A systematic review and meta-analysis of English language online patient education materials in breast cancer: Is readability the only story?

BACKGROUND: Online patient education materials (OPEMs) are an increasingly popular resource for women seeking information about breast cancer. The AMA recommends written patient material to be at or below a 6th grade level to meet the general public's health literacy. Metrics such as quality, understandability, and actionability also heavily influence the usability of health information, and thus should be evaluated alongside readability. PURPOSE: A systematic review and meta-analysis was conducted to determine: 1) Average readability scores and reporting methodologies of breast cancer readability studies; and 2) Inclusion frequency of additional health literacy-associated metrics. MATERIALS AND METHODS: A registered systematic review and meta-analysis was conducted in Ovid MEDLINE, Web of Science, Embase.com, CENTRAL via Ovid, and ClinicalTrials.gov in June 2022 in adherence with the PRISMA 2020 statement. Eligible studies performed readability analyses on English-language breast cancer-related OPEMs. Study characteristics, readability data, and reporting of non-readability health literacy metrics were extracted. Meta-analysis estimates were derived from generalized linear mixed modeling. RESULTS: The meta-analysis included 30 studies yielding 4462 OPEMs. Overall, average readability was 11.81 (95% CI [11.14, 12.49]), with a significant difference (p < 0.001) when grouped by OPEM categories. Commercial organizations had the highest average readability at 12.2 [11.3,13.0]; non-profit organizations had one of the lowest at 11.3 [10.6,12.0]. Readability also varied by index, with New Fog, Lexile, and FORCAST having the lowest average scores (9.4 [8.6, 10.3], 10.4 [10.0, 10.8], and 10.7 [10.2, 11.1], respectively). Only 57% of studies calculated average readability with more than two indices. Only 60% of studies assessed other OPEM metrics associated with health literacy. CONCLUSION: Average readability of breast cancer OPEMs is nearly double the AMA's recommended 6th grade level. Readability and other health literacy-associated metrics are inconsistently reported in the current literature. Standardization of future readability studies, with a focus on holistic evaluation of patient materials, may aid shared decision-making and be critical to increased screening rates and breast cancer awareness.

Impact of Health Care-Associated Cost Concerns on Mammography Utilization: Cross-Sectional Survey Results From the National Health Interview Survey.

PURPOSE: Health care-related cost concerns and financial toxicity are increasingly recognized barriers along the breast cancer care continuum. The purpose of this study was to evaluate the association between patient-reported cost concerns and screening mammography utilization. METHODS: Survey participants aged 40 to 74 years from the 2018 National Health Interview Survey without personal history of breast cancer were included (response rate: 64%). Respondents were queried if they had experienced specific access-related health care barriers. Multiple variable logistic regression analyses were performed to evaluate the association between barriers to care and patient-reported screening mammography utilization. RESULTS: Of survey respondents, 7,511 women were included. Of this group, 68.9% reported receiving a screening mammogram within the last 2 years and 52.2% reported receiving a screening mammogram within the last year. Of all survey respondents, 48.4% reported worry paying medical bills. Patients who reported worry about paying medical bills (odds ratio [OR] 0.86; 95% confidence interval [CI]: 0.76-0.97; P = .01), challenges affording dental care (OR 0.65; 95% CI: 0.54-0.77; P < .01), and challenges affording eyeglasses (OR 0.67; 95% CI: 0.54-0.84; P < .01) were less likely to report screening mammography use than their respective counterparts. Patients who skipped medication doses (OR 0.69; 95% CI: 0.52-0.91; P < .01), took less medication, (OR 0.63; 95% CI: 0.48-0.82; P < .01), and delayed filling prescriptions (OR 0.71; 95% CI: 0.56-0.90; P < .01) to save money were also less likely to report receiving mammography screening. CONCLUSION: Patient-reported cost-related barriers are associated with decreased utilization of routine mammography.

Patient Sociodemographic Characteristics Associated With Saturday Breast Imaging Clinic Utilization.

