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AI could help improve early detection of interval breast cancer

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A new study suggests that AI could help detect interval breast cancer — those that develop between routine screenings — before they become more advanced and harder to treat. This could potentially lead to better screening practices, earlier treatment and improved patient outcomes.

The study, led by investigators at the UCLA Health Jonsson Comprehensive Cancer Center and published in the Journal of the National Cancer Institute, found that AI was able to identify “mammographically-visible” types of interval cancers earlier by flagging them at the time of screening.

These include tumours that are visible on mammograms but not detected by radiologists, or have very subtle signs on mammography that are easy to miss because the signs were faint or arguably below the level of detection by the human eye.

Researchers estimate that incorporating AI into screening could help reduce the number of interval breast cancers by 30 per cent.

“This finding is important because these interval cancer types could be caught earlier when the cancer is easier to treat,” said Dr. Tiffany Yu, assistant professor of Radiology at the David Geffen School of Medicine at UCLA and first author of the study.

“For patients, catching cancer early can make all the difference. It can lead to less aggressive treatment and improve the chances of a better outcome.”

 

 

While similar research has been conducted in Europe, this study is among the first to explore the use of AI to detect interval breast cancers in the United States. Researchers point out that there are key differences between the US and European screening practices.

In the US, most mammograms are performed using digital breast tomosynthesis (DBT), often called 3D mammography, and patients are typically screened every year. In contrast, European programmes usually use digital mammography (DM), often called 2D mammography, and screen patients every two to three years.

The retrospective study analysed data from nearly 185,000 past mammograms from 2010 to 2019 that included both DM and DBT. From the data, the team looked at 148 cases where a woman was diagnosed with interval breast cancer.

Radiologists then reviewed these cases to determine why the cancer wasn’t spotted earlier. The new study adapted a European classification system to categorize the interval cancers. They include: Missed reading error, minimal signs–actionable, minimal signs–non–actionable, true interval cancer, occult (which is truly invisible on mammogram), and missed due to a technical error.

Researchers then applied a commercially available AI software called Transpara to the initial screening mammograms performed before the cancer diagnosis to determine if it could detect subtle signs of cancer that were missed by radiologists during initial screenings, or at least flag them as suspicious. The tool scored each mammogram from 1 to 10 for cancer risk. A score of 8 or higher was considered flagged as potentially concerning.

The team found that the AI flagged 76 per cent of the mammograms that had been originally read as normal but were later linked to an interval breast cancer. It flagged 90 per cent of missed reading error cases where the cancer had been visible on the mammogram but missed or misinterpreted by the radiologist.

It caught 89 per cent of minimal-signs-actionable cancers that showed very subtle signs and could reasonably have been acted upon, as well as 72 per cent of those with minimal-signs-non-actionable that were likely too subtle to prompt action.

For cancers that were occult or completely invisible on the mammogram, the AI flagged 69 per cent of cases.

It was somewhat less effective at identifying true interval cancers, those that were not present at the time of screening but developed later, flagging 50 per cent.

“While we had some exciting results, we also uncovered a lot of AI inaccuracy and issues that need to be further explored in real-world settings,” said Dr. Hannah Milch, assistant professor of Radiology at the David Geffen School of Medicine and senior author of the study.

“For example, despite being invisible on mammography, the AI tool still flagged 69 per cent of the screening mammograms that had occult cancers. However, when we looked at the specific areas on the images that the AI marked as suspicious, the AI did not do as good of a job and only marked the actual cancer 22 per cent of the time.”

Larger prospective studies are needed to understand how radiologists would use AI in practice and address key questions, such as how to handle cases where AI flags areas as suspicious that aren’t visible to the human eye, especially when the AI isn’t always accurate in pinpointing the exact location of cancer.

“While AI isn’t perfect and shouldn’t be used on its own, these findings support the idea that AI could help shift interval breast cancers toward mostly true interval cancers,” Yu added.

“It shows potential to serve as a valuable second set of eyes, especially for the types of cancers that are the hardest to catch early. This is about giving radiologists better tools and giving patients the best chance at catching cancer early, which could lead to more lives saved.”

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Black women want more accessible breast cancer screening info, study finds

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Black women in the UK want clearer, more accessible breast cancer screening information, research has found.

The study looked at why Black African and Black Caribbean women are less likely than white women to attend breast screening.

Researchers at the University of Surrey held focus groups and interviews with 47 Black African and Black Caribbean women aged 50 to 71.

Women in this age group are routinely invited for NHS breast screening.

The researchers said only 45 per cent of Black women attend screening, compared with 63 per cent of white women.

