{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T05:48:55Z","timestamp":1790660935721,"version":"4.1.0"},"reference-count":45,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T00:00:00Z","timestamp":1740009600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Victor Babes"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: The primary purpose of this study is to provide a more in-depth insight into various demographic, clinical, and lifestyle factors in relation to breast cancer and to predict the extent to which certain variables described as \u201cpredictors\u201d might lead to further investigation. By analyzing a large cohort, we are able to provide valuable and up-to-date information on breast cancer screening, support breast specialists, and further enhance international screening guidelines. Methods: We screened for breast cancer in a population of women aged 50 to 69 years by using the standardized breast cancer imaging screening method (breast mammography) and ultrasonography as a complementary imagistic tool, and we compared the results with the gold standard, breast biopsy. For this, 58,760 women with no known history of breast cancer coming from 4 major regions of Romania (North-East, North-West, South-East, and West) were first evaluated through mammography. Out of these, 3197 women with positive mammograms subsequently underwent a breast ultrasound examination. The remaining 688 patients with positive breast ultrasound were further referred for a breast biopsy. Results: The statistical analysis revealed several predictors such as the body mass index (BMI), positive family medical history of breast cancer, age at first birth, and age at menopause that influenced the progression from mammography (first stage of the screening program) towards echography (additional imaging modality). Furthermore, we established that age, age at first birth, and BMI are significant predictors of progression from echography towards biopsy (the last stage of the screening program). Furthermore, by analyzing the number of positive biopsies (688) out of the total number of patients in the study (58,760), we calculated a total breast cancer detection rate of 8 per 1000 patients. Lastly, by studying the patient demographics in the context of breast cancer (BC) screening, we observed that participants coming from an urban environment presented a higher rate of positive mammographic results as compared to ones of rural provenience. Conclusions: Our study analyzed a large cohort of patients and offers real world data which shows that multiple factors were positively associated with an increased risk of BC. Older age, older age at first birth, and an older menopausal age are all estrogen-dependent risk factors that were linked with an increased breast cancer risk in our study. Furthermore, our findings concerning the rural\/urban disparities and regional differences highlight the need for region-specific interventions to address lifestyle risk factors, improve healthcare access, and enhance breast cancer screening and follow-up protocols, particularly in underserved areas like the North-East and South-East regions.<\/jats:p>","DOI":"10.3390\/jcm14051415","type":"journal-article","created":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T06:10:21Z","timestamp":1740031821000},"page":"1415","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Comprehensive Analysis of Predictors and Outcomes in Breast Cancer Screening in Romania: Insights from Demographic, Clinical, and Lifestyle Factors"],"prefix":"10.3390","volume":"14","author":[{"given":"Oana Maria","family":"Burciu","sequence":"first","affiliation":[{"name":"Doctoral School, Faculty of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"},{"name":"Department of Functional Sciences, Medical Informatics and Biostatistics Discipline, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioan","family":"Sas","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian-Grigore","family":"Merce","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Institute of Cardiovascular Diseases, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Cerbu","sequence":"additional","affiliation":[{"name":"Discipline of Radiology and Medical Imaging, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurica Elisabeta","family":"Moatar","sequence":"additional","affiliation":[{"name":"ANAPATMOL Research Center, Faculty of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"},{"name":"Clinic of Internal Medicine-Cardiology, Klinikum Freudenstadt, 72250 