., lung, liver, thyroid, ovaries, colon). In 1998, the structured report model was adopted in Brazil. This article highlights the pioneering and successful role of BI-RADS®, created by ACR 30 years ago, on the eve of publishing its sixth edition, which has evolved into a comprehensive quality assurance tool for multiple imaging modalities. And, especially, it contextualizes the importance of recognizing how we are using BI-RADS® in Brazil, from its implementation to the present day, with a focus on breast cancer screening.

Pseudocalcifications: Radiologic-Pathologic Correlation of Postsurgical Gauze Artifacts.

Artifacts and foreign bodies can mimic microcalcifications. We report a series of 17 postsurgical women in whom mammograms showed fine linear radiodensities at the surgical bed. Vacuum-assisted biopsy histopathology of one of the lesions showed foreign bodies of different sizes with macrophage reaction. After discussion with the surgeons, we ascertained that a particular type of gauze was used that had fragmented, and we reproduced the mammographic appearance in a chicken breast. Furthermore, we showed the same pathology was reproduced in mice implanted with the gauze threads. It is important to be aware of this entity to avoid unnecessary examinations and even biopsy. The presence of foreign body linear gauze fragments at the surgical site can pose challenges in the mammographic follow-up of these patients.

[Adequacy of provision of procedures for early detection of breast cancer in the Brazilian Unified National Health System: a cross-sectional study conducted in Brazil and its regions, 2019]. / Adequação da oferta de procedimentos para a detecção precoce do câncer de mama no Sistema Único de Saúde: um estudo transversal, Brasil e regiões, 2019.

Early detection is a major strategy in breast cancer control and, for this reason, it is important to ensure access to investigation of suspected cases for care continuity and timely treatment. This study aimed to estimate the need for procedures of breast cancer early detection and assess their adequacy for providing care to screened and symptomatic women in the Brazilian Unified National Health System (SUS) in 2019. A descriptive cross-sectional study was conducted to analyze the provision of tests for breast cancer early detection, comparing the estimated need with the procedures performed in the SUS. Parameters provided by the Brazilian National Cancer Institute were used to estimate the population and the need for early detection tests. The number of procedures performed in 2019 was obtained from the Outpatient Information System of the SUS. A deficit in screening mammograms was observed in the country (-45.1%), ranging from -31.4% in the South Region to -70.5 % in the North Region. If this test was offered to the target population, the deficit in the country would reduce to -14.8% and there would be an oversupply in the South Region (6.2%). Diagnostic investigation procedures varied between the regions, with higher deficits in coarse needle biopsy (-90.8%) and breast lump biopsy/excision (-80.6%) observed in the Central-West Region, and the highest deficit in anatomopathological exams in the North Region (-88.5%). The comparison between the production and need for procedures of breast cancer early detection in Brazil and its regions identified deficits and inadequacies that must be better understood and addressed at the state and municipal levels.

A detecção precoce é uma das estratégias para o controle do câncer de mama e, para tanto, é fundamental garantir o acesso à investigação dos casos suspeitos para continuidade do cuidado e tratamento oportuno. Este estudo tem por objetivo estimar a necessidade de procedimentos para detecção precoce dessa neoplasia e avaliar a sua adequação no atendimento às mulheres rastreadas e sintomáticas no Sistema Único de Saúde (SUS), no ano de 2019. Foi realizado um estudo descritivo transversal para analisar a oferta de exames de detecção precoce do câncer de mama, comparando a necessidade estimada com os procedimentos realizados no SUS. Foram utilizados os parâmetros disponibilizados pelo Instituto Nacional de Câncer para estimar a população e a necessidade de exames para a detecção precoce. No Sistema de Informações Ambulatoriais do SUS, obteve-se o número de procedimentos realizados em 2019. Observou-se um déficit de mamografias de rastreamento no país (-45,1%), variando entre -31,4% na Região Sul a -70,5% na Região Norte. Se a oferta desse exame fosse direcionada para a população-alvo do rastreamento, o déficit no país reduziria para -14,8% e haveria sobreoferta no Sul (6,2%). Os procedimentos de investigação diagnóstica apresentaram variações entre as regiões, com maiores déficits de punção por agulha grossa (-90,8%) e biópsia/exérese de nódulo da mama (-80,6%) observados no Centro-oeste, e o maior déficit de exames anatomopatológicos no Norte (-88,5%). A comparação entre a produção e a necessidade de procedimentos para detecção precoce do câncer de mama no Brasil identificou déficits e inadequações que devem ser melhor conhecidos e equacionados em nível estadual e municipal.

