Recent studies have suggested that the diagnostic reliability and accuracy of breast ultrasonography in place of mammography in women with dense breast tissue results in more accurate breast cancer screening in this population. Since breast cancer is the second leading cause of cancer deaths among United States women, a more accurate and reliable breast cancer screening tool is needed (American Cancer Society [ACS], 2014). This process starts with describing breast screening practice patterns of nurse practitioners and analyzing their attitudes and beliefs of alternative screening modalities gathered from the survey results obtained from this DNP project. The purpose of this study is to determine the attitudes and beliefs of if nurse practitioners towards the use of ultrasonography alone in lieu of mammography followed by sonography in women aged 40-74 with mammographically dense breast tissue. A survey consisting of 23 questions was sent to nurse practitioners in Arizona through the Coalition of Arizona Nurses in Advanced Practice listserv, and through an email list provided by the president of the Allied Health Providers of Yuma. Analysis of survey responses indicated that the majority of respondents believe that it is difficult to detect cancer using mammography in women with dense breast tissue, and more than half of respondents believe that ultrasounds are more accurate and reliable at detecting cancer in women with dense breast tissue. The results also demonstrate that the majority of nurse practitioners surveyed are not familiar with current literature regarding ultrasonography screening in women with dense breast tissue.

Made available in DSpace on 2014-06-11T19:23:07Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-03-03Bitstream added on 2014-06-13T19:29:06Z : No. of bitstreams: 1 lourenco_ts_me_botfm.pdf: 671367 bytes, checksum: bd5532536c0dd51f6b69d6c1bf7e94fc (MD5) / Fundação Pio Xii - Barretos / A mamografia constitui o método populacional mais eficaz na redução da mortalidade por câncer de mama, visto a elevação do diagnóstico de lesões precoces. Países em desenvolvimento apresentam uma elevação na incidência e mortalidade por câncer de mama, decorrente da limitação do exame de mamografia e de programas efetivos de rastreamento. Há inúmeras barreiras relacionadas a não realização do exame de mamografia, podendo estar relacionadas ao sistema de saúde, à educação e à adesão da paciente. Iniciou-se em 2003 na DRS-V um rastreamento mamográfico, controlando as variáveis relacionadas ao sistema de saúde e educação. Na região da DRS/V do Estado de São Paulo, constituída por 19 cidades, iniciou-se um rastreamento mamográfico organizado, a mulheres na faixa etária dos 40-69 anos, através de uma Unidade Móvel de Prevenção (UMP) contendo um mamógrafo, ou em uma unidade fixa, em local onde havia limitação prévia a realização deste exame. Avaliou-se as características de 17.964 mulheres atendidas nos dois primeiros anos do projeto, sendo avaliado as características desta população; e após a cobertura populacional de 50,3% das mulheres, foram entrevistadas 550 mulheres que nunca haviam realizado o exame de mamografia anteriormente. Nas mulheres refratárias foi aplicado questionário avaliando o conhecimento sobre o auto-exame da mama, a importância da mamografia, bem como estratégias para identificação desta população refratária ao exame. No início do projeto o Programa de Saúde da Família foi o principal fator motivador a realização do exame de mamografia (46,8%) e a maioria dos exames foi realizada em UMP (63,7). Cerca de 42,1% das mulheres nunca havia realizado o exame de mamografia na vida, sendo que as mulheres que não haviam realizado o exame previamente constituído principalmente de mulheres da faixa etária 40-69 anos, baixa... / Mammography breast screening is related to early breast cancer diagnosis and the reduction of breast mortality is related to the increase in early breast cancer diagnosis. Developing countries have an increase in incidence and mortality for breast cancer is related to low income of mammography and the absence of organized screening. There are barriers related to the low adherence to mammography exam, and the main reasons are related to health system, education and adherence to guidelines. In 2003 started in DRS-V a mammography screening controlling the factors related to health system and knowledge. We began a mammographic screening in São Paulo state DRS/5 region, consisted with 19 cities, a mammographic breast cancer screening in women between 40-69 years old using a Mobile Unit with a mammography or in a fixed