Adult, Female, Humans, Middle Aged, Pregnancy, United States epidemiology, Breast Density physiology, Breast Neoplasms diagnostic imaging, Breast Neoplasms physiopathology, Diabetes, Gestational diagnostic imaging, Diabetes, Gestational epidemiology, Diabetes, Gestational physiopathology, and Mammography statistics numerical data

Purpose: Type II diabetes mellitus (T2DM) has consistently been associated with an increased risk of breast cancer, but the association of gestational diabetes mellitus (GDM) with breast cancer is less clear. T2DM and GDM may influence breast cancer risk through mammographic breast density, a strong risk factor for breast cancer. We examined whether T2DM and GDM are associated with higher mammographic breast density in a largely racial/ethnic minority sample.
Methods: We collected digital mammograms, anthropometric measures, and interview data from 511 racially diverse women recruited during screening mammography appointments between 2012 and 2016 (mean age 51 years; 70% Hispanic). We examined the associations of self-reported GDM, T2DM, and medication use (metformin and insulin) with mammographic breast density, measured as percent and area of dense tissue using Cumulus software.
Results: In multivariable linear regression models, history of T2DM and/or GDM and length of time since diagnosis were not associated with percent density or dense breast area, either before or after adjustment for current BMI. Use of metformin in diabetic women was associated with lower percent density (β = - 5.73, 95% CI - 10.27, - 1.19), only before adjusting for BMI. These associations were not modified by menopausal status.
Conclusions: Our results do not support associations between T2DM and/or GDM and higher amount of mammographically dense breast tissue, suggesting that the mechanism linking diabetes with breast cancer risk may not include mammographic breast density in midlife.

Adult, Bisexuality ethnology, Bisexuality statistics numerical data, Breast Neoplasms diagnosis, Breast Neoplasms diagnostic imaging, Breast Neoplasms ethnology, Colonoscopy, Colorectal Neoplasms diagnosis, Colorectal Neoplasms diagnostic imaging, Colorectal Neoplasms ethnology, Female, Heterosexuality ethnology, Heterosexuality statistics numerical data, Homosexuality, Female ethnology, Homosexuality, Female statistics numerical data, Humans, Mammography methods, Mass Screening, Middle Aged, Prospective Studies, Sexual Behavior ethnology, United States epidemiology, Breast Neoplasms epidemiology, Colorectal Neoplasms epidemiology, Mammography statistics numerical data, and Sexual Behavior statistics numerical data

Purpose: Underutilization of cancer screening has been found especially to affect socially marginalized groups. We investigated sexual orientation group patterns in breast and colorectal cancer screening adherence.
Methods: Data on breast and colorectal cancer screening, sexual orientation, and sociodemographics were gathered prospectively from 1989 through 2005 from 85,759 U.S. women in the Nurses' Health Study II. Publicly available data on state-level healthcare quality and sexual-orientation-related legal protections were also gathered. Multivariable models were used to estimate sexual orientation group differences in breast and colorectal cancer screening, controlling for sociodemographics and state-level healthcare quality and legal protections for sexual minorities.
Results: Receipt of a mammogram in the past 2 years was common though not universal and differed only slightly by sexual orientation: heterosexual 84 %, bisexual 79 %, and lesbian 82 %. Fewer than half of eligible women had ever received a colonoscopy or sigmoidoscopy, and rates did not differ by sexual orientation: heterosexual 39 %, bisexual 39 %, and lesbian 42 %. In fully adjusted models, state-level healthcare quality score, though not state-level legal protections for sexual minorities, was positively associated with likelihood of being screened for all women regardless of sexual orientation.
Conclusions: Concerns have been raised that unequal healthcare access for sexual orientation minorities may adversely affect cancer screening. We found small disparities in mammography and none in colorectal screening, though adherence to colorectal screening recommendations was uniformly very low. Interventions are needed to increase screening in women of all sexual orientation groups, particularly in areas with poor healthcare policies.