La detección temprana es una de las estrategias para el control del cáncer de mama y, para ello, es fundamental garantizar el acceso a la investigación de los casos sospechosos para la continuidad del cuidado y el tratamiento oportuno. El presente estudio tiene como objetivo estimar la necesidad de procedimientos para la detección temprana de esta neoplasia y evaluar su adecuación en la atención a las mujeres rastreadas y sintomáticas en el Sistema Único de Salud (SUS) brasileño, en el año 2019. Se realizó un estudio descriptivo transversal para analizar la oferta de pruebas para la detección temprana del cáncer de mama, comparando la necesidad estimada con los procedimientos realizados en el SUS. Se utilizaron los parámetros proporcionados por el Instituto Nacional del Cáncer para estimar la población y la necesidad de pruebas para la detección temprana. El número de procedimientos realizados en el 2019 se obtuvo del Sistema de Información Ambulatoria del SUS. Se observó un déficit de mamografías de tamizaje en el país (-45,1%), oscilando entre el -31,4% en la Región Sur y el -70,5% en la Región Norte. Si la oferta de esta prueba se dirigiera a la población objetivo del rastreo, el déficit en el país se reduciría al -14,8% y habría una sobreoferta en el Sur (6,2%). Los procedimientos de investigación diagnóstica presentaron variaciones entre regiones, observándose mayores déficits en punción con aguja gruesa (-90,8%) y biopsia/escisión de nódulo mamario (-80,6%) en el Centro-Oeste, y el mayor déficit de pruebas anatomopatológicas en el Norte (-88,5%). La comparación entre la producción y la necesidad de procedimientos para la detección temprana del cáncer de mama en Brasil y en las regiones identificó déficits e insuficiencias que deben ser mejor conocidos y abordados a nivel estatal y municipal.

BraNet: a mobil application for breast image classification based on deep learning algorithms.

Mobile health apps are widely used for breast cancer detection using artificial intelligence algorithms, providing radiologists with second opinions and reducing false diagnoses. This study aims to develop an open-source mobile app named "BraNet" for 2D breast imaging segmentation and classification using deep learning algorithms. During the phase off-line, an SNGAN model was previously trained for synthetic image generation, and subsequently, these images were used to pre-trained SAM and ResNet18 segmentation and classification models. During phase online, the BraNet app was developed using the react native framework, offering a modular deep-learning pipeline for mammography (DM) and ultrasound (US) breast imaging classification. This application operates on a client-server architecture and was implemented in Python for iOS and Android devices. Then, two diagnostic radiologists were given a reading test of 290 total original RoI images to assign the perceived breast tissue type. The reader's agreement was assessed using the kappa coefficient. The BraNet App Mobil exhibited the highest accuracy in benign and malignant US images (94.7%/93.6%) classification compared to DM during training I (80.9%/76.9%) and training II (73.7/72.3%). The information contrasts with radiological experts' accuracy, with DM classification being 29%, concerning US 70% for both readers, because they achieved a higher accuracy in US ROI classification than DM images. The kappa value indicates a fair agreement (0.3) for DM images and moderate agreement (0.4) for US images in both readers. It means that not only the amount of data is essential in training deep learning algorithms. Also, it is vital to consider the variety of abnormalities, especially in the mammography data, where several BI-RADS categories are present (microcalcifications, nodules, mass, asymmetry, and dense breasts) and can affect the API accuracy model.

Shared decision-making for supporting women's decisions about breast cancer screening.