unit. We evaluated the characteristics of 17.964 women screened from the first two years of the project. When 50,3% of women had been screened we found 550 women non adherent to the project and applied questions related to the knowledge about breast clinical examination or reasons related to non adherence to mammography exam, and we analyze the strategies used to find these women. The “Programa de Saúde da Família” was the main factor related to adherence to mammography (46,8%) and the main local related to exams was the Mobile Unit (63,7%). There were 42,1% of the women who hadn’t done de mammography in their life’s and these women were principally between 40-49 years old, low socio-economic status and low income. There was an inverse relation in mammography previously and years of schooling and income. There was 39,2% early breast cancer diagnosis. The 550 women had low years of schooling (84,7%), low income (66,8%) and were between 42-49 years old (43,8%). The clinical frequently doesn’t realize breast examination (14,9%), and low women know how to do this exam... (Complete abstract click electronic access below)

Orientador: César Cabello dos Santos / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T17:36:06Z (GMT). No. of bitstreams: 1 Marshall_PriscilaSilva_M.pdf: 6340031 bytes, checksum: 7722e11d2d40e27f2165bfa5967d55e8 (MD5) Previous issue date: 2011 / Resumo: Introdução: A densidade mamográfica, uma medida da extensão do tecido fibroglandular radiodenso da mama, é um fator de risco independente para o câncer de mama. Fatores de risco já estabelecidos para o câncer de mama como idade ao primeiro parto, paridade e uso hormonal na pós-menopausa, também estão associados com a densidade mamária. Contudo, a base biológica da associação da densidade mamográfica ao risco de câncer de mama ainda não foi determinada. A literatura conhecida sugere que ela esteja associada à presença de proliferação epitelial ou estromal, com uma delas podendo ser a responsável pela associação da densidade com o risco de câncer de mama. Objetivos: Avaliar a composição histológica e imunohistoquímica de áreas densa e não densa de mamas de mulheres submetidas à mastectomia por câncer de mama. Sujeitos e métodos: Foi realizado estudo de corte transversal em 18 mulheres com mamas de padrão P1, P2 ou Dy (Wolfe) com carcinoma mamário estádio clínico I ou II ou carcinoma in situ com indicação de mastectomia. Suas mamografias foram digitalizadas, sendo localizadas as áreas mais densa, menos densa e tumoral. Cada sujeito também teve sua mama fotografada em 4 posições. Foi utilizada uma técnica de localização baseada em um método de aproximação linear com interpolação das imagens mamográficas e as fotos da mama. Durante a mastectomia, as áreas selecionadas foram biopsiadas e enviadas para análise anatomopatológica, sendo estudados os seguintes critérios: avaliação macroscópica (tamanho das áreas, proporção de tecido adiposo e pontos pardacentos), avaliação microscópica quanto ao epitélio (unidades ductolobulares terminais, presença de lesões proliferativas e não proliferativas), avaliação microscópica do estroma (extensão da fibrose, tipo de fibrose e celularidade estromal), e avaliação imuno-histoquímica, com pesquisa da expressão de CD-34, Ki67 e receptores hormonais (RE e RPg). Resultados: As áreas densa e não densa apresentaram o mesmo tamanho. Não houve diferença na proporção de tecido adiposo entre as áreas (p = 0,070), porém a proporção de pontos pardacentos foi maior nas áreas densas (p = 0,022). O número de unidades ducto-lobulares terminais foi maior para as áreas densas do que para as não-densas (p = 0,001). Não foram encontradas lesões proliferativas com atipias no tecido não-denso, porém em 3 das áreas densas avaliadas foi encontrada atipia epitelial plana. Lesões proliferativas sem atipias foram encontradas nas duas áreas, porém foram mais frequentes no tecido denso do que no não denso (23,5% vs 11,8%, p = 0,045). Lesões não proliferativas também foram mais frequentes na área densa (17,6% vs 2,9%, p = 0,025) em relação a menos densa. Em ambas as áreas a distribuição celular foi mais comumente intra e interlobular. A celularidade estromal foi a mesma nos dois tecidos. A fibrose foi mais comumente extensa ou moderada no tecido mamário denso e leve no não-denso (p = 0,030). Quanto à análise imunohistoquímica, a expressão de receptores de estrógeno e progesterona, assim como de Ki67 e CD34, foi similar para as duas áreas. Conclusões: O estudo demonstrou que tanto a fibrose estromal quanto a proliferação epitelial são responsáveis pela maior densidade mamográfica