OBJECTIVE: To determine patient sociodemographic characteristics associated with breast imaging utilization on Saturdays to inform potential initiatives designed to improve access and reduce disparities in breast cancer care. METHODS: This was an IRB-approved retrospective cross-sectional study. All adult women (aged ≥18 years) who received a screening or diagnostic examination at our breast imaging facility from January 1, 2016 to December 31, 2017 were included. Patient characteristics including age, race, primary language, partnership status, insurance status, and primary care physician status were collected using the electronic medical record. Multiple variable logistic regression analyses were performed to evaluate patient characteristics associated with utilization. RESULTS: Of 53 695 patients who underwent a screening examination and 10 363 patients who underwent a diagnostic examination over our study period, 9.6% (5135/53 695) and 2.0% (209/10 363) of patients obtained their respective examination on a Saturday. In our multiple variable logistic regression analyses, racial/ethnic minorities (odds ratio [OR], 1.5; 95% confidence interval [CI]: 1.4-1.6; P < 0.01) and women who speak English as a second language (OR, 1.1; 95% CI: 1.0-1.3; P = 0.03) were more likely to obtain their screening mammogram on Saturday than their respective counterparts. CONCLUSION: Racial/ethnic minorities and women who speak English as a second language were more likely to obtain their screening mammogram on Saturdays than their respective counterparts. Initiatives to extend availability of breast imaging exams outside of standard business hours increases access for historically underserved groups, which can be used as a tool to reduce breast cancer-related disparities in care.

Current Gaps in Breast Cancer Screening Among Asian and Asian American Women in the United States.

Over the past two decades, the US Asian population has increased 72%, representing the fastest growth rate of any major racial group. Currently, there are over 20 million Asian and Asian American women in the United States, who identify with at least 1 of 19 different origin groups. Although women of Asian ancestry have traditionally been considered low risk for experiencing adverse breast cancer-specific outcomes, aggregated data may mask health disparities seen among subgroups. In the United States, recent data demonstrate that the burden of breast cancer among Asian women has increased each year over the past decade. We aim to characterize challenges faced by Asian and Asian American women in the United States related to cultural stigma, socioeconomic status, and overall access to breast cancer care. An increased understanding of barriers to breast cancer prevention and treatment efforts is needed to develop more effective strategies aimed at reducing disparities in care among segments of this heterogenous population.

Leveraging Emergency Department Encounters to Improve Cancer Screening Adherence.

OBJECTIVE: We aimed to estimate the proportion of patients visiting the emergency department (ED) who were not up to date with cancer screening guidelines to assess the scope of need and potential impact of ED-based cancer screening interventions. METHODS: Adult participants from the 2015 National Health Interview Survey were included. Among patients nonadherent to national breast, colorectal, or lung cancer screening guidelines, the proportion of patients reporting an ED visit within the last year was estimated, accounting for complex survey sampling design features. Multiple variable logistic regression analyses were then conducted to evaluate the association between sociodemographic characteristics and screening adherence. RESULTS: Of screening eligible respondents, 17.2% of women nonadherent to mammography screening, 16.9% of patients nonadherent to colorectal cancer screening, and 25.0% of patients nonadherent to lung cancer screening reported at least one ED visit in the preceding year. Patients visiting the ED with postsecondary school education were more likely to be up to date with mammography screening than those without advanced education (odds ratio [OR] 1.45; 95% confidence interval [CI]: 1.21-1.74; P = .01). Patients without insurance were less likely than those with insurance to report being up to date with both mammography screening (OR 0.31; 95% CI: 0.21-0.48; P = .01) and colorectal cancer screening (OR 0.56; 95% CI: 0.34-0.93; P = .03). DISCUSSION: Opportunities to improve cancer screening adherence exist through ED-based preventative care interventions, which leverage multidisciplinary partnerships, including radiologists, to reach large volumes of patients who are not engaged in cancer screening.

Perceptions of Adequacy of Breast Imaging Training in the United States among Breast Radiologists.

OBJECTIVE: To evaluate the perceptions of breast imaging training in the United States among practicing breast radiologists. METHODS: An anonymous electronic survey was sent to physician members of the Society of Breast Imaging. Study participants were queried about why they practice breast imaging, what percentage of their clinical practice consists of breast imaging, details about their breast imaging training, and how well their training prepared them for their breast imaging practice. Results were stratified by whether respondents completed a breast imaging fellowship and length of time practicing breast imaging. Results were compared using the Chi-squared test or Fisher's exact test. RESULTS: We received 271 completed survey responses. Of the survey respondents, 52.4% (141/269) were employed in private practice, 24.2% (65/269) in academic practice, and 23.4% (63/269) in a mixed/hybrid practice. Overall, 46.6% (125/268) of respondents reported practicing a greater proportion of breast imaging than anticipated during training and 18.7% (50/268) had not anticipated that their future practice would include breast imaging at all. The 62.3% (167/268) of survey respondents who had completed a breast or women's imaging fellowship were significantly more likely to report sufficient training in screening mammography, diagnostic mammography, breast procedures, and MRI interpretation. CONCLUSION: Our study highlights perceived areas of insufficiency in breast imaging training. These were most notable among those who did not complete a breast imaging fellowship. These insufficiencies may be considered when updating the next version of the residency training curriculum.

