Each state has its own personality and its own set of identifiers that make it unique from other states, and food is one of the biggest differentiators out there. While it might not necessarily be official, we've rounded up a list of iconic dishes from every state in the great U.S. of A. Read on to find out if we got your state's dish right and enjoy taking a look at the classics from other states!
While raw cheese curds can be enjoyed alone (with their recognizable squeakiness), it's deep-fried that's really the way to go. In fact, so many people eat them deep-fried, they end up referring to the fried versions as plain, ol' "cheese curds," then end up calling the non-fried ones "raw cheese curds." Can someone send some cheese curds our way??
Alaska is known for its amazing, cold-water seafood, and most especially for its king crab. Crab fishing season is very short (two to four weeks, typically) and incredibly dangerous – it's said that one fisherman dies a week during the fishing season.
While the origination of it isn't clear, one thing's for sure: breaded and fried pork tenderloin sandwiches are a Hoosier classic. Some things to get straight when making (or ordering) one: it should always be deep fried; it should always be pork tenderloin; the meat should always be substantially larger than the roll it's served on. Now go and get yourselves one!
Don't worry, no possums were harmed in the making of this dish! While also known as "Striped Delight" or "Chocolate Layer Pie," this is a 4-layer pie with a butter pecan shortbread crust topped with a cream cheese filling and from-scratch chocolate pudding, all topped off with whipped cream. We think it's called possum pie because all those delicious layers are "playing possum" and hiding underneath the whipped cream. Either way, we love it!
Originating in New Haven, CT at Frank Pepe Pizzeria Napoletana, the "white clam pie" was created when Pepe decided to not only sell clams on the half shell at the bar, but to also put them on their signature "apizzas"…now it's a Connecticut staple!
Although scrapple was technically invented in Pennsylvania, it's in Delaware that it really shines. Scrapple festivals and scrapple-flavored beer are just two of the ways that Delawareans show their appreciation for it. Regardless of the fact that it's made up of castoff pig parts, the flavor is unbeatable!
While the key lime pie was a very close runner up, the Cubano is more inherently Floridian. Packed full of ham, pork, swiss cheese, pickles and mustard, sandwiched between two pieces of soft, Cuban bread, this sandwich does not disappoint.
Just as Maine is known for its lobster rolls Maryland is known for its crab cakes. Purists say that crab cakes should consist of only blue crab all-lump meat, with very little filler so as to let the crab meat shine on its own. Whether it's served Boardwalk-style (breaded and deep-fried) or restaurant-style (all-lump, no filler), you can't go wrong with one of these bad boys.
Spam is to Hawaii what hot dogs are to the greater 48. It's everywhere from convenient stores to high-end restaurants – people love it! Spam musubi is a fried slice of spam on top of a mound of rice, all wrapped up in a piece of japanese nori (seaweed). This salty snack is so yummy, so it's great that you can find it just about anywhere in HA.
A distinctly Idahoan dish, finger steaks are wide strips of sirloin that have been battered and fried that are usually served with fries and buttered toast. While Idaho's also known for its potatoes, this dish surpasses its competition and is definitely the state icon.
If you haven't heard of it before, a boiled dinner is simply that, dinner where you boil each ingredient until they're all cooked to perfection. Corned beef, cabbage, carrots and potatoes…you name it and you can make it part of the boiled dinner…and for leftovers you can have red flannel hash!
Unlike a regular hamburger, loose meat sandwiches are where the beef is cooked (sometimes unseasoned) without being formed into a patty, then served in a bun with other typical burger fixings. Also known as a "tavern" these sammies are more than well known in Iowa and other parts of the Midwest.
There's no questioning it; Kansas is known for its ribs. While people might talk about the loose-meat sandwiches or the grebble or bierocks, it's the barbecued ribs that has people so hooked and keeps 'em coming back for more!
Literally the state dish of Louisiana, gumbo is a true meeting of the worlds. Influenced not only by French, Spanish, Choctaw and West African cooking practices, gumbo is a stew generally comprised of a flavorful broth, shellfish and/or sausage, celery, bell pepper and onion, and some sort of thickener. Served over rice, this is a dish so packed full of flavor it had to be the state dish!
Since Maine is known for having some of the best lobster around, it should come as no surprise that the lobster roll is one of the most "Maine" dishes there is. Technically speaking, a "lobster roll" is when the lobster is still warm in the sandwich, where as a "lobster salad roll" is when it's cold. We'll take one of each!