e que a expressão imunohistoquímica de receptores hormonais, CD-34 e Ki-67 é similar em áreas mais menos densas / Abstract: Introduction: The mammographic density, a measure of the extent of the radio dense fibroglandular tissue of the breast, is an independent risk factor for breast cancer. Established risk factors for breast cancer, including age at first birth, parity and hormone use in pos-menopausal women, are also associated to mammographic density. However, the biological basis of the association of mammographic density and breast cancer risk is still undefined. The known literature suggests that mammographic density is associated to proliferation of epithelium or stroma, and one of these may be responsible for the association of density and breast cancer risk. Objectives: To evaluate histological and immunochemical composition of radiologically-dense and -non-dense breast tissues of women undergoing mastectomy for breast cancer. Subjects and methods: We realized a transversal study of 18 women undergoing mastectomy with breasts classified as P1, P2 or Dy (Wolfe) and breast cancer of clinical stadium I or II or ductal carcinoma in situ (DCIS). Their mammograms were digitized and, in each mammogram, we localized the dense area, the nondense area and the tumor area. Pictures of the breast were taken in 4 different positions. We used a novel localization technique based on a linear approximation method with interpolation of the mammogram and breast images. During mastectomy, the selected areas were biopsied according to the localization method and sent for analyses. The following criterias were analyzed: tissue macroscopy (size of the selected areas, fat proportion and proportion of brownish spots), epithelium microscopy (number of terminal ductal lobular units, presence of proliferative and non-proliferative lesions), microscopy of the stroma (fibrosis extent, kind of fibrosis and cellularity) and immunohistochemical analyses of CD-34, Ki67 and hormone receptors expression (ER and PgR). Results: The dense and non-dense areas had the same weight and volume. We found no difference in percent composition of fat between dense and nondense tissue (p = 0.070). However, the percentage compositions of the brownish spots between dense and non-dense tissues were significantly different (p = 0.022). The number of terminal ductal lobular units was higher for dense than non-dense breast tissue (p = 0.001). There were no proliferative lesions with atypia in the non-dense tissue, however we found epithelial flat atypia in 3 of the 18 dense areas evaluated. Proliferative lesions without atypia were found in both tissues, but they were more frequent in dense breast tissues than in non-dense breast tissues (23.5% vs 11.8%, p = 0.045). Non-proliferative lesions were also more frequent in dense breast tissues (17.6% vs 2.9%, p = 0.025). In both areas, the cellular distribution was intra and inter-lobular. The stroma cellularity was the same in both tissues. Fibrosis was more frequently extensive or moderate in dense tissue, while it was predominantly mild in nondense tissue (p = 0.030). With regard to the immunochemical analysis, estrogen and progesterone receptors were equally expressed in both tissues, as were Ki67 and CD34. Conclusions: Our study findings lead to the conclusion that both stromal fibrosis and epithelial proliferation are responsible for higher mammographic density. Immunostaining of ER, PgR, CD-34 and Ki-67 were the same in dense and non-dense breast tissueS / Mestrado / Oncologia Ginecológica e Mamária / Mestre em Ciências da Saúde

This work includes a series of studies that examines the health and economic impacts of screening mammography from international and Canadian perspectives. This work is a compendium of several researched chapters that include an introduction, four body chapters, and a discussion. The body chapters include a systematic review of the health economic literature on screening mammography, a review of quantitative models used to examine the consequences of breast cancer screening, and cost-effectiveness analyses of screening mammography programs in Canada for the general female population and for subgroups of the population at high-risk for breast cancer. There are three analytic chapters that will be submitted as manuscripts for peer-reviewed publication. The main results of this research show that current screening mammography practices in Canada may extend life at an acceptable cost to the health care system. Due to the outlined methodological limitations of this research the results should be interpreted with caution.

