A major flaw in “Awareness of breast cancer and barriers to breast screening uptake in Bangladesh: A population based survey”

ObjectiveTo use newly available self-assigned ethnicity information to investigate variation in breast cancer screening uptake for women from the 16 specific ethnic groups within the broad Asian, Black and White groups that previous studies report.SettingNational cancer screening programme services within London.Participants655 516 female residents aged 50–69, invited for screening between March 2006 and December 2009. Ethnicity information was available for 475 478 (72.5%). White British women were the largest group (306 689, 46.8%), followed by Indian (34 687, 5.3%), White Other (30 053, 4.6%), Black Caribbean (25 607, 3.9%), White Irish (17 271, 2.6%), Black African (17 071, 2.6%) and Asian Other (10 579, 1.6%).Outcome measuresUptake for women in different ethnic groups aged 50–52 for a first call invitation to the programme, and for women aged 50–69 for a routine recall invitation after a previous mammography. Uptake is reported (1) for London overall, adjusted using logistic regression, for age at invitation, socioeconomic deprivation and geographical screening area, and (2) for individual areas, adjusted for age and deprivation.ResultsWhite British women attended their first call (67%) and routine recall (78%) invitations most often. Indian women were more likely to attend their first (61%) or routine recall (74%) than Bangladeshi women (43% and 61%, respectively), and Black Caribbean women were more likely than Black African women to attend first call (63% vs 49%, respectively) and routine recall (74% vs 64%, respectively). There was less variation between ethnic groups in some screening areas.ConclusionsBreast cancer screening uptake in London varies by specific ethnic group for first and subsequent invitations, with White British women being more likely to attend. The variation in the uptake for women from the same ethnic groups in different geographical areas suggests that collaboration about the successful engagement of services with different communities could improve uptake for all women.

Download Full-text

Invasive breast cancer and breast cancer mortality after ductal carcinoma in situ in women attending for breast screening in England, 1988-2014: population based observational cohort study

BMJ ◽

10.1136/bmj.m1570 ◽

2020 ◽

pp. m1570 ◽

Cited By ~ 4

Author(s):

Gurdeep S Mannu ◽

Zhe Wang ◽

John Broggio ◽

Jackie Charman ◽

Shan Cheung ◽

...

Keyword(s):

Breast Cancer ◽

Invasive Breast Cancer ◽

Breast Screening ◽

Ductal Carcinoma ◽

Breast Cancer Mortality ◽

Population Based ◽

Breast Screening Programme ◽

Observational Cohort

AbstractObjectiveTo evaluate the long term risks of invasive breast cancer and death from breast cancer after ductal carcinoma in situ (DCIS) diagnosed through breast screening.DesignPopulation based observational cohort study.SettingData from the NHS Breast Screening Programme and the National Cancer Registration and Analysis Service.ParticipantsAll 35 024 women in England diagnosed as having DCIS by the NHS Breast Screening Programme from its start in 1988 until March 2014.Main outcome measuresIncident invasive breast cancer and death from breast cancer.ResultsBy December 2014, 13 606 women had been followed for up to five years, 10 998 for five to nine years, 6861 for 10-14 years, 2620 for 15-19 years, and 939 for at least 20 years. Among these women, 2076 developed invasive breast cancer, corresponding to an incidence rate of 8.82 (95% confidence interval 8.45 to 9.21) per 1000 women per year and more than double that expected from national cancer incidence rates (ratio of observed rate to expected rate 2.52, 95% confidence interval 2.41 to 2.63). The increase started in the second year after diagnosis of DCIS and continued until the end of follow-up. In the same group of women, 310 died from breast cancer, corresponding to a death rate of 1.26 (1.13 to 1.41) per 1000 women per year and 70% higher than that expected from national breast cancer mortality rates (observed:expected ratio 1.70, 1.52 to 1.90). During the first five years after diagnosis of DCIS, the breast cancer death rate was similar to that expected from national mortality rates (observed:expected ratio 0.87, 0.69 to 1.10), but it then increased, with values of 1.98 (1.65 to 2.37), 2.99 (2.41 to 3.70), and 2.77 (2.01 to 3.80) in years five to nine, 10-14, and 15 or more after DCIS diagnosis. Among 29 044 women with unilateral DCIS undergoing surgery, those who had more intensive treatment (mastectomy, radiotherapy for women who had breast conserving surgery, and endocrine treatment in oestrogen receptor positive disease) and those with larger final surgical margins had lower rates of invasive breast cancer.ConclusionsTo date, women with DCIS detected by screening have, on average, experienced higher long term risks of invasive breast cancer and death from breast cancer than women in the general population during a period of at least two decades after their diagnosis. More intensive treatment and larger final surgical margins were associated with lower risks of invasive breast cancer.