Adult, Breast Neoplasms ethnology, Capital Financing economics, Confounding Factors, Epidemiologic, Continental Population Groups ethnology, Costs and Cost Analysis, Early Diagnosis, Eligibility Determination economics, Female, Health Services Accessibility economics, Humans, Medically Uninsured, Middle Aged, Population Surveillance, Poverty economics, Poverty ethnology, Program Evaluation, Time Factors, United States epidemiology, United States ethnology, Uterine Cervical Neoplasms ethnology, Breast Neoplasms diagnostic imaging, Health Services Needs and Demand economics, Mammography economics, Mass Screening economics, Medically Underserved Area, and Uterine Cervical Neoplasms diagnostic imaging

Objective: To examine the extent to which the National Breast and Cervical Cancer Early Detection Program (Program) has helped to meet the mammography screening needs of underserved women.
Methods: Low-income, uninsured women aged 40-64 are eligible for free mammography screening through the Program. We used data from the U.S. Census Bureau to estimate the number of women eligible for services. We obtained the number of women receiving Program-funded mammograms from the Program. We then calculated the percentage of eligible women who received mammograms through the Program.
Results: In 2002-2003, of all U.S. women aged 40-64, approximately 4 million (8.5%) had no health insurance and had a family income below 250% of the federal poverty level, meeting Program eligibility criteria. Of these women, 528,622 (13.2%) received a Program-funded mammogram. Rates varied substantially by race and ethnicity. The percentage of eligible women screened in each state ranged from about 2% to approximately 79%.
Conclusions: Although the Program provided screening services to over a half-million low-income, uninsured women for mammography, it served a small percentage of those eligible. Given that in 2003 more than 2.3 million uninsured, low-income, women aged 40-64 did not receive recommended mammograms from either the Program or other sources, there remains a substantial need for services for this historically underserved population.

Adult, Age Distribution, Breast Neoplasms epidemiology, Case-Control Studies, Early Diagnosis, European Continental Ancestry Group, Female, Humans, Middle Aged, Neoplasm Staging, Odds Ratio, Postmenopause, Premenopause, Risk Factors, SEER Program, United States epidemiology, Breast Neoplasms diagnosis, Mammography statistics numerical data, and Mass Screening methods

Objective: We studied the benefit of modern mammography screening in community settings, evaluating age-related differences in rates of late-stage breast cancer detection.
Methods: Our multicenter population-based case-control study included 931 black and white women with incident breast cancer (American Joint Commission on Cancer Stage IIB or higher) diagnosed 1994-1998 and 4,016 randomly sampled controls never diagnosed with breast cancer. Adjusted odds ratios (ORs) estimated the relative rate of late-stage diagnosis in screened and non-screened women.
Results: Women aged 50-64 at diagnosis with at least one screening mammogram in the previous 2 years were significantly less likely to have late-stage diagnosis (OR = 0.41, 95% CI 0.33-0.52). Results for women aged 40-49 were consistent with a screening benefit, although the confidence interval marginally overlapped the null (OR = 0.81, 95% CI 0.64-1.02). Mammography screening was associated with lower rates of late-stage breast cancer among both premenopausal (OR = 0.64, 95% CI 0.50-0.81) and postmenopausal (OR = 0.44, 95% CI 0.35-0.56) women.
Conclusions: With modern mammography in the community, rates of late-stage breast cancer diagnoses are lower in screened compared to non-screened women ages 40 and older, but age-related differences persist.

Adult, Aged, Breast Neoplasms epidemiology, Female, Follow-Up Studies, Health Promotion, Humans, Middle Aged, Patient Education as Topic, Time Factors, United States epidemiology, Breast Neoplasms diagnostic imaging, Counseling, Mammography, Patient Compliance statistics numerical data, and Telephone

Background: Interventions to improve adherence to regular mammography screening have had conflicting results. Many studies have depended on women's self-report rather than clinical evidence of a mammography encounter.
Methods: We tested the impact of two interventions on a population-based sample of NH women who were not receiving routine mammography to determine if adherence to screening could be improved. The interventions included a mailing of women's health information and a telephone counseling intervention based on the Transtheoretical Model. Participant eligibility and outcome measures were based on clinical events obtained from a population-based mammography registry.
Results: Two hundred and fifty eight women completed all aspects of the intervention study. The women were randomly assigned to one of two study groups: 51% received the mail intervention and 49% received the telephone intervention. Among women who received the telephone counseling intervention, 67% percent reported being in either an action or maintenance stage at Call 1, which increased to 84% at Call 2 (p<0.001). Seventy-six percent of women identified barriers to screening mammography at Call 1, which decreased to 44% at Call 2 (p<0.01). The most frequently identified barrier was confusion over the guidelines for screening mammography. At the first assessment time interval, greater than 60% of women were up-to-date for screening mammography in the group that received telephone counseling versus 48% in the group that received health information by mail (p = 0.04). However, women's status as up-to-date fell for both groups between the first and second assessment time intervals.
Conclusions: Tailored telephone counseling based on the Transtheoretical Model can improve adherence to screening mammography, though the duration of this effect is in question.