Not just the title of the iconic film, fried green tomatoes really are an Alabamian specialty! Pick 'em in October, before the first frost, while they're still green and you'll have the best tomatoes of your life!
Basically a New Jersian version of poutine, disco fries are a NJ classic, found at all diners and dive bars. The fries are topped with a brown gravy and plenty of mozzarella cheese, making this dish an indulgent choice that always delivers.
A northeastern (and now national) standard, clam chowder is a hearty, creamy soup that's filled with plenty of clams and veggies, with nary a tomato in sight. Whatever you do, don't get your New England chowder and your Manhattan chowder confused – the red stuff has no place here!
If there's one thing that North Carolina's known for, it's its pulled pork. It doesn't get more tender or flavorful than this stuff, and the secret is all in cooking it low and slow…sometimes for over 12 hours! If you haven't had the pleasure of trying it yet, next time you're there you should definitely grab a big serving of Carolina pulled pork!
Denver omelettes at this point are so classic, you can find them on just about any menu across the country! Ham, bell pepper, onion and cheese, it doesn't get much better than this breakfast staple!
If you haven't spent much (read: any) time in the Midwest, you might not know what a hot dish is. The heartiest of casserole, with some sort of beef, sometimes a veggie, cream soup and a starch – with tater tots being the preferred choice. If you haven't tried it yet, you need to ASAP!
Named supposedly for its resemblance to the muddy banks of the Mississippi River, a Mississippi mud pie means business; stuffed so full of chocolate it's definitely not for the faint of heart…but don't let that stop you from trying it!
Created in Hollywood, CA in 1937, this salad truly is iconic. Made traditionally with iceberg, watercress, endives and romaine lettuce, it's what it's topped with that gets people excited: bacon, hard-boiled egg, roasted chicken, bleu cheese, tomatoes and avocado. This salad has everything but the kitchen sink in it!
While barbecue is popular all over the south, Missouri has made its mark on BBQ with a noted smokiness to the meat, a slightly spicy rub and a thick and hearty, tomato-based sauce to round everything off. Grab your napkins and dig in!
Whether it was Monica Flin who dropped a burrito in the deep frier and shouted "chimichanga!" in 1922 or someone else later on, there's no mistaking this dish came from Arizona – it's a classic!
While bison burgers are starting to become more popular, they were never out of favor in Montana! Bison meat also has less cholesterol and fat as beef, so it's a healthier, delicious choice that anyone who likes a good burger should try.
Inspired by the classic Welsh rabbit, the Kentucky Hot Brown is an open-faced turkey and bacon sandwich that's topped with a hot, cheesy sauce. The whole things goes under the broiler until it's crisped up and, let us tell you, it's delicious!
Traditionally using cubed pieces of mutton or lamb that are then deep-fried, chislic is a South Dakotan mainstay. Any bar you go to will have it, and it makes for a wonderful accompaniment to a nice, cold beer. We'll cheers to that.
When you think of food in Nevada, does anything else come to mind but a buffet?? Famous for its many All You Can Eat (AYCE) buffets, Nevada really pulls out all the stops. For when you're not looking for any specific food in general, but do want to eat (as much as you possibly can), a Las Vegas buffet is the best place to go!
Seeing as the chile is New Mexico's "largest agricultural crop", it makes sense that it's a huge part of regional cuisine. The altitude and arid nature of the climate affects New Mexican green chiles' texture and flavor, plus, leads to hotter varieties that people can't get enough of. Are you a green chile person or a red chile person?
Marionberries are actually a specific breed of blackberries that grow primarily in Oregon, making marionberry pie a natural fit as the iconic state dish. These berries are more juicy and flavorful than regular blackberries, and thus, marionberry pie reigns supreme.
Sort of like a Norwegian flatbread or savory pancake, lefse is a traditional classic in North Dakota, typically made with potatoes (which differentiates it from its Norwegian ancestor) and rolled up and eaten with butter or jam. Some people save making it for the holidays, for others it's part of their daily routine.
Washington takes great pride in its salmon populations and making sure they stay healthy and thriving is a top priority…leading to excellent salmon in all its many forms! If you want the freshest of the fresh, Washington is the place to go!
While it might be confusing at first, chicken fried steak is actually just steak – there's no chicken involved at all. The name refers to the method of cooking fried chicken, and the Oklahomans just applied that same method to steak – a genius idea if you ask us!
