Breast cancer is a major health problem across the globe. Many incidences in the underdeveloped nations go unreported, due to non-availability or lack of access to breast screening programs. Mammography, the current gold standard for breast screening, comes with several inherent limitations in terms of cost, radiation exposure, and associated discomfort. The cost of equipment and personnel alone puts mammography out of reach for most developing nations. Hence, there is a great and growing need for an adjunct breast screening modality, within reach of general masses, especially in the overpopulated, underdeveloped countries. Digital Image Elasto Tomography (DIET) is intended to be a low cost, radiation free, noninvasive and portable breast cancer screening modality that will be accessible to the general population and will encourage more women to undergo breast screening. The DIET imaging concept induces mechanical vibrations into a breast and its surface motion is captured with digital cameras and reconstructed in 3D, for elastic characterization of the breast tissues. Ex-vivo trials and limited in-vivo trials show promise in breast cancer diagnostic evaluation. The current DIET system is, as noted, functional, but not suitable for wide scale screening. There are significant development issues in hardware, software and algorithms required to improve its speed of testing and quality of diagnostic results. The main aim of this thesis is to overcome these issues taking the DIET system from the lab to a more directly useful and usable system. This thesis presents a complete design development and analysis of the DIET clinical system, developing a prototype suitable for large-scale in-vivo trials, to establish the sensitivity and specificity of this novel technology. The major components of this research are development, of the imaging array to capture surface motion, strobe illumination for reliable image capture, actuation system to vibrate the breast harmonically, remote positioning of the actuator, ergonomic design of the imaging device, and the development of a graphical interface for easy operation of the system. Moreover, anthropomorphic silicone breast phantoms suitable for diagnostic evaluation of elastographic imaging modalities, including DIET and MRE are also presented. A new approach in software based DIET diagnosis through separate modal analysis, focusing on the second natural frequency of the breast, is also presented. Finally, the new DIET technology developed is validated ex-vivo, using two different diagnostic techniques. The trials results are positive and demonstrate viability of this new technology for commercialization. All of these aspects have advanced the clinical and technological future of this overall DIET system concept. The overall thesis makes several technical advances necessary to advance the DIET concept from a purely research concept to clinical feasibility. These advances are coupled within an advanced design to create an all new clinical prototype system. The final, validated result shows the clinical potential, both ex-vivo and in-vivo, and clinical feasibility of the DIET concept and this research.

Breast cancer is the second leading cause of cancer death among women in the United States. Nonadherence to recommended screening guidelines and lack of screening contribute to late stage diagnosis and increased morbidity and mortality among racial and ethnic women in the United States. The purpose of this study was to assess breast cancer screening practices, knowledge, and beliefs among Cameroonian immigrant women who were 40 years and older living in the metropolitan Washington, D.C. region. This quantitative cross-sectional study was guided by the health belief model and used the revised version of Champion's health belief model scale. A convenience sample (N=267) responded to a 60-item self-administered online survey that assessed knowledge of breast cancer screening, demographic variables, constructs of the health belief model and adherence (defined as obtaining a mammogram within two years). Data analyses performed included descriptive analysis, correlational and multiple linear regression. Results of this study revealed that increased level of education and self-efficacy were associated with greater knowledge of the benefits of mammography. Additionally, women who had more self-efficacy in obtaining a mammogram, perceived less cultural barriers, lived longer in the United States, and who had a regular healthcare provider were more likely to be adherent. Study findings suggest that positive social change can be achieved by empowering women to take control of their health. Efforts promoting awareness of breast cancer screening guidelines and facilitating access to a regular healthcare provider could significantly increase uptake of screening services and lead to better health outcomes and reduced mortality.

