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Artificial intelligence (AI) readers of mammograms compare favourably to individual radiologists in detecting breast cancer. However, AI readers cannot perform at the level of multi-reader systems used by screening programs in countries such as Australia, Sweden, and the UK. Therefore, implementation demands human-AI collaboration. Here, we use a large, high-quality retrospective mammography dataset from Victoria, Australia to conduct detailed simulations of five potential AI-integrated screening pathways, and examine human-AI interaction effects to explore automation bias. Operating an AI reader as a second reader or as a high confidence filter improves current screening outcomes by 1.9–2.5% in sensitivity and up to 0.6% in specificity, achieving 4.6–10.9% reduction in assessments and 48–80.7% reduction in human reads. Automation bias degrades performance in multi-reader settings but improves it for single-readers. This study provides insight into feasible approaches for AI-integrated screening pathways and prospective studies necessary prior to clinical adoption. Successful human-AI collaboration could greatly contribute to breast cancer mammographic screening. Here, the authors use a large-scale retrospective mammography dataset to simulate and compare five plausible AI-integrated screening pathways, finding optimal ways in which human-AI collaboration could be implemented in real-world settings.

Background There is growing scientific evidence supporting the potential of artificial intelligence (AI) to enhance breast cancer screening by improving the accuracy and efficiency of mammography interpretation. Aligned with this, several empirical studies, predominantly quantitative, have explored lay women's perceptions of AI in breast screening, often framing attitudes in binary terms—positive or negative. This approach can overlook the complexity and nuance of women's views. Aim This article aims to unpack that complexity by developing a typology of women's attitudes towards the use of AI in the breast screening service. It builds on Birkland's (2019) information and communication technology (ICT) user typology among older adults and further explores the relationship between the attitude types and varying levels of AI acceptability. Method Adopting an interpretative qualitative research approach, we conducted a combination of focus groups, paired interviews and one‐on‐one interviews with 26 women who had participated in the BreastScreen programme in Victoria, Australia. Data were thematically analysed using inductive coding. Findings The analysis identified four attitude types—Enthusiast, Practicalist, Traditionalist and Guardian. Each type reflected unique motivations and experiences that shaped each participant's acceptance and rejection of AI. Most participants were classified as either Enthusiasts or Practicalists, indicating a generally high or moderate level of AI acceptance. Enthusiasts viewed AI as an exciting and necessary progression, and Practicalists valued its practical utility as a useful tool. Both groups shared the belief that AI represents the future of healthcare, underpinned by technological advancement. Traditionalists, on the other hand, expressed a preference for the status quo, advocating for the exclusive role of human doctors. Guardians typically had higher levels of AI knowledge and advocated for a cautious approach, citing social and ethical concerns about AI integration. Conclusion The typology illustrates that the BreastScreen Victoria clients' attitudes towards AI are more nuanced and dynamic than a simple positive–negative dichotomy. Recognising these perspectives is critical for designing AI implementation strategies that are sensitive to the needs and concerns of care recipients. Patient or Public Contribution This study was shaped by extensive stakeholder engagement with BreastScreen Victoria and its consumer representatives from the outset. Research materials were collaboratively developed and reviewed, ensuring the study design was fit‐for‐purpose.

Women diagnosed with cancer during pregnancy (gestational cancer) are a small but vulnerable population, with experts suggesting they require greater psycho-social support than either other women with cancer or other pregnant women. However, information on their psychological needs remains sparse. This commentary describes our work exploring the psychological needs of women diagnosed with gestational cancer, areas of unmet need we identified, and our recommendations for future programs and research. We conducted in-depth, semi-structured interviews with 23 Australian women diagnosed with gestational cancer in the preceding 5 years. Our findings depicted a group of women for whom cancer diagnosis and treatment had resulted in a sense of isolation and loneliness. Women reported seeking tailored information about their condition and treatments as well as one-on-one peer support with other gestational cancer survivors, which was challenging for them to access and which existing services struggled to provide. To address these unmet needs, innovative solutions may be necessary. Technology has the potential to connect and match women with one-to-one peer support, and research exploring the efficacy and acceptability of such interventions is required. Creative solutions, such as virtual resource hubs monitored or moderated by experts, would potentially meet the information needs of this group. However, as gestational cancer is relatively rare, the development and evaluation of such interventions would require a collaborative effort across multiple sites, as well as international collaboration and data pooling.