Introduction: Breast density is an important independent risk factor for breast cancer and is negatively associated with diagnostic sensitivity of mammography. Measurement of breast density can be used to identify women at increased risk of developing breast cancer and those who would benefit from additional imaging. However, measurement techniques are generally subjective and do not reflect the true three-dimensional nature of the breast and its component tissues.Method: A semi-automated method for determining the volume of glandular tissue from digitised mammograms has been developed in Manchester. It requires a calibration device (stepwedge) to be imaged alongside the breast during mammography, with magnification markers on the compression paddle to accurately determine breast thickness. Improvements to the design of the stepwedge and markers have enabled the method to be applied to the screening population for the first time. 1,289 women had their volumetric breast density measured using this method and additionally completed a questionnaire on breast cancer risk factors.Results: The method has demonstrated excellent intra- and inter-observer agreement. The median percentage breast density in the study cohort was 8.4% (interquartile range 4.9 – 14.2%). There was no significant difference between left and right breasts; the difference between MLO and CC views was significant (CC view was denser), but values were closely correlated (r = 0.92, p < 0.001). The median glandular volume was 60.1cm3 and exhibited no significant variation between left/right breasts or CC/MLO views. A number of breast cancer risk factors were found to be significantly correlated with glandular volume and percentage breast density, including age, weight, BMI, parity, current HRT use and current smoking. The strength of correlation was equal to or greater than that of visually assessed mammographic density. Glandular volume and percentage breast density measurements demonstrated strong relationships with visually assessed mammographic density, which has been shown to be highly correlated with risk.Conclusions: These findings are promising and suggest that volumetric breast density measured using this method should be associated with breast cancer risk. However, further work is required to establish this relationship directly. The method will be used in a large study, known as PROCAS (Predicting Risk Of Cancer At Screening) which aims to develop individualised breast cancer risk prediction models; these have the potential to form the basis of tailored screening intervals. Preliminary work has been undertaken to adapt the method for full field digital mammography, which suggests that it is possible to use the integrated digital detector as the calibration device.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2016-04-15T15:22:54Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTAÇÃO Aline Carvalho da Silva Xavier.pdf: 7741739 bytes, checksum: a144ef1082bc63af0c0c529b5b83b059 (MD5) / Made available in DSpace on 2016-04-15T15:22:54Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTAÇÃO Aline Carvalho da Silva Xavier.pdf: 7741739 bytes, checksum: a144ef1082bc63af0c0c529b5b83b059 (MD5) Previous issue date: 2015-08-28 / FACEPE / A mamografia é o método de diagnóstico mais eficaz na detecção precoce de doenças mamárias. Os sistemas digitais permitem obter radiografias com melhor qualidade de imagem, mas nem sempre estão associadas a protocolos de aquisição otimizados, resultando em doses absorvidas mais elevadas nas glândulas mamárias. Neste sentido, tornam-se pertinentes levantamentos dosimétricos e avaliações da proteção radiológica nas instituições que realizam mamografias. O presente trabalho tem como objetivo estimar a dose glandular média (DGM) em pacientes que realizaram mamografias em sistemas digitais de Recife, Brasil e avaliar a qualidade das imagens obtidas. Foram avaliados: um mamógrafo Siemens, modelo Mammomat 3000 Nova e leitora CR Carestream, modelo Kodak DirectView; dois mamógrafos digitais DR Lorad, modelo Hologic Selenia e um equipamento analógico (telafilme) Lorad M-IV com uma processadora de filmes Kodak, modelo X-Omat 2000. As DGMs foram estimadas a partir da metodologia descrita por Dance e colaboradores, em pacientes com idades entre 40 e 64 anos, com espessuras de mama comprimida que variaram entre 2 e 9 cm. Foram levadas em conta apenas as incidências de rotina (CCD, CCE, MLOD, MLOE). Ao todo, foram coletados os seguintes