It doesn't take a genius to guess why the Philly cheesesteak is the obvious choice here, as it has a cult following that borders on regional (and national!) obsession. Thin strips of beef and onion, all topped with provolone cheese or cheese whiz, then stuffed into a soft Italian roll. Whichever way you like it, you can't go wrong with a cheesesteak!
While Maryland has crab cakes, Rhode Island has clam cakes. Instead of being pan-fried, these bad boys are battered and deep-fried, like a savory doughnut hole with perfectly fresh bites of clam in every bite. We don't know about you, but we could devour a whole lot of these!
Made as early as the 1840s, Hoppin' John is a typical South Carolinian dish consisting of rice, black-eyed peas, bacon (or ham hock) and collard greens. This is a dish traditionally eaten around New Year's since it represents wealth and prosperity; the black-eyed peas signify pennies or coins and the greens allude to the color of U.S. currency. Now there's a tradition we can get behind!
Different from just fried chicken, hot chicken is marinated chicken breast or thigh that's fried and topped with a spicy paste, then served on white bread. While some of the spicy paste ingredients might vary, you can count on there being lard and cayenne pepper as the staples of it that pull everything together. Excuse us while we go get ourselves some hot chicken….
Although they're initially a Cornish specialty, pasties made their way to the Upper Peninsula of Michigan and became such a hit that there's even an annual festival now to celebrate them (and to eat as many of them as possible).
While you might read the name and think of something akin to a chili and cornbread dish, you'd be wrong here. Cincinnati chili is a mediterranean-inspired chili that's served atop a heaping pile of spaghetti (- this chili served on hot dogs is known as a "coney") that was invented by Macedonian immigrants in Ohio in the 1920s. This dish is definitely not to be missed!
This one is a no-brainer. No one goes to Illinois without doing (at the very least) a basic roundup of the best deep dish in the area. In a nutshell: deep-dish pizza has a very deep, almost bowl-like crust, then the crust is topped with cheese and meats, then the whole things is topped with tomato sauce. Doing the toppings upside-down like this ensures that the cheese won't burn during the long bake time. We want a slice right now!
If you've ever spent any time in Utah, it's very likely you've heard of funeral potatoes. Originating as a popular dish that people would bring to funeral luncheons, these creamy and crunchy potatoes gained popularity and now no get-together is complete without them!
As the biggest producer of it in the United States, Vermont lays claim to the maple syrup industry, making it a clear choice as the iconic food of the state. The way we see it, pancakes, waffles or French toast are just vehicles for as much maple syrup as possible.
Known for its country ham, or "Smithfield ham" as it's more specifically known, Virginia is very particular about its curing process, ensuring that all ham products in the area are the very best of the best, including their ham biscuits. Fluffy biscuits stuffed full of sweet ham…does it get any better??
There's not really a more iconic dish in West Virginia than the classic pepperoni roll. The pepperoni is baked right into the soft white bread and the oil then permeates throughout the roll, giving it its flavor and texture…we could definitely go for one of those right about now!
Originally from Germany, runza made their way to the midwest and set up shop. Beef, cabbage and veggie-stuffed bread pockets, there's no wrong time for a runza! Other iterations of the runza are baked in varying shapes, but in Nebraska they're rectangular.
Although the first bagel was originally created in the Jewish communities of 17th century Poland, it was brought to New York by immigrant Polish Jews and the rest was history. New York is known for its superior bagels, which are slightly puffy and with a moist crust – next time you're in the area, make sure to pick one up!
Given that the peach is Georgia's state fruit, it makes total sense that it would play a large part in state cuisine. And what better way to showcase their fruit than in a classic, time-tested pie…this just goes to show that sometimes keeping it simple can really pay off!
The name "Rocky Mountain Oysters" is euphemistic for something slightly more unsavory…bull testicles. That's right, in an area where male cattle is frequently castrated it's typical to bread and fry the testicles…and they do make pretty good bar food, so if you're feeling adventurous, you should try them!
While Texas is known in general for its barbecue, brisket in particular has the deepest roots in the Lone Star State. Since it's one of the tougher cuts of meat, it needs to be cooked for hours and hours until it's broken down and tender…and then you're going to want a lot of it.
And there you have it – the most iconic dish from every state! Do you agree with the dish from your state? Are there any from other states that you definitely want to try now?
The most iconic DESSERTS from every state: Click "Next Page" below!


