Chiara Lorini

Mammographic screening can reduce breast cancer (BC) mortality in women. In Italy, although attendance rates increased recently, they are still far from the recommended levels internationally. Inadequate health literacy (HL) may be a reason for poor awareness and/or knowledge about the importance of completing cancer screening. This study examined the relationship between HL, other sociodemographic determinants, and their influence on participation in both opportunistic and organized BC screenings among women aged 50–69 in Tuscany. The study analyzed 2017–2019 data from the Tuscan population subsample in the Italian Behavioral Risk Factor Surveillance System PASSI (Progressi delle Aziende Sanitarie per la Salute in Italia). HL was assessed using the Italian version of the six-item European Health Literacy Survey Questionnaire (HLS-EU-Q6). Among the 2250 interviewees, 75.3% underwent the organized BC screening and 9.4% on voluntary basis. Although to a different extent, HL was significantly associated to compliance rates with both opportunistic and organized screenings. Among sociodemographic factors, only occupational status was associated with opportunistic screening attendance rates. As expected, being invited by letter resulted to be strongly associated with participation to organized screening programs and the medical advice predicts for participating to both opportunistic and organized screening. This study highlights the relevant role that HL plays in BC, opportunistic and organized, screening adherence in a universal healthcare system. To increase BC screening participation rates, healthcare systems would benefit by implementing interventions for improved HL at population level or within healthcare organizations.

The purpose of this study was to differentiate post-chemoradiotherapy (CRT) changes from tumor persistence/recurrence in early follow-up of naso-oropharyngeal carcinoma on magnetic resonance (MRI) with diffusion (DWI) and dynamic contrast-enhanced perfusion-weighted imaging (DCE-PWI). A total of 37 patients were assessed with MRI both for tumor staging and 4-month follow-up from ending CRT. Mean apparent diffusion coefficient (ADC) values, area under the curve (AUC), and K(trans) values were calculated from DWI and DCE-PWI images, respectively. DWI and DCE-PWI values of primary tumor (ADC, AUC, K(trans)pre), post-CRT changes (ADC, AUC, K(trans)post), and trapezius muscle as a normative reference before and after CRT (ADC, AUC, K(trans)muscle pre and muscle post; AUCpost/muscle post:AUCpre/muscle pre (AUCpost/pre/muscle); K(trans)post/muscle post:K(trans)pre/muscle pre (K(trans)post/pre/muscle) were assessed. In detecting post-CRT changes, ADCpost > 1.33 × 10−3 mm2/s and an increase >0.72 × 10−3 mm2/s and/or >65.5% between ADCpost and ADCpre values (ADCpost-pre; ADCpost-pre%) had 100% specificity, whereas hypointense signal intensity on DWIb800 images showed specificity 80%. Although mean AUCpost/pre/muscle and K(trans)post/pre/muscle were similar both in post-CRT changes (1.10 ± 0.58; 1.08 ± 0.91) and tumor persistence/recurrence (1.09 ± 0.11; 1.03 ± 0.12), K(trans)post/pre/muscle values < 0.85 and >1.20 suggested post-CRT fibrosis and inflammatory edema, respectively. In early follow-up of naso-oropharyngeal carcinoma, our sample showed that ADCpost > 1.33 × 10−3 mm2/s, ADCpost-pre% > 65.5%, and ADCpost-pre > 0.72 × 10−3 mm2/s identified post-CRT changes with 100% specificity. K(trans)post/pre/muscle values less than 0.85 suggested post-CRT fibrosis, whereas K(trans)post/pre/muscle values more than 1.20 indicated inflammatory edema.