Are caregiving responsibilities associated with non-attendance at breast screening?

<p>Abstract</p> <p>Background</p> <p>Previous research showed that deprived individuals are less likely to attend breast screening and those providing intense amounts of informal care tend to be more deprived than non-caregivers. The aim of this study was to examine the relationship between informal caregiving and uptake of breast screening and to determine if socio-economic gradients in screening attendance were explained by caregiving responsibilities.</p> <p>Methods</p> <p>A database of breast screening histories was linked to the Northern Ireland Longitudinal Study, which links information from census, vital events and health registration datasets. The cohort included women aged 47 - 64 at the time of the census eligible for breast screening in a three-year follow-up period. Cohort attributes were recorded at the Census. Multivariate logistic regression was used to examine the relationship between informal caregiving and uptake of screening using STATA version 10.</p> <p>Results</p> <p>37,211 women were invited for breast screening of whom 27,909 (75%) attended; 23.9% of the cohort were caregivers. Caregivers providing <20 hours of care/week were more affluent, while those providing >50 hours/week were more deprived than non-caregivers. Deprived women were significantly less likely to attend breast screening; however, this was not explained by caregiving responsibilities as caregivers were as likely as non-caregivers to attend (Odds Ratio 0.97; 95% confidence intervals 0.88, 1.06).</p> <p>Conclusions</p> <p>While those providing the most significant amounts of care tended to be more deprived, caregiving responsibilities themselves did not explain the known socio-economic gradients in breast screening attendance. More work is required to identify why more deprived women are less likely to attend breast screening.</p

The Influence of Mammographic Technologists on Radiologists' Ability to Interpret Screening Mammograms in Community Practice

PURPOSE: To determine whether the mammographic technologist has an effect on the radiologists’ interpretative performance of screening mammography in community practice. MATERIALS AND METHODS: In this institutional review board approved retrospective cohort study, we included Carolina Mammography Registry (CMR) data from 372 radiologists and 356 mammographic technologists from 1994 to 2009 who performed 1,003,276 screening mammograms. Measures of interpretative performance (recall rate, sensitivity, specificity, positive predictive value (PPV(1)), and cancer detection rate (CDR)) were ascertained prospectively with cancer outcomes collected from the state cancer registry and pathology reports. To determine if the mammographic technologist influenced the radiologists’ performance, we employed mixed effects logistic regression models, including a radiologist-specific random effect and taking into account the clustering of examinations across women, separately for screen-film mammography (SFM) and full field digital mammography (FFDM). RESULTS: Of the 356 mammographic technologists included, 343 performed 889,347 SFM examinations and 51 performed 113,929 FFDM examinations, and 38 performed both SFM and FFDM. A total of 4,328 cancers were reported for SFM and 564 cancers for FFDM. The technologists had a statistically significant effect on the radiologists’ recall rate, sensitivity, specificity and CDR for both SFM and FFDM (p-values<0.01). For PPV(1), variability by technologist was observed for SFM (p-value<0.0001) but not for FFDM (p-value=0.088). CONCLUSION: The interpretative performance of radiologists in screening mammography varies substantially by the technologist performing the examination. Additional studies should aim to identify technologist characteristics that may explain this variation

Computer-aided detection in full-field digital mammography in a clinical population: performance of radiologist and technologists

International audienceThe purpose of the study was to evaluate the impact of a computer-aided detection (CAD) system on the performance of mammogram readers in interpreting digital mammograms in a clinical population. Furthermore, the ability of a CAD system to detect breast cancer in digital mammography was studied in comparison to the performance of radiologists and technologists as mammogram readers. Digital mammograms of 1,048 consecutive patients were evaluated by a radiologist and three technologists. Abnormalities were recorded and an imaging conclusion was given as a BI-RADS score before and after CAD analysis. Pathology results during 12 months follow up were used as a reference standard for breast cancer. Fifty-one malignancies were found in 50 patients. Sensitivity and specificity were computed before and after CAD analysis and provided with 95% CIs. In order to assess the detection rate of malignancies by CAD and the observers, the pathological locations of these 51 breast cancers were matched with the locations of the CAD marks and the mammographic locations that were considered to be suspicious by the observers. For all observers, the sensitivity rates did not change after application of CAD. A mean sensitivity of 92% was found for all technologists and 84% for the radiologist. For two technologists, the specificity decreased (from 84 to 83% and from 77 to 75%). For the radiologist and one technologist, the application of CAD did not have any impact on the specificity rates (95 and 83%, respectively). CAD detected 78% of all malignancies. Five malignancies were indicated by CAD without being noticed as suspicious by the observers. In conclusion, the results show that systematic application of CAD in a clinical patient population failed to improve the overall sensitivity of mammogram interpretation by the readers and was associated with an increase in false-positive results. However, CAD marked five malignancies that were missed by the different readers

Factors associated with breast screening attendance: A controlled comparison between attenders and non-attenders in Scotland.

The present study aimed to compare a sample of screening mammography attenders with a sample of non-attenders, in terms of knowledge about breast cancer and mammography, health beliefs and personality variables, and identify factors associated with attendance. The sample consisted of 58 women; 29 had attended the National Breast Screening Programme and 29 had declined an invitation to attend. Assessment was made by use of anonymous questionnaire. Significant differences were found between the two groups in use of focusing and venting on emotions as a health-related coping style, knowledge about breast cancer and knowledge about mammography. The most powerful predictor of attendance was knowledge about mammography. Results are discussed predominantly in relation to provision of emotional-related and fact-related information