text:
#include "PixelArray.h"

template <class T > void invertImageY( T * pixels, int width, int height ) {
    int size = width * height;
    int targetIndex = 0;

    for ( int i = 0; i < size / 2; ++i ) {
        int px = i % width;
        int py = i / width;
        T temp = pixels[ i ];

        targetIndex = size - ( py + 1 ) * width + px;

        pixels[ i ] = pixels[ targetIndex ];
        pixels[ targetIndex ] = temp;
    }
}

// Helper functions
//GLuint * enlargeImage( GLuint *oldPixels, int width, int height, int newWidth, int newHeight );

redpajama_set_name: RedPajamaGithub


text:
Q: Pythonic way to determine if two given numbers are adjacent in integer sequence Given integers a, b such that a < b; and some ordered iterable sequence of integers, seq.  Determine whether a and b appear adjacent, in that order, anywhere in seq
The obvious first pass is :
assume
a < b (if a > b, just switch values).
>>> idx = 0
>>> for i in range(0, len(l)):
...     if a == l[i]:
...             idx = i
...
>>> b == l[idx+1]

This feels clumsy.
For example, given
>>> [1, 2, 3, 8]

If a is 1 and b is 3, they are not adjacent, if a is 3 in b is 8, they are.
Something tells me there is a more pythonic way of doing this or that this is a well explored problem, and I am missing a clearer/cleaner way to approach it.

A: Use the any reducer to determine whether any adjacent pair matches (a,b):
>>> seq = [1, 2, 3, 8]
>>> a = 3
>>> b = 8
>>> any((seq[i], seq[i+1]) == (a,b) for i in range(len(seq)-1))
True
>>> b = 1
>>> any((seq[i], seq[i+1]) == (a,b) for i in range(len(seq)-1))
False
>>>

A: Very short answer using zip:
(a, b) in zip(seq[:-1], seq[1:])

This works when you are allowed to flip
(a, b) in zip(seq[:-1], seq[1:]) or (b, a) in zip(seq[:-1], seq[1:])

To make it logically correct you can test for a in seq first. If it passes then the previous test(s) should hold.
Some info on what the zip is doing
>>> print seq
[1, 2, 3, 8]
>>> zip(seq[:-1], seq[1:])
[(1, 2), (2, 3), (3, 8)]

Using izip and islice from the itertools package
from itertools import izip, islice
N = len(seq)
(a, b) in izip(islice(seq, 0, N - 1), islice(seq, 1, N))

A: You could iterate through pairs of the elements in the sequence and check if a pair consists of a and b. Using the pairwise recipe from itertools:
>>> from itertools import tee
>>> def pairwise(iterable):
...     x, y = tee(iterable)
...     next(y, None)
...     return zip(x, y)
...
>>> a, b, seq = 3, 8, [1, 2, 3, 8]
>>> (a, b) in pairwise(seq)
True

This will work fast for arbitrary large sequences (unlike list slicing solutions).