Anietie Aliu, lead author, postgraduate researcher at the University of Surrey and registered nurse, said: “Diagnosing breast cancer early can dramatically improve a person’s chance of survival.

“Breast cancer screening plays an important role in this by identifying the cancer and ensuring a person receives speedy treatment.

“Despite the importance of screening, Black women are less likely to attend appointments than white females.

“This puts them at risk of a potential cancer being diagnosed late and spreading to other areas of the body. We need to understand what is preventing Black women from attending these appointments and help identify ways to remove such barriers.”

The study found a need to increase awareness of breast cancer screening, especially among women less familiar with the service.

Some women, particularly those born outside the UK, knew little about breast screening before receiving their first invitation.

Others questioned why they needed screening when they had no symptoms.

The importance of trusted conversations was also identified.

Researchers found that some Black women expected their GPs to speak to them about breast screening, particularly before they reached screening age.

Although NHS breast screening is organised through national screening services, researchers said GPs often have established relationships with patients and may be well placed to offer brief advice on preventive care, including breast screening.

Participants called for stronger links between GP practices, breast screening services and Black community champions.

They said this could help women receive trusted information, ask questions and feel reassured.

Faith and religious beliefs also shaped decisions for some women.

Some Black African Christian women said illness, including cancer, was not permitted by God in their bodies, while others saw screening as a personal choice that did not conflict with Christian faith.

Muslim women highlighted the importance of being able to state their religion on medical appointment forms to help ensure they were seen by a female mammographer.

A mammographer is a healthcare professional trained to carry out breast screening scans.

Aliu added: “Breast screening can save lives, but our findings show that attendance is shaped by multiple factors, not just awareness, although awareness remains important.

“Women need relatable screening information, reassurance, flexible appointments and services that are accessible within their communities.

“Many felt that invitation letters were too formal, and that leaflets and media imagery did not reflect them, making it harder to relate to screening.”

Dr Afrodita Marcu, senior research fellow at the University of Surrey and member of the research team, said: “We need a more collaborative approach, where primary care, screening services and community voices work together to support women before, during and after the invitation.”

The researchers said future breast screening interventions should be designed with Black women, rather than for them.

They said user-friendly and culturally relevant resources, developed with communities, healthcare professionals and screening services, could improve understanding, reduce fear and make breast screening feel more accessible and reassuring.

Dr Robert Kerrison, associate professor of cancer care at the University of Surrey, said: “There is no question that breast screening can be lifesaving, but we need to make it easier for women to understand, access and feel reassured by the programme.

“This means improving communication, addressing practical barriers and making sure healthcare professionals and community partners are supported to provide clear and trusted information.”

The team has also explored healthcare professionals’ perspectives and worked with stakeholders to develop user-friendly materials with Black women.

Researchers said this co-designed approach could help ensure breast screening messages are culturally relevant, practical and shaped by the people they are intended to support.

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Breast cancer rising rapidly in Asian American women, study finds

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Breast cancer rates have risen rapidly among Asian American women over the past two decades, with some of the steepest increases among women under 50, new research has revealed.

Rates rose by more than three per cent a year in nearly every Asian American ethnic group studied, much faster than in any other US ethnic group.

The increase was particularly marked among women under 50 and in cases involving advanced-stage disease or certain aggressive subtypes of the cancer.

The study found even larger increases among Chinese and Vietnamese women.

Breast cancer rates among Native Hawaiian women were already among the highest recorded among US women, but rose by about one per cent a year, less than the increases seen in Asian American groups.

The researchers said increased screening was unlikely to explain the trend because screening would be expected to identify more cancers at an earlier stage.

Instead, cancers that had already spread increased at the fastest rate.

Triple-negative breast cancer, considered the most aggressive subtype, rose by more than six per cent a year among Chinese American women between 2017 and 2022.

Scarlett Lin Gomez, senior author and professor of epidemiology and biostatistics at the University of California, San Francisco, said: “These patterns are highly concerning from a disparities standpoint.

“They underscore why it is so important to move beyond treating Asian Americans, Native Hawaiians, and Pacific Islanders as a single population.”

Researchers analysed about 150,000 cases of invasive breast cancer diagnosed between 2000 and 2022 using data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results Programme.

The analysis covered nine Asian American, Native Hawaiian and Pacific Islander populations across 14 states. Together, these states account for about two-thirds of the US population within these groups.

Except for Native Hawaiian women, Asian American women have historically had lower breast cancer rates than non-Hispanic white women.

However, the gap has narrowed rapidly. By 2022, incidence among Asian American women under 50 was comparable with that recorded among white women.

