Reaching the Hard to Reach: Early Detection Is Not Enough

INTRODUCTION: A public health initiative was launched to improve screening and breast lesion early detection rate in low-income communities. The goal of the study was to assess usefulness of handheld breast scanner, Intelligent Breast Exam (iBE), in screening breast lesions. METHODS: Women presenting to outreach events in Westchester County and Hudson Valley from May to August 2021 were recruited for iBE. Women were educated on breast health and received iBE in 5 minutes and clinical breast exam (CBE) in 15 minutes by trained researchers. iBE examiners were blinded to CBE results, and vice-versa. iBE recorded breast screening data on a tablet, which was processed by an automated software algorithm and topographically displayed on a breast map. Women overdue for annual mammography or with positive CBE and/or iBE are referred for mammography. The primary endpoint was assessment of accuracy (correct predictions/total predictions) and AUROC for iBE in breast lesion detection compared with the gold standard of mammography. RESULTS: A total of 133 women enrolled resulting in 266 iBE and CBE. Mean (SD) age was 49.5 (13) years. Of 266 exams, 30 had completion mammography. Accuracy and AUROC were 0.66 for iBE, 0.56 for CBE, and 0.70 for iBE + CBE (Figure). CONCLUSION: iBE added an additional 10% lesion detection accuracy over CBE. Outreach events are successful in reaching hard-to-reach communities but remain challenged in retaining women for completion of care. Two-thirds of those who screened iBE positive are expected to have a positive mammogram but remain lost to follow-up.Figure