Background Risk-based breast cancer screening would be a dramatic shift from the current one-size-fits-all model to a tailored approach where screening modality and frequency is directed by individual risk. This project assesses what key stakeholders, defined as those holding managerial and decision-making roles within BreastScreen, consider the issues are with implementing a risk-based approach to screening. Methods A qualitative approach was undertaken, recruiting participants through professional networks with interviews guided by the Consolidated Framework of Implementation Research (CFIR). Participants were key stakeholders defined as those managing, overseeing and influencing Breast Screen throughout Australia. Data were deductively coded against a CFIR-informed codebook, followed by content analysis per CFIR domain. Results Twenty interviews were conducted with 21 participants. 144 initial codes consolidated into 17 final themes. Key stakeholders are supportive and optimistic about risk-based screening in principle; however several issues exist, including knowledge gaps precluding support of evidence-based implementation. Concerns about worsening inequities within screening, cost and communication with clients are major issues key stakeholders consider important to address in the planning and implementing a change to the program. Conclusions Key stakeholders in Australia were overwhelmingly enthusiastic about the benefits of a risk-based approach however there are concerns about risk assessment utility, cost and the potential risk to equity in the program. Systematic assessment of these concerns will be required to facilitate successful change to the well-established breast screening program in Australia should risk-stratification be undertaken.

Internationally, population breast cancer screening is moving towards a risk-stratified approach and requires engagement and acceptance from current and future screening clients. A decision aid (www.defineau.org) was developed based on women’s views, values, and knowledge regarding risk-stratified breast cancer screening. This study aims to evaluate the impact of the decision aid on women’s knowledge, risk perception, acceptance of risk assessment and change of screening frequency, and decision-making. Here we report the results of a pre and post-survey in which women who are clients of BreastScreen Victoria were invited to complete an online questionnaire before and after viewing the decision aid. 3200 potential participants were invited, 242 responded with 127 participants completing both surveys. After reviewing the decision aid there was a significant change in knowledge, acceptance of risk-stratified breast cancer screening and of decreased frequency screening for lower risk. High levels of acceptance of risk stratification, genetic testing and broad support for tailored screening persisted pre and post review. The DEFINE decision aid has a positive impact on acceptance of lower frequency screening, a major barrier to the success of a risk-stratified program and may contribute to facilitating change to the population breast screening program in Australia.

IntroductionPatients with node-positive breast cancer having primary surgery currently undergo axillary node clearance (ANC) to reduce the risk of breast cancer recurrence. Evidence that this highly morbid procedure improves survival is lacking, but approximately 30% of patients will develop lifelong complications which significantly impact their quality of life.Targeted axillary dissection (TAD) may be a safe, less morbid alternative to ANC and will be evaluated in the upcoming Targeted Axillary Dissection versus axillary node clearance in patients with POsitive axillary Lymph nodes in Early breast cancer (TADPOLE) randomised controlled trial.TAD is not currently routine practice in patients having primary surgery, so it is vital that the procedure is performed in an agreed upon, standardised way within the trial and procedure fidelity monitored to ensure the results are generalisable and will be accepted by the surgical community. Robust surgical quality assurance (SQA) is essential. Here we describe the first phase of the TADPOLE SQA, a consensus process with the breast surgical community to agree upon how (1) surgery should be performed and standardised; (2) procedure fidelity will be monitored and (3) requirements for surgeon credentialling within the trial.Methods and analysisThe consensus process will have three phases:Generation of a long list of possible components of TAD from a scoping review and expert opinion. Identified items will be categorised and formatted into Delphi consensus questionnaire items.At least two rounds of an online Delphi survey in which at least 100 breast cancer surgeons will rate the importance of mandating/prohibiting, standardising and/or monitoring each component.A consensus meeting with surgeons to discuss, agree upon and ratify the approach to SQA within TADPOLE.Ethics and disseminationEthical approval has been obtained from the University of Bristol Faculty of Health Sciences Ethics Committee. Educational materials including videos and webinars will be developed and shared with surgeons participating in TADPOLE. Results will be presented at national/international meetings and published in peer-reviewed journals.

Chylous ascites is a rare clinical entity that historically has been accompanied by high mortality due to the association with malignancy. Here we present a case of chylous ascites as a complication of mild pancreatitis in a young woman. We review the literature of similar cases, which revealed four similar cases with a range of outcomes. Treatment options vary from dietary restriction of medium chain fatty acids, total parental nutrition, radiological intervention and surgery.