Alzheimer's Disease and its Related Dementias among Asian Americans, Native Hawaiians, and Pacific Islanders: A Scoping Review.

BACKGROUND: The Asian American, Native Hawaiian, and Pacific Islander (AANHPI) aging population is rapidly growing and the burden of Alzheimer's disease and its related dementias (ADRD) will likely mirror this demographic growth. AANHPIs face significant barriers in obtaining timely ADRD diagnosis and services; yet little is known about ADRD in this population. OBJECTIVE: The study objective is to conduct a systematic review on the published literature on ADRD among AANHPIs to identify gaps and priorities to inform future research and action plans. METHODS: The systematic review was conducted following the PRISMA Protocol for Systematic Reviews. Co-author (TR), an experienced Medical Librarian, searched PubMed, EMBASE, PsycINFO, Cochrane Central of Clinical Trials, Ageline, and Web of Science for peer-reviewed articles describing ADRD among AANHPIs. The search was not limited by language or publication date. Each citation was reviewed by two trained independent reviewers. Conflicts were resolved through consensus. RESULTS: The title/abstract and full texts of 1,447 unique articles were screened for inclusion, yielding 168 articles for analysis. Major research topics included prevalence, risk factors, comorbidities, interventions and outreach, knowledge and attitudes, caregiving, and detection tools. A limited number of studies reported on national data, on NHPI communities generally, and on efficacy of interventions targeting AANHPI communities. CONCLUSION: To our knowledge, this is the first systematic review on ADRD among AANHPI populations. Our review provides a first step in mapping the extant literature on ADRD among this underserved and under-researched population and will serve as a guide for future research, policy, and intervention.

Rare case of invasive lobular carcinoma in a male.

Invasive lobular carcinoma (ILC) in the male breast is a rare subtype of a rare disease in men, accounting for approximately 1%-2% of all male breast cancers [1,2]. Only a few cases have been reported in the literature. The pathophysiology is uncommon due to a paucity of lobular development seen in men. We present a rare case of ILC in the male breast, highlighting imaging, pathology findings, and clinical management.

Habitual dislocation of the hip in children: report of eight additional cases and literature review.

The purpose of this study was to report eight additional cases of habitual dislocation of the hip (HDH) and to combine the authors' data with a compilation of the cases from the literature. The authors attempted to investigate the various causative factors, outcomes, and indications for conservative and operative treatments. The results suggest that an unusual ability to dislocate the hip voluntarily at a young age constitutes a specific pediatric entity, and no single factor can be determined to be the definite cause of HDH. Multiple triggering factors (generalized ligamentous laxity, excessive anteversion of the femur and acetabulum, osteocartilaginous defect of acetabulum, coxa valga, psychiatric immaturity) appear to be associated with HDH. Treatment should be conservative in the first instance; it includes simple observation with or without psychiatric counseling and immobilization with cast or brace. Hip stabilization by surgical means is selectively indicated when the episodes of hip dislocation do not fade away in due time despite conservative treatment and when primary or secondary capsular laxity or osteocartilaginous deformation or defect of the hip is severe enough to cause repeated dislocation or residual subluxation, which may cause persistent pain or discomfort.

Aneurysmal bone cyst arising from a fibrous metaphyseal defect in a toddler.

This is a case of aneurysmal bone cyst arising from a fibrous metaphyseal defect of the proximal tibia in a toddler. A 32-month-old girl presented with physiologic bowing with a small metaphyseal defect at the medial aspect of the left proximal tibia. A large aneurysmal bone cyst, occupying almost the entire metaphysis of the proximal tibia, evolved from this lesion during the following 1 year 3 months. The lesion healed uneventfully after curettage and bone grafting. This case emphasizes the importance of regular followups to observe the clinical course of a fibrous metaphyseal defect during childhood.