Age Distribution, Aged, Breast Neoplasms drug therapy, Breast Neoplasms epidemiology, Breast Self-Examination, Chemotherapy, Adjuvant, Cross-Sectional Studies, Female, Humans, Longitudinal Studies, Middle Aged, Models, Biological, Registries, Regression Analysis, Risk Factors, SEER Program, Survival Rate, United States epidemiology, Breast Neoplasms diagnosis, Breast Neoplasms mortality, Mammography, and Mass Screening methods

Objective: This paper presents a methodology for piecing together disparate data sources to obtain a comprehensive model for the use of mammography screening in the US population for the years 1975-2000.
Methods: Two aspects of mammography usage, the age that a woman receives her first mammography and the interval between subsequent mammograms, are modeled separately. The initial dissemination of mammography is based on cross-sectional self report data from national surveys and the interval length between screening exams is fit using longitudinal mammography registry data.
Results: The two aspects of mammography usage are combined to simulate screening histories for individual women that are representative of the US population. Simulated mammography patterns for the years 1994-2000 were found to be similar to observed screening patterns from the state level mammography registry for Vermont.
Conclusions: The model presented gives insight into screening practices over time and provides an alternative public health measure for screening usage in the US population. The comprehensive description of mammography use from its introduction represents an important first step to understanding the impact of mammography on breast cancer incidence and mortality.

Adult, African Americans psychology, Aged, Breast Neoplasms ethnology, European Continental Ancestry Group psychology, Female, Humans, Insurance, Health, Middle Aged, Surveys and Questionnaires, United States epidemiology, African Americans statistics numerical data, Breast Neoplasms diagnosis, Diagnostic Tests, Routine statistics numerical data, European Continental Ancestry Group statistics numerical data, Health Services Accessibility statistics numerical data, Mammography statistics numerical data, and Patient Acceptance of Health Care ethnology

Results from recent studies indicate that many women in the US undergo routine screening for breast cancer, but some groups of women are under-screened. In this study, we examined the breast cancer screening practices of white and black women in the United States, according to Hispanic ethnicity and other factors, using data from the 2000 National Health Interview Survey. Among women aged > or =40 years, 71.2% (95% confidence interval, CI: 70.0-72.4%) of the 8201 white women and 67.6% (95% CI: 64.5-70.6%) of the 1474 black women in this sample reported having a mammogram in the past two years. About 60.3% (95% CI: 56.7-70.3%) of 970 Hispanic women (including those who reported they were white or black) and 71.5% (95% CI: 70.3-72.7%) of 8705 non-Hispanic women reported having a mammogram in the past two years. About 74.8% (95% CI: 73.8-76.8%) of 8176 white women and 73.8% (95% CI: 71.1-76.6%) of 1471 black women aged > or =40 years had received a clinical breast examination in the past two years. About 60.1% (95% CI: 56.1-64.0%) of 969 Hispanic women (including those who reported they were white or black) and 75.6% (95% CI: 74.6-76.6%) of 8678 non-Hispanic women had received a clinical breast examination in the past two years. Women with lower incomes, those with less education, and recent immigrants were less likely to be screened. Women who had a usual source of health care and those with health insurance coverage were more likely to have been screened. These results underscore the need for continued efforts to ensure that uninsured women and those who are medically underserved have access to cancer screening services.