A: Using binary search will be fastest.
The following implementation should be rather fast, will work even if b > a, on unsorted lists and if a and/or b are not present in the list (will return False in this case):
from bisect import bisect_left

def is_adjacent(a, b, l):
    ind = bisect_left(l,a)
    if ind >= len(l):
        return False
    if l[ind] == a and l[ind+1] == b:
        return True
    else:
        return is_adjacent(a,b,l[ind+1:])

# e.g.
is_adjacent(1, 3, [1, 2, 3, 8])  # gives False
is_adjacent(3, 8, [1, 2, 3, 8])  # gives True

A: Everyone else is implementing something entirely different from what the problem definition says to implement. Specifically, we're supposed to do the following:

Determine if a == l[i] implies b == l[i+1] where i < len(l)

That doesn't require a or b to even be in the list, and (if "ordered" isn't intended to mean "sorted") a and b could show up multiple times in the list.
To determine what the problem definition actually says to determine, we can go through all pairs of adjacent elements and test whether the implication holds:
if l and l[-1] == a:
    # Problem definition doesn't say what to do.
    shrug()
return all(x != a or y == b for (x, y) in zip(l[:-1], l[1:]))

If we are supposed to assume the input is sorted, we can do better with a binary search:
import bisect

if l and l[-1] == a:
    # We still don't know what to do for this case.
    shrug()

possible_leftmost_a_index = bisect.bisect_left(l, a)
if possible_leftmost_a_index == len(a):
    # All elements of l are lower than a.
    return True
elif l[possible_leftmost_a_index] != a:
    # a isn't in the list.
    return True
elif l[possible_leftmost_a_index+1] == b:
    # The implication holds. (We don't have to look for more occurrences of a,
    # because bisect guarantees no a occurrences to the left, and everything to
    # the right is greater than a.)
    return True
else:
    return False

A: The problem can be broken down into two subproblems:

*

*Converting a sequence into a sequence of pairs, e.g. [a, b, c] should be converted to [(a, b), (b, c)].

*Determining whether a given pair (x, y) is in the sequence generated in step 1.

You can convert an iterable to a sequence of pairs with:
def pairs(collection):
    collection = iter(collection)
    a = next(collection)
    for b in collection:
        yield a, b
        a = b

collection can be a list or even an infinite generator.
To determine whether (x, y) is in the output of pairs you just need to do:
(x, y) in pairs(seq)

redpajama_set_name: RedPajamaStackExchange


Bitcoin price continues to decline and touched has the $4,090 mark in Asia as Chinese mining pools are taking their ASICs down to stop further losses. Where is the BTCUSD pair now headed? The following technical analysis reveals.
November 23, OctaFX – The value of Bitcoin continued to plummet lower this week, with the world's number one cryptocurrency falling within a touching distance of the $4,000 support level.
Bitcoin shed over thirty per cent of its market value as a number of important technical levels were breached below the psychological $5,000 level. The decline in the value of the BTCUSD pair and the broader cryptocurrency market has been blamed on Bitcoin Cash, as the world's fourth-largest cryptocurrency recently split into two distinct entities.
Chinese miners drop out of business as it is no longer profitable to mine cryptocurrency. According to the co-founder of F2Pool, one of the Chinese mining pools, the recent price collapse forced companies to switch thousands of miners off to stop losses.
"Tens of thousands of #bitcoin miners were shut down due to the recent market crash, according to the co-founder of F2Pool, one of the largest/oldest mining pools in China," he replied in the tweet to cnLedger.
The BTCUSD pair is strongly bearish while trading below the $5,000 level, key support is found at the $4,000 and $3,300 levels.
If the BTCUSD pair trades above the $5,000 level, key resistance is found at the $5,300 and $5,705 levels.