parâmetros de irradiação de 5200 mamografias: tensão (kV); carga (mAs); combinação anodo/filtro, bem como, a espessura da mama comprimida, força de compressão utilizada e idade da paciente. Em relação à qualidade da imagem, foram analisadas a função da transferência de modulação (MTF), a razão sinal-ruído (SNR) e a razão contraste-ruído (CNR) para diferentes espessuras de simuladores de mama, de acordo com o documento Humam Health Series 17, da Agência Internacional de Energia Atômica. Paralelamente, utilizando os mesmos critérios de avaliação, médicos radiologistas analisaram 50 imagens mamográficas. Os resultados mostraram que os valores das DGMs foram de: 2,70±0,50 mGy para o equipamento tela-filme, 3,91±0,72 mGy para o equipamento CR, 2,86±0,53 mGy para o DR1 e 3,83±0,70 mGy para o DR2. As espessuras médias das mamas foram, respectivamente: 4,82 cm; 6,73 cm; 6,02 cm; 6,11 cm. A força de compressão foi menor do que o indicado para os equipamentos digitais e maior para o tela-filme. Os valores de DGM obtidos com o simulador de mama foi menor que os obtidos para paciente com espessura de mama equivalente. O parâmetro SNR foi considerado adequado para todos os equipamentos. A razão contraste-ruído não foi satisfatória para mamas mais espessas, porém a DGM se mostrou bem abaixo do limite recomendado para este tipo de mama, fazendo-se necessário o ajuste no controle automático de exposição. A MTF foi satisfatória tanto para o equipamento CR quanto para o DR1. A avaliação das imagens clínicas identificou falhas no posicionamento, indicando a necessidade de treinamento para os operadores dos equipamentos de mamografia digital. De maneira geral, espera-se, com este estudo, despertar e educar os profissionais envolvidos sobre a importância dos conceitos de proteção radiológica em mamografias digitais. / The mammography is the most effective diagnostic method for breast disease detection. Digital systems improve image quality, but not always follow optimization protocols for image acquisition and it may result in higher doses absorbed by the mammary glands. Therefore, it is important to conduct radiological protection studies in patients. Thus, this study aims to estimate the mean glandular dose (MGD) in patients who underwent mammograms in digital systems in Recife, Brazil, and to analyze the image quality. This study was conducted with: one Siemens mammography unit and a Carestream CR reader, Kodak DirectView; two Lorad Hologic Selenia digital mammography DR, and one Lorad M-IV analogic equipment with a Kodak film processor, X-Omat 2000. In order to evaluate the MGD, tests were conducted in patients with ages between 40 and 64 years old and breast thickness between 2 and 9 cm. Only the routine incidents were taken into account (RCC, LCC, RMLO, LMLO). The irradiation parameters of 5200 mammograms were analyzed among these four equipment. were recorded (kV, mAs, anode/filter), as well as the thickness of the compressed breast and the patient’s age. The MGD was calculated using the methodology described by Dance et al. The image quality was assessed through the modulation transfer function (MTF), the signal to noise ratio (SNR) and contrast to noise ratio (CNR) for different thicknesses of phatom, according to Humam Health Series 17 document of the International Atomic Energy Agency. Furthermore, the quality of 50 mammograms were evaluated by radiologists. The results showed that the value of MGD was 2.70±0.50 mGy to screen-film equipment, 3.91±0.72 mGy for CR equipment, 2.86±0.53 mGy for the DR1 and 3.83±0.70 mGy for the DR2. The average thicknesses were, respectively: 4.82 cm; 6.73 cm; 6.02 cm; 6.11 cm. The compression force was smaller than indicated for the digital equipment and greater for screen-film. The MGD values obtained with the phantom were lower than those obtained for patients with breast equivalent thickness. The SNR was suitable for all equipment. In most thicker breasts, CNR was not satisfactory, but DGM was below the recommended range for this type of breast, allowing to conclude that an adjustment in automatic exposure control is needed to improve the CNR, even though MGD might increase. The MTF was satisfactory for both CR and DR1 equipment. The evaluation of clinical images showed failure in positioning which indicates lack of training of mammography technicians. In general this study expects to awake and educate professionals of this field about the importance of radiation protection concepts in digital mammograms.