Adult, Aged, Breast Diseases diagnosis, Breast Diseases epidemiology, Breast Neoplasms epidemiology, Breast Neoplasms pathology, Case-Control Studies, Cohort Studies, Female, Follow-Up Studies, Humans, Logistic Models, Mass Screening methods, Middle Aged, Multivariate Analysis, Odds Ratio, Prospective Studies, Risk Assessment, Risk Factors, United States epidemiology, Breast Diseases pathology, Cell Transformation, Neoplastic pathology, Mammography methods, Precancerous Conditions epidemiology, and Precancerous Conditions pathology

Background: Having either a history of benign breast disease, particularly atypical hyperplasia or extensive mammographic breast density, is associated with increased breast cancer risk. Previous studies have described an association between benign breast disease histology and breast density. However, whether these features measure the same risk, or are independent risk factors, has not been addressed.
Methods: This case-control study, nested within the prospective follow-up of the Breast Cancer Detection Demonstration Project, evaluated both benign histologic and mammographic density information from 347 women who later developed breast cancer and 410 age- and race-matched controls without breast cancer. Multivariate logistic regression analyses provided maximum-likelihood estimates of the odds ratios (OR) and 95% confidence intervals (CI) to evaluate the relative risk of breast cancer associated with each exposure.
Results: Adjusting for mammographic density, the OR for atypical hyperplasia was 2.1 (95% CI: 1.3-3.6), and adjusting for benign breast histology, the OR for > or = 75% density was 3.8 (95% CI: 2.0-7.2). Women with nonproliferative benign breast disease and > or = 75% density had an OR of 5.8 (95% CI: 1.8-18.6), and women with < 50% density and atypical hyperplasia had an OR of 4.1 (95% CI: 2.1-8.0).
Conclusions: In this study, both benign breast disease histology and the percentage of the breast area with mammographic density were associated with breast cancer risk. However, women with both proliferative benign breast disease and > or = 75% density were not at as high a risk of breast cancer due to the combination of effects (p = 0.002) as women with only one of these factors.

Adult, Aged, Breast Neoplasms diagnostic imaging, Cohort Studies, Female, Humans, Incidence, Middle Aged, Models, Statistical, United States epidemiology, Breast Neoplasms epidemiology, and Mammography statistics numerical data

A number of studies have attributed much of the sharp increase in breast cancer incidence in the United States during the 1980s to the increased detection through mammography. The most recent breast cancer data from the US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program show that the incidence trend has slowed, while results from the National Health Interview Survey (NHIS) of 1987 and 1990 indicate that the percentage of women receiving mammograms continues to increase. This phenomenon suggested the need to reassess the relationship between increasingly early detection of breast cancer and overall incidence trends. A polynomial age-cohort model was used to establish the secular trend in incidence rates excluding the impact of recent increases in detection due to the rising use of mammography. Based on the model, the incidence trend in the youngest age group (40 to 49 years) would peak and then begin to decline in the early 1980s. This pattern would manifest itself later in successively older age groups as these younger cohorts age. Breast cancer trends are seen to be generally consistent with the impact of the increased use of mammography when its effect is superimposed upon the background of declining or slowing secular trends. These results support previous reports linking incidence rates with the increase in screening-mammography.

Adult, Age Factors, Aged, Breast Neoplasms diagnosis, Breast Neoplasms mortality, Diseases in Twins diagnosis, Diseases in Twins epidemiology, Female, Health Surveys, Humans, Mammography statistics numerical data, Mass Screening statistics numerical data, Middle Aged, Physical Examination statistics numerical data, Survival Rate, United States epidemiology, Breast Neoplasms prevention control, Diseases in Twins prevention control, Family psychology, Health Behavior, Mammography psychology, Mass Screening psychology, Physical Examination psychology, and Twins psychology

Reports of breast-cancer-screening behavior were collected from 591 twin sisters of women with breast cancer and 182 non-twin sisters of the same women, and compared with the patterns found by national surveys. Timeline plots indicate that prior to the diagnosis of breast cancer in a sister, these women were being screened at prevailing rates. In the year after diagnosis, the annual frequency of use by them of both mammograms and physician breast exams increased by approximately 25 percent, but in subsequent years these rates dropped to a plateau no more than 10 to 15 percent higher than the baseline. The sisters over age 60 were screened with unusually low frequency, as were those with no partner in the home, those with no regular source of medical care, and especially the siblings of cases that died soon after the diagnosis. The relatively infrequent adoption of a long-term, annual, screening pattern in the face of certain knowledge of personal high risk gives cause for concern about the effectiveness of any intervention program requiring recognition of personal high risk for effectiveness. One cause for optimism is that higher screening rates prevail among those with co-twins diagnosed since 1980, suggesting that the increase in publicity and public education in recent decades has had a beneficial impact.