text:
Rebecca LeMire
Fort Atkinson WI 53538
The City of Fort Atkinson has a Council-Manager form of government.
City Manager's Role: The city manager is hired to serve the council and the community and brings to the city the benefits of his training and experience in administering municipal projects and programs. The manager prepares a budget for the council's consideration; recruits hires, terminates, and supervises government staff; serves as the council's chief advisor; and carries out the council's policies. The manager makes policy recommendations to the council for consideration and final decision. The city manager also serves as chair of the city planning commission.
City Council's Role: The city council is the community's legislative and policymaking body. Power is centralized in the elected council, which, for example, approves the budget and determines the tax rate. The council also focuses on the community's goals, major projects, and such long-term considerations as community growth, land use development, and capital improvement and financing. The council hires the city manager to implement the administrative responsibilities related to these goals.
2022 City Manager's Message (from annual flyer)
Dear City of Fort Atkinson residents and taxpayers,
Your City government is responsible for mailing the enclosed tax bill as well as for collecting taxes by the deadline of Jan. 31. However, as you review the tax bill, I encourage you to consider the four entities that receive funding through your property taxes: the City, the Fort Atkinson School District, Madison Area Technical College, and Jefferson County. All of these entities use funding through taxes to pay for services that benefit the entire community. To learn more about the services provided by each entity, I encourage you to review the 2023 budget documents available through each entity's website or upon request.
The City's 2023 Operating Budget document is available for review on the City's website (www.fortatkinsonwi.gov) under "Forms and Documents." The Budget document provides a description of all of the services provided on an annual basis in exchange for your taxes. It also outlines goals and priorities for the upcoming year as well as information about the City's portion of the tax bill.
As I am sure you noticed, the City's portion of the tax bill saw a substantial increase this year, which has not been the case in the past. Note that most of the increase is due to the approval of the April 2022 Public Safety Referendum. With this voter-approved revenue increase, the City has been able to hire 12 new Paramedic/Firefighters or Advanced Emergency Medical Technician/Firefighters to provide 24/7, 911 EMS and Fire protection; and hire two new Police Patrol Officers to provide full-time high-quality public safety services to our residents, visitors, and guests. This is a long-term and reliable solution to the substantial increase in call volume and need for these services. We are hopeful that our State Legislators will understand the need for these public safety services and provide additional funding to support them outside of our general tax dollars in the future. City Elected Officials and staff will continue efforts at advocacy for additional and diverse municipal funding in 2023.
I am honored to continue to serve the City of Fort Atkinson as the City Manager. I take immense pride in representing this City and its residents. Locally, we have a lot to accomplish in 2023, and we look forward to continuing to provide the highest-quality municipal services at the lowest possible cost.
Please continue to engage in our community – through attendance at some of our wonderful holiday events; through volunteerism with service organizations or City boards, commissions, and committees; or simply by following our local businesses and institutions on social media. As we all stay informed and engaged in our community, we will continue to create a positive environment that encourages community growth and economic development.
Best wishes for a happy and healthy holiday season!
Rebecca Houseman LeMire, City Manager
Your Link Name

redpajama_set_name: RedPajamaCommonCrawl


text:
Q: Spring Boot Queue Poll I am using Spring Boot (server) to post an API request (Android, retrofit). Spring Boot supports multiple threads to post the API.
When I receive multiple API requests to the server at exactly the same time, I need them to run asynchronously, but Spring launches a new thread for each.
I have tried to use Queues and then to poll the object one by one, however the Queue is either polled at the same time, or if I make the thread sleep, all of the threads sleep for exactly that amount of time, then every object is retrieved concurrently.
Can anyone advise how to poll slowly one by one. Please note, that the concurrency is needed for all other post request, but only this particular post request requires this delay.