Purpose When a pregnant woman is diagnosed with cancer, she faces complex and unique challenges while navigating both obstetric and oncological care. Despite often being the primary support for women diagnosed with cancer during pregnancy (CDP), little is known about the experiences of their partners. We undertook an in-depth exploration of the experiences of partners of women diagnosed with CDP in Australia. Methods Semi-structured interviews were conducted with partners of women diagnosed with CDP treated in Australia. Interviews explored partners’ inclusion in decision making and communication with health professionals and their own coping experiences. Data were analysed thematically. Results Data from interviews with 12 male partners ( N  = 12) of women diagnosed with CDP were analysed. Two unique themes relevant to partners were identified: ‘Partners require support to adjust to changing roles and additional burdens’ and ‘Treating the couple as a team facilitates agency and coping, but partners’ needs are placed second by all’. Conclusion Partners of women diagnosed with CDP commonly experience unique stressors and a substantial shift in previously established roles across multiple domains including medical advocacy, household coordination and parenting. Partners’ coping is interlinked with how the woman diagnosed with CDP is coping. Inclusion of partners in treatment decisions and communications, and considering partners’ wellbeing alongside that of the woman with CDP, is likely to be supportive for partners. In turn, this is likely to enhance the quality of support that women diagnosed with CDP receive from their partners.

A 56-year-old woman with a 12-year history of recurrent triple-negative invasive carcinoma of the breast presented with progressive enlargement of lymph nodes in the setting of established rupture of the ipsilateral silicone breast implant. Although this was proven to be benign on cytology, its progressive nature led to repeated core biopsies for histology, which were necessary given the high-risk nature of triple-negative breast cancer and the multiple proven previous recurrences. The histology demonstrated features of silicone deposits without evidence of malignancy. This case demonstrates the dilemma in surveillance of high-risk patients with breast cancer who have had previous silicone lymphadenopathy.

Few studies have investigated whether the associations between pregnancy-related factors and breast cancer (BC) risk differ by underlying BC susceptibility. Evidence regarding variation in BC risk is critical to understanding BC causes and for developing effective risk-based screening guidelines. To examine the association between pregnancy-related factors and BC risk, including modification by a of BC where scores are based on age and BC family history. This cohort study included participants from the prospective Family Study Cohort (ProF-SC), which includes the 6 sites of the Breast Cancer Family Registry (US, Canada, and Australia) and the Kathleen Cuningham Foundation Consortium (Australia). Analyses were performed in a cohort of women enrolled from 1992 to 2011 without any personal history of BC who were followed up through 2017 with a median (range) follow-up of 10 (1-23) years. Data were analyzed from March 1992 to March 2017. Parity, number of full-term pregnancies (FTP), age at first FTP, years since last FTP, and breastfeeding. BC diagnoses were obtained through self-report or report by a first-degree relative and confirmed through pathology and data linkages. Cox proportional hazards regression models estimated hazard ratios (HR) and 95% CIs for each exposure, examining modification by PARS of BC. Differences were assessed by estrogen receptor (ER) subtype. The study included 17 274 women (mean [SD] age, 46.7 [15.1] years; 791 African American or Black participants [4.6%], 1399 Hispanic or Latinx participants [8.2%], and 13 790 White participants [80.7%]) with 943 prospectively ascertained BC cases. Compared with nulliparous women, BC risk was higher after a recent pregnancy for those women with higher PARS (last FTP 0-5 years HR for interaction, 1.53; 95% CI, 1.13-2.07; P for interaction < .001). Associations between other exposures were limited to ER-negative disease. ER-negative BC was positively associated with increasing PARS and increasing years since last FTP (P for interaction < .001) with higher risk for recent pregnancy vs nulliparous women (last FTP 0-5 years HR for interaction, 1.54; 95% CI, 1.03-2.31). ER-negative BC was positively associated with increasing PARS and being aged 20 years or older vs less than 20 years at first FTP (P for interaction = .002) and inversely associated with multiparity vs nulliparity (P for interaction = .01). In this cohort study of women with no prior BC diagnoses, associations between pregnancy-related factors and BC risk were modified by PARS, with greater associations observed for ER-negative BC.