Download Full-text

The association between breast density and HER2-positive breast cancer: A population-based case-control study.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e12556 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e12556-e12556

Author(s):

Vivian Tan ◽

Jennifer Payne ◽

Nicole Paquet ◽

Sian Iles ◽

Daniel Rayson ◽

...

Keyword(s):

Breast Cancer ◽

Breast Density ◽

Breast Screening ◽

Hormone Replacement ◽

Menopausal Status ◽

Population Based ◽

Case Control ◽

Mammographic Breast Density ◽

Her2 Positive ◽

Increased Risk

e12556 Background: Little is known about the association between mammographic breast density and the subtypes of breast cancer including HER2-positive breast cancers (HER2-BrCa). The objective of this study was to assess the strength of association between breast density and HER2-BrCa in a population-based screening program. Methods: This is a population-based case-control breast cancer study of women aged 40 to 75 who underwent digital breast screening from 2009 to 2015 in Nova Scotia, Canada. Cases included women diagnosed with HER2-BrCa at screen or before their next screen (interval); controls included women without screen-detected cancer matched to cases by age and year of screen. Measures of mammographic breast density (percent density, BI-RADS-4th and -5th edition) were obtained from automated software (densitasai) and linked with clinical risk factor data (age, parity, total breast volume, post-menopausal status, hormone replacement therapy, family history and history of core biopsy). The association between breast density and cancer risk was assessed by calculating the odds ratios [OR] with 95% confidence intervals using multivariable logistic regression. Results: A total of 209 cases (median age, 58.8 years) and 6812 controls (median age, 59.4 years) were included. The risk of HER2-BrCa increased with increasing levels of percent breast density. High breast density according to BIRADS-4th and -5th editions was significantly associated with HER2-BrCa: BIRADS -4th 3/4 vs 1: OR 2.50 (1.68 - 3.68); BIRADS-5th C/D vs A: OR 2.58 (1.71 - 4.01). The association between higher breast density and increased risk of HER2-BrCa remained after adjustment for clinical factors. Conclusions: The risk of HER2-BrCa was associated with progressively higher mammographic breast density, although to a lesser extent than breast cancer in general. Accurate risk models including breast density may support the development of more breast-screening protocols that can lead to more strategic use of healthcare resources.

Download Full-text

Cervical Screening Uptake, Political Interest and Voter Turnout: A Population-Based Survey of Women in England

Journal of Medical Screening ◽

10.1258/jms.2012.012073 ◽

2012 ◽

Vol 19 (4) ◽

pp. 189-194 ◽

Cited By ~ 1

Author(s):

Ana Macedo ◽

Jo Waller ◽

Julietta Patnick ◽

Laura Marlow

Keyword(s):

Voter Turnout ◽

Cervical Screening ◽

Population Based ◽

Political Interest ◽

Screening Uptake ◽

Population Based Survey

Download Full-text

Does poor mental health explain socio-demographic gradients in breast cancer screening uptake? A population-based study

European Journal of Public Health ◽

10.1093/eurpub/ckz220 ◽

2019 ◽

Vol 30 (3) ◽

pp. 538-543

Author(s):

Emma Ross ◽

Aideen Maguire ◽

Michael Donnelly ◽

Adrian Mairs ◽

Clare Hall ◽

...

Keyword(s):

Breast Cancer ◽

Mental Health ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Breast Screening ◽

Poor Mental Health ◽

Targeted Interventions ◽

Screening Uptake ◽

The Uk ◽

The Impact

Abstract Background Research from the USA indicates disparities in breast cancer screening uptake for women with poor mental health. However, no attempt has been made to examine the contribution of poor mental health to socio-demographic variations in breast screening uptake. The current study aims to examine the impact of self-reported chronic poor mental health on attendance at breast screening in the UK, and to what extent this explains socio-demographic inequalities in screening uptake. Methods Breast screening records were linked to 2011 Census records within the Northern Ireland Longitudinal Study. This identified a cohort of 57 328 women who were followed through one 3-year screening cycle of the National Health Service Breast Screening Programme. Information on mental health status, in addition to other individual and household-level attributes, was derived from the 2011 Census. Logistic regression was employed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of attendance at screening. Results 10.7% of women in the cohort reported poor mental health, and in fully adjusted analyses, these individuals were 23% less likely to attend breast screening (OR 0.77; 95% CI 0.73–0.82). Although poor mental health was a strong predictor of screening uptake, it did not explain the observed inequalities in uptake by socio-economic status, marital status, or area of residence. Conclusions This study provides novel evidence of inequalities in breast screening uptake for women with chronic poor mental health in the UK. Targeted interventions are necessary to ensure equitable screening access and to enhance overall mortality benefit.

Download Full-text