A: You can use thread synchronisation to protect your Queue from concurrent access. I've added a sample code below.
private static final Queue<T> queue = initQueue();

public void accessQueueA() {
    synchronized(queue) {
       // access queue;
    }
}


This stunning two bedroom apartment in the "Imperial residential complex" is designed to impress with spectacular views of the city and ultra-sleek contemporary living. Two generous sized bedrooms, master with walk in robe and ensuite bathroom. Light and bright, open plan living spaces, dining and kitchen opening out to the balcony area.
All within walking distance to Westfield Shopping town Doncaster and local public transport. The Eastern Freeway, Aquarena Aquatic and Leisure Centre, Macedon shopping, Doncaster Primary, St Gregory The Great Primary and local parklands only minutes away.


text:
https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTk0NTQ5OC1vdmVydmlldw==
Author: Erin V Newton, MD; Chief Editor: Marie Catherine Lee, MD, FACS more...
Sections Breast Cancer Screening
Self-examination and Clinical Examination
Early detection remains the primary way to prevent the development of life-threatening breast cancer. Breast cancers that are detected when smaller or nonpalpable are more treatable and thus are associated with a more favorable prognosis.
Imaging studies used in breast cancer screening include the following:
The survival benefit of early detection with mammography screening has been demonstrated. However, advances in imaging technology and disagreements over recommended schedules have complicated the issue of screening. As with any cancer screening program, careful consideration must be given to the risks of developing breast cancer as well as the benefits and harms of the screening intervention, along with the cost involved. Breast cancer screening guidelines provide different recommendations for women at average risk versus those with elevated risk; for full discussion of risk calculation, see Breast Cancer Risk Factors.
Early detection is widely endorsed by organizations that issue clinical recommendations for breast cancer care. Many expert groups have offered their recommendations for breast cancer screening, and much of the controversy lies in the fact that there is not a consensus about when to begin and end screening, how often to screen, and by what technique. These groups include the following;
American Cancer Society (ACS)
American College of Obstetricians and Gynecologists (ACOG)
American College of Physicians (ACP)
American College of Radiology (ACR)
National Comprehensive Cancer Network (NCCN)
United States Preventive Services Task Force (USPSTF)
For further information, see Breast Cancer. Also see Breast Lumps in Young Women: Diagnostic Approaches, a Critical Images slideshow, to help manage palpable breast lumps in young women.
For women younger than 40 years at average risk for breast cancer, there have no been randomized studies done to suggest a benefit to screening. The various experts groups have not reached a consensus among them, but several recommend a clinical breast exam (CBE) every 3 years and a discussion about breast awareness (ie, encouraging women to be familiar with their breasts and to promptly report any changes to their health care provider).
For women age 40 years and older who are at average risk for breast cancer, many expert groups recommend CBE annually. With respect to imaging, in the past the most widely recommended screening approach in the United States for this group has been annual mammography, starting at age 40 years. [1] Increasingly, however, guidelines are advising clinicians to discuss the benefits and risks of mammography with patients and offer the option of starting screening at age 40, but do not strongly recommend starting screening until age 45 or 50. Current guidelines also offer conflicting recommendations on whether to perform mammography annually or biennially.
Recommendations regarding discontinuation of mammography vary as well, with both age—typically, 75 years [2] —and life expectancy as criteria. For example, the American College of Radiology recommends annual screening mammography until the life expectancy is less than 5 to 7 years, based on comorbidities. [3]
Although mammography guidelines have been in place for over 30 years, 20-30% of women still do not undergo screening as indicated. The 2 most significant factors in determining whether a woman undergoes mammography are physician recommendation and access to health insurance. Non-white women and those of lower socioeconomic status remain less likely to obtain mammography services, and these women are more likely to present with life-threatening, advanced-stage disease.
See the table below.