Freudenstadt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian-Petru","family":"Merce","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Institute of Cardiovascular Diseases, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3240-4793","authenticated-orcid":false,"given":"Ionut Marcel","family":"Cobec","sequence":"additional","affiliation":[{"name":"ANAPATMOL Research Center, Faculty of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"},{"name":"Clinic of Obstetrics and Gynecology, Klinikum Freudenstadt, 72250 Freudenstadt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"\u0141ukasiewicz, S., Czeczelewski, M., Forma, A., Baj, J., Sitarz, R., and Stanis\u0142awek, A. (2021). Breast Cancer\u2014Epidemiology, Risk Factors, Classification, Prognostic Markers, and Current Treatment Strategies\u2014An Updated Review. Cancers, 13.","DOI":"10.3390\/cancers13174287"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.breast.2022.08.010","article-title":"Current and future burden of breast cancer: Global statistics for 2020 and 2040","volume":"66","author":"Arnold","year":"2022","journal-title":"Breast"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Varzaru, V.B., Anastasiu-Popov, D.-M., Eftenoiu, A.-E., Popescu, R., Vlad, D.C., Vlad, C.S., Moatar, A.E., Puscasiu, D., and Cobec, I.M. (2024). Observational Study of Men and Women with Breast Cancer in Terms of Overall Survival. Cancers, 16.","DOI":"10.3390\/cancers16173049"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e20224","DOI":"10.1016\/j.heliyon.2023.e20224","article-title":"Estrogens and the risk of breast cancer: A narrative review of literature","volume":"9","author":"Awadi","year":"2023","journal-title":"Heliyon"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Moisand, A., Mad\u00e9ry, M., Boyer, T., Domblides, C., Blaye, C., and Larmonier, N. (2023). Hormone Receptor Signaling and Breast Cancer Resistance to Anti-Tumor Immunity. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms242015048"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Varzaru, V.B., Vlad, T., Popescu, R., Vlad, C.S., Moatar, A.E., and Cobec, I.M. (2024). Triple-Negative Breast Cancer: Molecular Particularities Still a Challenge. Diagnostics, 14.","DOI":"10.3390\/diagnostics14171875"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"522","DOI":"10.3892\/etm.2021.9954","article-title":"First clinical experience with CDK4\/6 inhibitors in breast cancer therapy","volume":"21","author":"Cobec","year":"2021","journal-title":"Exp. Ther. Med."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Burciu, O.M., Sas, I., Merce, A.-G., Cerbu, S., Moatar, A.E., Eftenoiu, A.-E., and Cobec, I.M. (2024). Comprehensive Analysis of Receptor Status, Histopathological Classifications (B1\u2013B5), and Cumulative Histological Dimensions in Breast Cancer: Predictors of Malignancy and Diagnostic Implications. Cancers, 16.","DOI":"10.3390\/cancers16203471"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2184","DOI":"10.1002\/cncr.31308","article-title":"Breast cancer-specific survival by age: Worse outcomes for the oldest patients","volume":"124","author":"Freedman","year":"2018","journal-title":"Cancer"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"151","DOI":"10.2147\/BCTT.S176070","article-title":"Epidemiological characteristics of and risk factors for breast cancer in the world","volume":"ume 11","author":"Momenimovahed","year":"2019","journal-title":"Breast Cancer Targets Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1186\/s13058-024-01839-0","article-title":"Association of early menarche with breast tumor molecular features and recurrence","volume":"26","author":"Harris","year":"2024","journal-title":"Breast Cancer Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.cpt.2023.03.002","article-title":"Association between high body mass index and prognosis of patients with early-stage breast cancer: A systematic review and meta-analysis","volume":"1","author":"Li","year":"2023","journal-title":"Cancer Pathog. Ther."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Crispo, A., Augustin, L.S.A., Luongo, A., Calderaio, C., Breda, J., Coluccia, S., Calabrese, A., Marrazzo, V., Giannatiempo, R., and Trasacco, P. (2023). Central obesity, body mass index, metabolic syndrome and mortality in Mediterranean breast cancer patients. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-45439-y"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e2139161","DOI":"10.1001\/jamanetworkopen.2021.39161","article-title":"Association of the Interaction Between Mammographic Breast Density, Body Mass Index, and Menopausal Status With Breast Cancer Risk Among Korean Women","volume":"4","author":"Tran","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s13058-018-1087-7","article-title":"Impact of obesity on breast cancer recurrence and minimal residual disease","volume":"21","author":"Ecker","year":"2019","journal-title":"Breast Cancer Res."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Liu, L., Hao, X., Song, Z., Zhi, X., Zhang, S., and Zhang, J. (2021). Correlation between family history and characteristics of breast cancer. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-85899-8"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Aurin, J., Thorlacius, H., and Butt, S.T. (2020). Age at first childbirth and breast cancer survival: A prospective cohort study. BMC Res. Notes, 13.","DOI":"10.1186\/s13104-019-4864-1"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Londero, A.P., Bertozzi, S., Xholli, A., Cedolini, C., and Cagnacci, A. (2024). Breast cancer and the steadily increasing maternal age: Are they colliding?. BMC Women\u2019s Health, 24.","DOI":"10.1186\/s12905-024-03138-4"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"28","DOI":"10.5455\/msm.2022.33.28-32","article-title":"Breastfeeding and Breast Cancer Risk: Our Experience and Mini-review of the Literature","volume":"34","author":"Bothou","year":"2022","journal-title":"Mater. Socio Medica"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e37695","DOI":"10.1097\/MD.0000000000037695","article-title":"Exploring the profound link: Breastfeeding\u2019s impact on alleviating the burden of breast cancer\u2014A review","volume":"103","author":"Obeagu","year":"2024","journal-title":"Medicine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"4616","DOI":"10.1002\/cam4.5288","article-title":"Breastfeeding reduces the risk of breast cancer: A call for action in high-income countries with low rates of breastfeeding","volume":"12","author":"Stordal","year":"2022","journal-title":"Cancer Med."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Collaborative Group on Hormonal Factors in Breast Cancer (2019). Type and timing of menopausal hormone therapy and breast cancer risk: Individual participant meta-analysis of the worldwide epidemiological evidence. Lancet J., 394, 1159\u20131168.","DOI":"10.1016\/S0140-6736(19)31709-X"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"101577","DOI":"10.1016\/j.beem.2021.101577","article-title":"Menopausal hormone therapy and breast cancer risk","volume":"35","author":"Rozenberg","year":"2021","journal-title":"Best Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1038\/s41416-024-02590-1","article-title":"Menopausal hormone therapy and breast cancer risk: A population-based cohort study of 1.3 million women in Norway","volume":"131","author":"Vangen","year":"2024","journal-title":"Br. J. Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3136","DOI":"10.7150\/jca.54624","article-title":"Association Between Smoking And Cancers Among Women: Results From The FRiCaM Multisite Cohort Study","volume":"12","author":"Mezzoiuso","year":"2021","journal-title":"J. Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1158\/1055-9965.EPI-19-0546","article-title":"Alcohol Consumption, Cigarette Smoking, and Risk of Breast Cancer for BRCA1 and BRCA2 Mutation Carriers: Results from The BRCA1 and BRCA2 Cohort Consortium","volume":"29","author":"Li","year":"2020","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e26531","DOI":"10.1097\/MD.0000000000026531","article-title":"Comparison of the sensitivity of mammography, ultrasound, magnetic resonance imaging and combinations of these imaging modalities for the detection of small (\u22642 cm) breast cancer","volume":"100","author":"Chen","year":"2021","journal-title":"Medicine"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Wang, L. (2024). Mammography with deep learning for breast cancer detection. Front. Oncol., 14.","DOI":"10.3389\/fonc.2024.1281922"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Katsika, L., Boureka, E., Kalogiannidis, I., Tsakiridis, I., Tirodimos, I., Lallas, K., Tsimtsiou, Z., and Dagklis, T. (2024). Screening for Breast Cancer: A Comparative Review of Guidelines. Life, 14.","DOI":"10.3390\/life14060777"},{"key":"ref_30","first-page":"1723","article-title":"Effect of age of initiation of mammography breast cancer screening","volume":"18","year":"2024","journal-title":"Ecancermedicalscience"},{"key":"ref_31","first-page":"291","article-title":"Ovarian cancer under the magnifying glass","volume":"124","author":"Gynecology","year":"2021","journal-title":"Rom. J. Mil. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.3892\/etm.2021.10651","article-title":"Ovarian cancer health politics in Romania and Germany: A comparative study","volume":"22","author":"Cobec","year":"2021","journal-title":"Exp. Ther. Med."},{"key":"ref_33","first-page":"353","article-title":"Are There Regional Differences in Triple Negative Breast Cancer among Non-Hispanic Black Women?","volume":"113","author":"Bartley","year":"2021","journal-title":"J. Natl. Med. Assoc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"106741","DOI":"10.1016\/j.ypmed.2021.106741","article-title":"Identifying key barriers to effective breast cancer control in rural settings","volume":"152","author":"Sprague","year":"2021","journal-title":"Prev. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1007\/s10552-019-01217-8","article-title":"US urban\u2013rural disparities in breast cancer-screening practices at the national, regional, and state level, 2012\u20132016","volume":"30","author":"Tran","year":"2019","journal-title":"Cancer Causes Control"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1111\/jrh.12308","article-title":"Rural-Urban Disparities in Access to Breast Cancer Screening: A Spatial Clustering Analysis","volume":"35","author":"Chandak","year":"2018","journal-title":"J. Rural. Health"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1159\/000446359","article-title":"Implementation of the German Mammography Screening Program (German MSP) and first results for initial examinations, 2005\u20132009","volume":"11","author":"Malek","year":"2016","journal-title":"Breast Care"},{"key":"ref_38","first-page":"45","article-title":"Breast Cancer Screening in Romania: Challenges and Opportunities for Early Detection","volume":"20","author":"Mihai","year":"2024","journal-title":"Acta Endocrinol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1186\/s13058-017-0908-4","article-title":"Smoking and risk of breast cancer in the Generations Study cohort","volume":"19","author":"Jones","year":"2017","journal-title":"Breast Cancer Res."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Dehesh, T., Fadaghi, S., Seyedi, M., Abolhadi, E., Ilaghi, M., Shams, P., Ajam, F., Mosleh-Shirazi, M.A., and Dehesh, P. (2023). The relation between obesity and breast cancer risk in women by considering menstruation status and geographical variations: A systematic review and meta-analysis. BMC Women\u2019s Health, 23.","DOI":"10.1186\/s12905-023-02543-5"},{"key":"ref_41","unstructured":"Giannuzzi, P., Temporelli, P.L., Marchioli, R., Maggioni, A.P., Balestroni, G., Ceci, V., Chieffo, C., Gattone, M., Griffo, R., and Schweiger, C. (2008). Global Secondary Prevention Strategies to Limit Event Recurrence After Myocardial Infarction Results of the GOSPEL Study, a Multicenter, Randomized Controlled Trial From the Italian Cardiac Rehabilitation Network, American Medical Association. Available online: https:\/\/archinte.jamanetwork.com\/."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.ejca.2016.02.028","article-title":"Body weight and sensitivity of screening mammography","volume":"60","author":"Njor","year":"2016","journal-title":"Eur. J. Cancer"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e2318053","DOI":"10.1001\/jamanetworkopen.2023.18053","article-title":"Analysis of Breast Cancer Family History, Estrogen Receptor Status, and Breast Cancer Outcomes in Sweden","volume":"6","author":"Zhang","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"6","DOI":"10.54178\/2993-3579.v1i1a1994","article-title":"Challenges in Imaging the Obese Patients","volume":"1","author":"Biswas","year":"2023","journal-title":"Ser. Clin. Med. Case Rep. Rev."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Heinze, F., Czwikla, J., Heinig, M., Langner, I., and Haug, U. (2023). German mammography screening program: Program sensitivity between 2010 and 2016 estimated based on German health claims data. BMC Cancer, 23.","DOI":"10.1186\/s12885-023-11378-0"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/5\/1415\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:38:44Z","timestamp":1760027924000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/5\/1415"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,20]]},"references-count":45,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["jcm14051415"],"URL":"https:\/\/doi.org\/10.3390\/jcm14051415","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,20]]}}}