Background: Breast cancer is the most common malignancy among adults in Jordan accounting for 39.4% of all newly diagnosed cancers. Jordan is a lower-middle–income country that lacks national screening program. King Hussein Cancer Foundation/Center (KHCF/KHCC) and Jordan Breast Cancer Program had put significant efforts over past years to increase awareness about breast cancer and improve mammography services. They have introduced two mobile mammography units aiming at reaching women in their local communities, in underserved and underprivileged regions. Aim: Describe the experience of making mammography accessible and free of charge to women in rural and remote areas with limited access to mammography services. Methods: Local health educators were trained to recruit women aged 40 years and above to get free screening mammogram in mobile mammography unit. Data collected from five rural areas in Jordan from 2012 until 2017. Total number is 13570 women. Recall was performed at the fixed mammography unit at KHCC and was free of charge until the diagnosis of cancer affirmed or deferred. Results: The highest percentage of women 55.2% (N: 7733) aged 41-50 years. Women aged less than 40 years were recruited due to their breast-related symptoms. It was ethically difficult to refrain imaging symptomatic women in van in remote areas. However, in areas closer to KHCC symptomatic women with no medical insurance were directly referred to KHCC with voucher for free mammogram and workup. Total number of women referred for screening was 13058 (96.2%) and those referred as diagnostic was 512 (3.8%); their mean age was 48.8 and 45 years respectively. Overall recall rate was 29.3% (N: 3822) among screening cases. Cancer detection rate was 0.85% (N: 112) among screened women and 6.8% (N: 35) among diagnostic cases. Number of women who failed to adhere to follow-up procedures was N=1191 (8.8%). It was noticed that family history of cancer correlated with better adherence to complete follow-up procedures. Conclusion: Mobile mammography unit enabled access to screening mammography in rural areas and also encouraged symptomatic women to seek medical advice early. Ensuring financial coverage may have been an additional motivational factor. Follow-up studies may be conducted to compare tumor size differences between screening and diagnostic cases, prognosis and quality of life.

Background: CYP1A1 is a candidate gene for low-penetrance breast cancer susceptibility, as it plays an important role in the metabolism of carcinogens and estrogens. Purpose: The objective of this study was to assess the association between M2 (A2455G, Ile462Val) and M4 (C2453A, Thr461Asn) polymorphisms in CYP1A1 and breast cancer risk among Jordanian women and in subgroups stratified by menopausal status and smoking history. Materials and Methods: Blood samples were collected from 112 breast cancer female patients and 115 age-matched controls who underwent breast cancer screening with imaging and showed negative results (BI-RADS I or BI-RADS II). Genotyping was performed using the PCR-RFLP technique. Results: No statistically significant overall association was found between breast cancer risk and CYP1A1 M2 genotypes (p= 0.55; OR = 0.77; 95% CI= 0.32-1.83) nor with the M4 polymorphism (p= 0.95; OR= 0.95; 95% CI= 0.51-1.88). Analysis of subgroups defined by menopausal status or smoking history also revealed no association with these polymorphisms. Furthermore, the four identified haplotypes (AC; AA; GC and GA) were equally distributed among cases and controls, and haplotype analysis showed a strong linkage disequilibrium of both studied loci in either cases or controls (D'=1). Conclusions: Based on the study results, CYP1A1 M2 and M4 polymorphisms do not seem to play a major role in breast cancer risk among Jordanian females.

Introduction: Differences in radiologists' experience can potentially introduce interobserver variability in reading mammograms. This work investigated the effect of radiologists' experience on agreement on mammographic final classification. Methods: This was a cross-sectional study. Seventeen radiologists were asked to provide their final impression on 60 mammogram cases. Experience parameters included breast subspecialty, years reading mammograms, cases read per year and career caseload. Career caseload was calculated by multiplying years reading mammograms by the average number of cases read per year. The interobserver agreement was calculated using Cohen kappa (j). The difference in j between radiologists' groups was compared using the independent-sample t-test and analysis of variance. Results: The average interobserver agreement was 0.25 (fair). A small difference was found in favour of breast radiologists against general radiologists (j = 0.21 and 0.29, respectively, P = 0.019). Years reading mammograms and cases read per year did not seem to significantly affect the interobserver agreement (P = 0.056 and 0.273 respectively). Radiologist who had career caseload of at least 2500 cases showed significantly higher consistency than those who read less. j for radiologists who had career caseload of 2500-4000 cases and >4000 cases was 0.33 and 0.28, respectively, whereas for <2500 j was 0.17 (P = 0.001). Conclusion: A fair level of interobserver agreement on the final classification of a mammogram was demonstrated. Career caseload was the most important experience parameter to associate with the interobserver agreement. Training strategies aiming to increase radiologists' career caseload may be beneficial.

Aim of the study: Ultrasound-guided vacuum-assisted biopsy is being increasingly used in the diagnosis of breast lesions. The advantages of vacuum-assisted biopsy over core needle biopsy include large sample and higher diagnostic accuracy. Indications for ultrasound-guided vacuum-assisted biopsy include suspicious calcifications visible on ultrasound, architectural distortion, and very subtle or insinuating lesions. Case description: We present three patients treated for breast cancer with breast-conserving surgery who developed suspicious findings on mammogram and MRI at or near the surgical scar. The findings were subtle, small, or atypical lesions on ultrasound. Ultrasound-guided vacuum-assisted biopsy was performed, and recurrence was diagnosed. The technique was advantageous due to real-time imaging, ability to control the path of the needle, obtaining multiple cores with a single skin puncture and single pass, supine position, no radiation, and no IV contrast. Conclusions: Ultrasound-guided vacuum-assisted biopsy should be considered in cases involving multiple suspicious findings at or near the surgical scar, with subtle or atypical sonographic correlates. Vacuum-assisted biopsy is indicated; yet ultrasound guidance is more comfortable, no radiation and no contrast.