The objective of this study was to examine the relationship between psychosocial correlates (big 5 personality traits, dispositional optimism, the Health Belief Model, breast cancer fear, mammography self efficacy, and social support) and breast self examination (BSE) and mammography in breast cancer-free women. In order to measure the social support of the participants, the MOS social support survey was adapted to Turkish culture in the scope of study 1. The sample of the study 1 included 241 participants. The analyses showed that Turkish version of the MOS social support survey had satisfactory psychometric properties. The sample of the study 2 was composed of 230 asymptomatic women for breast cancer. Independent samples t-test results indicated that among the Health Belief Model notions, perceived benefit, barrier, confidence, and health motivation significantly differentiated women who practiced BSE and who did not. However, the HBM notions were not able to differentiate women who had mammography and who did not have. Instead, social support significantly clarified the difference between v women who had mammography and women who did not have. Two hierarchical logistic regression analyses were carried out for BSE and mammography. Big 5 personality traits and dispositional optimism were entered at the first step. The HBM factors and self efficacy were entered at the second step. Breast cancer fear was added at the third step / and for the last step social support measures were added to the equation. For BSE, hierarchical logistic regression yielded no significant predictors but BSE confidence and susceptibility from the HBM. For mammography, the hierarchical logistic analysis resulted that only functional support, which was entered at the fourth step was significant. The strengths and limitations, as well as the implications of the findings, were discussed.

Cancer is the second leading cause of death among the world and it has an increasing share among all causes of death. Economical burden of cancer is increasing especially in high and middle-income countries. Leaving cancer in competitive markets would lead to inefficiencies / hence governments should intervene in the market and make public decisions in struggling cancer. Among all cancer types breast cancer has the highest incidence and mortality rates in females. Causes of breast cancer still remains indeterminate and only way to cope with breast cancer are by early diagnoses. Early diagnoses can best be achieved by regular mammography screenings. This study analyzes the possible outcomes of implementing regular breast cancer mammography screening program in Turkey. A simulation model is constructed and run for 10 years, to obtain the costs and benefits of such a screening program. Costs of such a program include the screening costs and costs due to abnormal mammograms. Benefits, on the other hand are reduced treatment costs due to early diagnosis, reduced mortality and morbidity. Simulation model is run for 11 different screening strategies for determining the optimal screening strategy in terms of screening interval and minimum age to screen. The necessary data is obtained from hospital records, Cancer Early Diagnosis and Treatment Center records, IMF, WHO and TUIK databases and literature. Results of the simulation suggest that women over 40 in Turkey should be screened biennially for economical efficiency.

Benign breast biopsy (BBB) can be a stressful experience for many women. Few studies have examined the specific aspects of the BBB more and less distressing. However, no research studies have examined demographic and clinical variables as they relate to distress associated with specific aspects of the BBB or the informational interests of women following a BBB. This study evaluated the magnitude of distress associated with each aspect of the BBB (additional mammography, waiting for the results of the mammography, being informed of needing a biopsy, etc.) as well as the clinical (family history of BC in first degree relative, history of BBB, and type of biopsy) and demographic (age and education) variables as correlates of distress associated with each aspect of a BBB. Additionally, we examined health information interests in women following a BBB and the manner in which women preferred to have this health information communicated.

This thesis focuses on the modelling and prediction of factors affecting attendance to screening invitations of the NHS Breast Screening Programme. The analysis is based on data collected by the Warwickshire, Solihull and Coventry Breast Screening Unit from 1989 up to 2001 with respect to invitation to screening for the prevention of breast cancer in non-symptomatic women. Using a novel approach to the analysis of the data, from the perspective of the screening episode of each woman, rather than the usual analysis from the perspective of the screening round of the units, a statistical analysis is carried out on the whole registered population for the first time. Amendments to the current formulae for coverage calculations, the introduction of a new parameter (invitation rate) and the proposal for a reduction of the invitation period (period of time between two consecutive invitations) follows from the analysis. A preliminary analysis of predictive methodologies, including traditional statistical methods and artificial intelligent methods, gives the foundation to the formulation of two new algorithms; the first, for the prediction of attendance of women to screening invitations, and the second for the prediction of occurrence of screening variation (change of appointment dates) of women to invitations. Both algorithms are based on neural network generated models able to learn from the previous screening behaviour history of the woman, a technique not previously explored for the prediction of attendance. The accuracy of the new proposed algorithm for the prediction of attendance to invitation is tested on a blind study using data not previously seen by the predictive system, and for which results were unknown at the time when the predictions were made. From the obtained results, it is concluded to recommend the implementation by the NHS Breast Screening Unit of the two algorithms proposed for the prediction of the women’s attendance and screening variation to their invitation for screening. With these predictions, women likely not to attend, or change appointment date, can be identified and appropriately targeted with the aim of increasing their attendance in the short term, and in the long term, reducing breast cancer mortality.