Introdução: O câncer de mama corresponde a 28,1% dos casos de neoplasia maligna na mulher. O aumento na cobertura dos rastreamentos, melhorias nos fluxos hierarquizados de atendimento e notáveis avanços no conhecimento da biologia tumoral têm permitido expressivas quedas na mortalidade nos países desenvolvidos. No estado de São Paulo, existem dados disponíveis para se estimar a evolução da cobertura mamográfica e variáveis relativas ao cancer de mama a partir do ano 2000. Objetivo: Avaliar a eficácia da mamografia no aumento da proporção de tumores localizados de câncer de mama e redução do risco de morte por câncer de mama no contexto de triagem oportunista. Métodos: Realizamos a coleta de dados de fontes públicas de todos os casos registrados no estado de São Paulo sobre câncer de mama e mortalidade registrada. Os dados sobre história médica, diagnóstico, terapia e acompanhamento de todos os pacientes submetidos ao sistema de saúde do estado de São Paulo (FOSP-FUNDAÇÃO ONCOCENTRO DE SÃO PAULO) por câncer de mama primário, foram documentados retrospectivamente, no total de 42.850 mulheres, com idade entre 50 e 69 anos, diagnosticadas de 2000 a 2016 e dados de três pesquisas sobre cobertura mamográfica aplicadas em 2003, 2008 e 2013. As principais medidas de desfecho foram cobertura mamográfica, tendências de distribuição de etádios e estimativas da mortalidade por câncer de mama. Resultados: A cobertura de mamografia bianual aumentou de 62,4% em 2003 para 73,9% em 2013. Houve um aumento de 6,9% na proporção de tumores in situ de 2000 a 2016 e um aumento de 6% na proporção de tumores localizados entre 2000 e 2006 sem mais mudanças substanciais após. O risco de morte por câncer de mama em 5 anos teve um decréscimo mínimo de 25,9% em 2000-2002 para 22,5% em 2003-2005, sem alterações após. Conclusão: A estratégia de aumentar a cobertura de mamografia, em um contexto de rastreamento oportunista do câncer de mama, é limitada em conseguir uma redução substancial da mortalidade por câncer de mam / Introduction: Breast cancer accounts for 28.1% of malignant neoplasms in women. Increased coverage of trails, improvements in hierarchical care flows, and notable advances in the knowledge of tumor biology have allowed notable declines in mortality in the developed countries. In the state of São Paulo, there are data available to estimate the mammography coverage and variables related to breast cancer from the year 2000. Objective: To assess the effectiveness of mammography in increasing the proportion of localized breast cancer tumors and reducing the risk of death due to breast cancer in the context of opportunistic screening. Methods: We collected data from public sources of all registered cases in the state of São Paulo on breast cancer and recorded mortality. The data on medical history, diagnosis, therapy and follow-up of all patients submitted to the health system of the state of São Paulo (FOSP-FOUNDATION ONCOCENTRO DE SÃO PAULO) for primary breast cancer, were documented retrospectively, a total of 42,850 women, aged between 50 and 69 years, diagnosed with breast cancer from 2000 to 2016 and data from three surveys on mammography coverage applied in 2003, 2008 and 2013. Main outcome measures were Mammography coverage, stage distribution trends, and estimates of breast cancer mortality. Results: Biannual mammography coverage increased from 62.4 % in 2003 to 73.9% in 2013. There was a 6.9% increase in the proportion of in situ tumors from 2000 to 2016, and a 6% increase in the proportion of localized tumors from 2000 to 2006 without further substantial changes after that. Five-year risk of death due breast cancer had a minimal decrease from 25.9% in 2000-2002 to 22.5 % in 2003-2005, without changes after that. Conclusion: The strategy of increasing mammography coverage in a context of opportunistic breast cancer screening is limited in achieving a substantial reduction of breast cancer mortality

Underutilization of screening mammography by Latinas continues unabated and may contribute to disparities in disease-free survival and mortality. Objective. Comparison of two discussion group-centered educational interventions at enhancing breast cancer knowledge, breast self-exams (BSE), and screening mammography. Methods. Pre-test post-test study design. Two cohorts of 200 Latinas each participated in survey screening and discussion groups at baseline. One cohort also viewed an animated video and had BSE training. Breast cancer knowledge, self-reported BSE and mammography history were measured at baseline and three months post-intervention. Results. Breast cancer knowledge scores were good for both groups at baseline, and significantly increased at three month follow-up for both groups (p<.05) but no significant difference was observed between groups at baseline or post-intervention. Conclusion. Community-based discussion groups are a cost-effective method for improving breast cancer knowledge and promoting screening behaviors.

The goal of this study was to understand the unique needs and barriers to breast cancer control among African American women in the rural South. This population experiences barriers that surpass that of other minorities. Researchers conducted 6 focus groups to assess barriers of minority women in Mississippi toward breast cancer prevention and clinical trials. These women had little knowledge of treatment options and negative perceptions of screening and clinical trial participation. This research equips others to identify new health education strategies. Conclusions also provide insight into prevention for other minority populations, such as Latina, Asian, and American Indian women.

This thesis explores the current deep learning (DL) approaches to computer aided diagnosis (CAD) of digital mammographic images and presents two novel designs for overcoming current obstacles endemic to the field, using convolutional neural networks (CNNs). The first method employed utilizes Bayesian statistics to perform decision level fusion from multiple images of an individual. The second method utilizes a new data pre-processing scheme to artificially expand the limited available training data and reduce model overitting.