The reasons for the increase among women under 50 remain unclear.

Changes in reproductive patterns, diet and other lifestyle factors may play a part, but researchers said they did not fully explain the findings.

They said previously unidentified risk factors may also be contributing to the rises in some Asian American communities.

Researchers hope two UCSF-based studies, the CRANE breast cancer study and the ASPIRE cohort study, will provide insights into these factors.

Gomez said: “Understanding why breast cancer is increasing so rapidly in these communities is critical.

“At the same time, we need to ensure that women across all Asian American, Native Hawaiian, and Pacific Islander communities have access to culturally appropriate education, screening, and timely follow-up care.”

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Postpartum breast cancers may be biologically more aggressive, new study finds

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Breast cancer diagnosed within three years of childbirth, especially the first year, may be biologically more aggressive, a study suggests.

The findings add to evidence that postpartum breast cancer may be a distinct form of the disease.

They also suggest the period of greatest biological risk may occur earlier than previously thought.

The study was led by investigators at the UCLA Health Jonsson Comprehensive Cancer Center.

Dr Nimmi Kapoor, associate professor of surgery at the David Geffen School of Medicine at UCLA and senior author of the study, said: “We’ve long recognised that breast cancers diagnosed after pregnancy can behave differently, but we haven’t known when that increased risk is biologically strongest.

“Our findings suggest that the first one to three years after childbirth represent an important window when some tumours may have more aggressive characteristics.”

Breast cancer rates among younger women have been rising, and scientists have been investigating whether women having their first child later may help explain some of the trend.

Pregnancy causes major changes in breast tissue. Previous studies have found that cancers diagnosed soon after childbirth are more likely to have aggressive features and worse outcomes.

Researchers have not agreed on how long the period of increased risk lasts. Some studies define postpartum breast cancer as occurring within one or two years of delivery, while others extend the period to five or even 10 years.

To better define the period of risk, the team studied whether tumour biology varied according to the time since a woman’s most recent childbirth.

The study involved 385 women aged 45 or younger with early-stage, hormone receptor-positive and HER2-negative breast cancer who were treated at UCLA between 2011 and 2024.

Hormone receptor-positive cancers grow in response to hormones such as oestrogen or progesterone. HER2-negative cancers do not have unusually high levels of a protein that can promote tumour growth.

Each tumour had been assessed using the Oncotype DX Breast Recurrence Score, a genomic test that measures the activity of 21 genes linked to the risk of cancer returning and the potential benefit of chemotherapy.

Researchers grouped the women according to the time between their last childbirth and breast cancer diagnosis.

They compared women who had never given birth with those diagnosed at different intervals after childbirth.

The team then examined whether recurrence scores and other tumour features differed between the groups and whether any patterns remained after accounting for factors including age and lymph node status.

Women diagnosed within the first year after childbirth had significantly higher recurrence scores than those who had never given birth.

This suggested biological features associated with a higher risk of the cancer returning.

Scores were also higher, but to a lesser extent, among women diagnosed during the second and third years after delivery.

Women diagnosed within three years of childbirth were nearly three times more likely to fall into a higher recurrence score category than women who had never given birth.

They were also more likely to have higher-grade tumours, meaning their cancer cells appeared more abnormal and potentially more aggressive under a microscope.

Women diagnosed more than three years after childbirth did not show the same consistent increase in recurrence scores.

The findings also suggest that standard clinical measures, including tumour size and whether the cancer has reached the lymph nodes, may not fully capture the differences in this group.

Gene expression testing appeared to identify biological risk that was not always reflected in routine examination of tumour tissue.

The researchers said reproductive history could therefore provide additional context when genomic test results are interpreted in younger patients.

Despite the more aggressive genetic features, women diagnosed within three years of childbirth did not have significantly worse short-term outcomes.

After about four years of follow-up, recurrence and survival rates were similar to those among other patients in the study.

Researchers said one possible explanation was that women with higher-risk tumours received more intensive treatment, including chemotherapy, ovarian function suppression and newer targeted therapies.

The findings also suggest that aggressive tumour biology does not necessarily lead to worse short-term outcomes when patients receive effective treatment.

The researchers said larger studies involving several institutions and longer follow-up periods are needed to confirm the findings.

They added that postpartum status may need greater consideration when breast cancer is assessed and treated in younger women.

Kapoor said: “Our findings suggest that the years immediately following childbirth represent a unique biological window for some breast cancers.

“Understanding why these tumours behave differently may help us better identify patients who need closer monitoring or more tailored treatment approaches.”

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