A culturally-based theoretical model about how cultural beliefs about cancer and breast cancer screening techniques influence the screening behaviors of women of Mexican descent was developed using grounded theory. Across levels of acculturation and socioeconomic status, 34 women (49 to 81 years old) were interviewed through focus groups. Women who hold more traditional health beliefs about causes, nature, and responsibility with regard to breast cancer are more likely to "feel healthy" and not engage in breast cancer screening. Women who hold more traditional beliefs about propriety of female and health care provider behavior are more likely to "feel indecent" and also not engage in screening. The cultural health belief model is integrated within a sociocultural and a socioeconomic context.

No description available.

In Boston Massachusetts, Black and White women aged 50-74, experience limited access to breast cancer screening. The purpose of this quantitative study was to investigate whether there is a correlation between breast cancer screening access to personal healthcare providers among Black and White women, aged 50- 74, in Boston, MA. The study focused on whether there was a correlation between breast cancer screening access and socioeconomic status among women, and whether a correlation existed between breast cancer screening and their educational levels. The study was informed by the health belief psychological framework. The study consisted of secondary data from the Behavioral Risk Factor Surveillance System with a sample size of n =1815, 18 years and above. Exclusion criteria consisted of adults under age 40, women above age 74 diagnosed with cancer, and had mastectomies previously. A chi square test examined the relationship between the independent and dependent variables. The key results showed a significant relation between race and access to healthcare providers. The study also found a significant relationship between low income levels and limited access. The study results portrayed a nonsignificant relationship between breast cancer screening and educational levels among black and white women. The results concluded that access to healthcare providers was significant among the races as well as their income levels. The study contributes to social change by promoting awareness through education of individuals, communities, organizations and the society at large.

Purpose: This study assessed effectiveness of five tools recommended by the US Preventive Services Task Force (USPSTF), designed to help primary care clinicians determine which unaffected patients to refer to genetics specialists for breast cancer risk assessment based on concerning family history. Design: This descriptive secondary analysis included 85 women aged 40-74. All participants had a first-degree female relative previously diagnosed with breast cancer who also had uninformative negative BRCA1/2 tests. Methods: Each pedigree was evaluated using the five tools including the Family History Screen-7 (FHS-7), Pedigree Assessment Tool (PAT), Manchester Scoring System, Referral Screening Tool (RST), and Ontario-Family History Assessment Tool (Ontario-FHAT). All five tools were applied to each study participant. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated to describe each tool’s ability to identify women with elevated risk as calculated by the Claus model. Receiver operating curves (ROC) were also plotted. Differences between areas under the curve (AUCs) for all possible pairs of tools were estimated through logistic regression to assess for differences in tool performance. Results: Claus calculations identified 14 women out of 85 whose lifetime risk of breast cancer was elevated at > 15%. Only two tools, the Ontario-FHAT and FHS-7, identified all 14 women with elevated risk, a sensitivity of 100%. The FHS-7 tool flagged all 85 participants, meaning its specificity was zero. The Ontario-FHAT flagged 59 participants as needing referral (specificity 36.2%) and had a negative predictive value (NPV) of 100%, indicating that if a woman was not found to need a referral to a genetics professional, it is likely she did not have an elevated lifetime risk of developing breast cancer. AUC values were not significantly different between tools (all p values > .05), and thus were not helpful in discriminating between the tools. Conclusion: In this population, the Ontario-FHAT out-performed other tools in terms of sensitivity and negative predictive value; however, low specificity and positive predictive value must be balanced against these findings. Thus, the Ontario-FHAT can help determine which women would benefit from referral to a genetics specialist.