Overdiagnosis from screening can result from the detection of indolent preclinical cancer or progressive preclinical cancer where the person would have died of an unrelated cause before clinical di... Visual Estimation of Breast Cancer Overdiagnosis in a U.S. Breast Screening Cohort. Overdiagnosis from screening can result from the detection of indolent preclinical cancer or progressive... Background: Mammography screening can lead to overdiagnosis—that is, screen-detected breast cancer that would not have caused symptoms or signs in the remaining lifetime. There is no consensus abou...

USA states have begun legislating mammographic breast density reporting to women, requiring that women undergoing screening mammography who have dense breast tissue (Breast Imaging Reporting and Data System [BI‐RADS] density c or d) receive written notification of their breast density; however, the impact that misclassification of breast density will have on this reporting remains unclear. The aim of this study was to assess reproducibility of the four‐category BI‐RADS density measure and examine its relationship with a continuous measure of percent density. We enrolled 19 radiologists, experienced in breast imaging, from a single integrated health care system. Radiologists interpreted 341 screening mammograms at two points in time 6 months apart. We assessed intra‐ and interobserver agreement in radiologists'; interpretations of BI‐RADS density and explored whether agreement depended upon radiologist characteristics. We examined the relationship between BI‐RADS density and percent density in a subset of 282 examinations. Intraradiologist agreement was moderate to substantial, with kappa varying across radiologists from 0.50 to 0.81 (mean = 0.69, 95% CI [0.63, 0.73]). Intraradiologist agreement was higher for radiologists with ≥10 years experience interpreting mammograms (difference in mean kappa = 0.10, 95% CI [0.01, 0.24]). Interradiologist agreement varied widely across radiologist pairs from slight to substantial, with kappa ranging from 0.02 to 0.72 (mean = 0.46, 95% CI [0.36, 0.55]). Of 145 examinations interpreted as “nondense” (BI‐RADS density a or b) by the majority of radiologists, 82.8% were interpreted as “dense” (BI‐RADS density c or d) by at least one radiologist. Of 187 examinations interpreted as “dense” by the majority of radiologists, 47.1% were interpreted as “nondense” by at least one radiologist. While the examinations of almost half of the women in our study were interpreted clinically as having BI‐RADS density c or d, only about 10% of examinations had percent density >50%. Our results suggest that breast density reporting based on a single BI‐RADS density interpretation may be misleading due to high interradiologist variability and a lack of correspondence between BI‐RADS density and percent density.

Estimating advanced breast cancer risk in women undergoing annual or biennial mammography could identify women who may benefit from less or more intensive screening. We developed an actionable model to predict cumulative 6-year advanced cancer (prognostic pathologic stage II or higher) risk according to screening interval. We included 931 186 women aged 40-74 years in the Breast Cancer Surveillance Consortium undergoing 2 542 382 annual (prior mammogram within 11-18 months) or 752 049 biennial (prior within 19-30 months) screening mammograms. The prediction model includes age, race and ethnicity, body mass index, breast density, family history of breast cancer, and prior breast biopsy subdivided by menopausal status and screening interval. We used fivefold cross-validation to internally validate model performance. We defined higher than 95th percentile as high risk (>0.658%), higher than 75th percentile to 95th or less percentile as intermediate risk (0.380%-0.658%), and 75th or less percentile as low to average risk (<0.380%). Obesity, high breast density, and proliferative disease with atypia were strongly associated with advanced cancer. The model is well calibrated and has an area under the receiver operating characteristics curve of 0.682 (95% confidence interval = 0.670 to 0.694). Based on women’s predicted advanced cancer risk under annual and biennial screening, 69.1% had low or average risk regardless of screening interval, 12.4% intermediate risk with biennial screening and average risk with annual screening, and 17.4% intermediate or high risk regardless of screening interval. Most women have low or average advanced cancer risk and can undergo biennial screening. Intermediate-risk women may consider annual screening, and high-risk women may consider supplemental imaging in addition to annual screening.

PURPOSE: We extended the Breast Cancer Surveillance Consortium (BCSC) version 2 (v2) model of invasive breast cancer risk to include BMI, extended family history of breast cancer, and age at first live birth (version 3 [v3]) to better inform appropriate breast cancer prevention therapies and risk-based screening. METHODS: We used Cox proportional hazards regression to estimate the age- and race- and ethnicity-specific relative hazards for family history of breast cancer, breast density, history of benign breast biopsy, BMI, and age at first live birth for invasive breast cancer in the BCSC cohort. We evaluated calibration using the ratio of expected-to-observed (E/O) invasive breast cancers in the cohort and discrimination using the area under the receiver operating characteristic curve (AUROC). RESULTS: We analyzed data from 1,455,493 women age 35-79 years without a history of breast cancer. During a mean follow-up of 7.3 years, 30,266 women were diagnosed with invasive breast cancer. The BCSC v3 model had an E/O of 1.03 (95% CI, 1.01 to 1.04) and an AUROC of 0.646 for 5-year risk. Compared with the v2 model, discrimination of the v3 model improved most in Asian, White, and Black women. Among women with a BMI of 30.0-34.9 kg/m ² , the true-positive rate in women with an estimated 5-year risk of 3% or higher increased from 10.0% (v2) to 19.8% (v3) and the improvement was greater among women with a BMI of ≥35 kg/m ² (7.6%-19.8%). CONCLUSION: The BCSC v3 model updates an already well-calibrated and validated breast cancer risk assessment tool to include additional important risk factors. The inclusion of BMI was associated with the largest improvement in estimated risk for individual women.

This study was conducted within the context of providing an improved understanding of New Mexico’s food, energy, water systems (FEWS) and their behavior under variable climate and socioeconomic conditions. The goal of this paper was to characterize the relationships between production and prices of some forage crops (hay, grain sorghum, and corn) that can be used as feed supplements for beef cattle production and the potential impacts from a changing climate (precipitation, temperature) and energy inputs (crude oil production and prices). The analysis was based on 60 years of data (1958–2017) using generalized autoregressive conditional heteroscedasticity models. Hay production showed a declining trend since 2000 and in 2017, it dropped by ~33% compared to that of 2000. Crude oil production (R² = 0.83) and beef cattle population (R² = 0.85) were negatively correlated with hay production. A moderate declining trend in mean annual hay prices was also observed. Mean annual range conditions (R² = 0.60) was negatively correlated with mean annual hay prices, whereas mean annual crude oil prices (R² = 0.48) showed a positive relationship. Grain sorghum production showed a consistent declining trend since 1971 and in 2017, it dropped by ~91% compared to that of 1971. Mean annual temperature (R² = 0.58) was negatively correlated with grain sorghum production, while beef cattle population (R² = 0.61) and range conditions (R² = 0.51) showed positive linear relationships. Mean annual grain sorghum prices decreased since the peak of 1974 and in 2017, they dropped by ~77% compared to those of 1974. Crude oil prices (R² = 0.72) and beef cattle population (R² = 0.73) were positively correlated with mean annual grain sorghum prices. Corn production in 2017 dropped by ~61% compared to the peak that occurred in 1999. Crude oil production (R² = 0.85) and beef cattle population (R² = 0.86) were negatively correlated with corn production. Mean annual corn prices showed a declining trend since 1974 and in 2017, they dropped by ~75% compared to those of 1974. Mean annual corn prices were positively correlated with mean annual precipitation (R² = 0.83) and negatively correlated with crude oil production (R² = 0.84). These finding can particularly help in developing a more holistic model that integrates FEWS components to explain their response to internal (i.e., management practices) and external (i.e., environmental) stressors. Such holistic modeling can further inform the development and adoption of more sustainable production and resource use practices.