BACKGROUND: In breast cancer screening programmes, women may have discussions with a healthcare provider to help them decide whether or not they wish to join the breast cancer screening programme. This process is called shared decision-making (SDM) and involves discussions and decisions based on the evidence and the person's values and preferences. SDM is becoming a recommended approach in clinical guidelines, extending beyond decision aids. However, the overall effect of SDM in women deciding to participate in breast cancer screening remains uncertain. OBJECTIVES: To assess the effect of SDM on women's satisfaction, confidence, and knowledge when deciding whether to participate in breast cancer screening. SEARCH METHODS: We searched the Cochrane Breast Cancer Group's Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform on 8 August 2023. We also screened abstracts from two relevant conferences from 2020 to 2023. SELECTION CRITERIA: We included parallel randomised controlled trials (RCTs) and cluster-RCTs assessing interventions targeting various components of SDM. The focus was on supporting women aged 40 to 75 at average or above-average risk of breast cancer in their decision to participate in breast cancer screening. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion and conducted data extraction, risk of bias assessment, and GRADE assessment of the certainty of the evidence. Review outcomes included satisfaction with the decision-making process, confidence in the decision made, knowledge of all options, adherence to the chosen option, women's involvement in SDM, woman-clinician communication, and mental health. MAIN RESULTS: We identified 19 studies with 64,215 randomised women, mostly with an average to moderate risk of breast cancer. Two studies covered all aspects of SDM; six examined shortened forms of SDM involving communication on risks and personal values; and 11 focused on enhanced communication of risk without other SDM aspects. SDM involving all components compared to control The two eligible studies did not assess satisfaction with the SDM process or confidence in the decision. Based on a single study, SDM showed uncertain effects on participant knowledge regarding the age to start screening (risk ratio (RR) 1.18, 95% confidence interval (CI) 0.61 to 2.28; 133 women; very low certainty evidence) and frequency of testing (RR 0.84, 95% CI 0.68 to 1.04; 133 women; very low certainty evidence). Other review outcomes were not measured. Abbreviated forms of SDM with clarification of values and preferences compared to control Of the six included studies, none evaluated satisfaction with the SDM process. These interventions may reduce conflict in the decision made, based on two measures, Decisional Conflict Scale scores (mean difference (MD) -1.60, 95% CI -4.21 to 0.87; conflict scale from 0 to 100; 4 studies; 1714 women; very low certainty evidence) and the proportion of women with residual conflict compared to control at one to three months' follow-up (rate of women with a conflicted decision, RR 0.75, 95% CI 0.56 to 0.99; 1 study; 1001 women, very low certainty evidence). Knowledge of all options was assessed through knowledge scores and informed choice. The effect of SDM may enhance knowledge (MDs ranged from 0.47 to 1.44 higher scores on a scale from 0 to 10; 5 studies; 2114 women; low certainty evidence) and may lead to higher rates of informed choice (RR 1.24, 95% CI 0.95 to 1.63; 4 studies; 2449 women; low certainty evidence) compared to control at one to three months' follow-up. These interventions may result in little to no difference in anxiety (MD 0.54, 95% -0.96 to 2.14; scale from 20 to 80; 2 studies; 749 women; low certainty evidence) and the number of women with worries about cancer compared to control at four to six weeks' follow-up (RR 0.88, 95% CI 0.73 to 1.06; 1 study, 639 women; low certainty evidence). Other review outcomes were not measured. Enhanced communication about risks without other SDM aspects compared to control Of 11 studies, three did not report relevant outcomes for this review, and none assessed satisfaction with the SDM process. Confidence in the decision made was measured by decisional conflict and anticipated regret of participating in screening or not. These interventions, without addressing values and preferences, may result in lower confidence in the decision compared to regular communication strategies at two weeks' follow-up (MD 2.89, 95% CI -2.35 to 8.14; Decisional Conflict Scale from 0 to 100; 2 studies; 1191 women; low certainty evidence). They may result in higher anticipated regret if participating in screening (MD 0.28, 95% CI 0.15 to 0.41) and lower anticipated regret if not participating in screening (MD -0.28, 95% CI -0.42 to -0.14). These interventions increase knowledge (MD 1.14, 95% CI 0.61 to 1.62; scale from 0 to 10; 4 studies; 2510 women; high certainty evidence), while it is unclear if there is a higher rate of informed choice compared to regular communication strategies at two to four weeks' follow-up (RR 1.27, 95% CI 0.83 to 1.92; 2 studies; 1805 women; low certainty evidence). These interventions result in little to no difference in anxiety (MD 0.33, 95% CI -1.55 to 0.99; scale from 20 to 80) and depression (MD 0.02, 95% CI -0.41 to 0.45; scale from 0 to 21; 2 studies; 1193 women; high certainty evidence) and lower cancer worry compared to control (MD -0.17, 95% CI -0.26 to -0.08; scale from 1 to 4; 1 study; 838 women; high certainty evidence). Other review outcomes were not measured. AUTHORS' CONCLUSIONS: Studies using abbreviated forms of SDM and other forms of enhanced communications indicated improvements in knowledge and reduced decisional conflict. However, uncertainty remains about the effect of SDM on supporting women's decisions. Most studies did not evaluate outcomes considered important for this review topic, and those that did measured different concepts. High-quality randomised trials are needed to evaluate SDM in diverse cultural settings with a focus on outcomes such as women's satisfaction with choices aligned to their values.

Breast density quantification in dual-energy mammography using virtual anthropomorphic phantoms.

PURPOSE: Breast density is a significant risk factor for breast cancer and can impact the sensitivity of screening mammography. Area-based breast density measurements may not provide an accurate representation of the tissue distribution, therefore volumetric breast density (VBD) measurements are preferred. Dual-energy mammography enables volumetric measurements without additional assumptions about breast shape. In this work we evaluated the performance of a dual-energy decomposition technique for determining VBD by applying it to virtual anthropomorphic phantoms. METHODS: The dual-energy decomposition formalism was used to quantify VBD on simulated dual-energy images of anthropomorphic virtual phantoms with known tissue distributions. We simulated 150 phantoms with volumes ranging from 50 to 709 mL and VBD ranging from 15% to 60%. Using these results, we validated a correction for the presence of skin and assessed the method's intrinsic bias and variability. As a proof of concept, the method was applied to 14 sets of clinical dual-energy images, and the resulting breast densities were compared to magnetic resonance imaging (MRI) measurements. RESULTS: Virtual phantom VBD measurements exhibited a strong correlation (Pearson's r > 0.95 $r > 0.95$ ) with nominal values. The proposed skin correction eliminated the variability due to breast size and reduced the bias in VBD to a constant value of -2%. Disagreement between clinical VBD measurements using MRI and dual-energy mammography was under 10%, and the difference in the distributions was statistically non-significant. VBD measurements in both modalities had a moderate correlation (Spearman's ρ $\rho \ $ = 0.68). CONCLUSIONS: Our results in virtual phantoms indicate that the material decomposition method can produce accurate VBD measurements if the presence of a third material (skin) is considered. The results from our proof of concept showed agreement between MRI and dual-energy mammography VBD. Assessment of VBD using dual-energy images could provide complementary information in dual-energy mammography and tomosynthesis examinations.