Table. Guideline Recommendations for Breast Cancer Screening in Women at Average Risk (Open Table in a new window)
Organization (year)
Clinical Breast Examination
Age to Start Screening Mammography or Begin Discussions of Screening
Age to Stop Screening Mammography
American Cancer Society (2015) [4]
Discuss: 40-44 y
Recommended: 45 y
Age 45-54 y: Annual
≥55: Biennial; annual is optional
Not specified; continue as long as a woman is in good health and has life expectancy of at least 10 y
American College of Obstetricians and Gynecologists (2017) [5]
No recommendation
Discuss: 40 y
Annual or biennial
≥75 y
American College of Physicians (2019) [6]
American College of Radiology (2017) [7]
National Comprehensive Cancer Network (2021) [8]
U.S. Preventive Services Task Force (2016) [9]
Individual choice, 40-49 y
World Health Organization (2014) [10]
Recommended only in low-resource settings
USPSTF guidelines
The current guidelines on breast cancer screening from the US Preventive Services Task Force (USPSTF), issued in 2016, include the following recommendations [9, 2] :
The USPSTF recommends biennial screening mammography for women aged 50 to 74 years
No requirement for routine screening mammography in women aged 40-49 years (grade C recommendation); the decision to start regular, biennial screening mammography before age 50 years should be an individual one and should take into account patient context, including the patient's values regarding specific benefits and harms
Insufficient current evidence to assess the additional benefits and harms of screening mammography in women aged 75 years or older
Insufficient current evidence to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as a screening modality for breast cancer
No requirement for clinicians to teach women how to perform BSE (grade D recommendation); this recommendation is based on studies that found that teaching BSE did not reduce breast cancer mortality but instead resulted in additional imaging procedures and biopsies
Insufficient current evidence to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women aged 40 years or older
American Cancer Society guidelines
The 2015 update of the American Cancer Society guidelines includes the following recommendations [4] :
Women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years (strong recommendation).
Women aged 45 to 54 years should be screened annually (qualified recommendation).
Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation).
Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (qualified recommendation).
Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation).
The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation).
American College of Obstetricians and Gynecologists guidelines
The 2017 update of the American College of Obstetricians and Gynecologists guidelines on screening in average-risk women includes the following recommendations for practitioners [5] :
Use shared decision-making to select screening choices
Clinical breast examination may be offered every 1-3 years for women aged 29-39 years and annually for women aged ≥ 40 years
Start offering mammography at age 40 years; initiate after counseling, if patient desires
Recommend starting mammography screening by no later than age 50 years
Mammography may be annual or biennial; biennial screening is particularly reasonable after age 55 years
Continue mammography until age 75 years, then discuss discontinuation, with the woman's health status and longevity as considerations
American College of Physicians guidelines
A 2019 guidance statement from the American College of Physicians (ACP), based on a review of existing guidelines, addresses mammography in women at average risk, which is defined as the absence of the following:
History of breast cancer or previous diagnosis of a high-risk lesion
Genetic mutations such as BRCA1/2 or another familial breast cancer syndrome
History of radiation therapy to the chest in childhood
The ACP provides the following recommendations to clinicians for breast cancer screening in average-risk women, according to age [6] :
Ages 40 to 49 years: Discuss whether to screen for breast cancer with mammography before age 50 years. The discussion should include the potential benefits and harms and the woman's preferences. For most women in this age group, the potential harms outweigh the benefits.
Ages 50 to 74 years: Offer screening for breast cancer with biennial mammography.
Ages 75 years or older or in women with a life expectancy of 10 years or less: Discontinue screening for breast cancer.
All ages: Do not use clinical breast examination to screen for breast cancer.
National Comprehensive Cancer Network guidelines
The NCCN on screening in average-risk women includes the following recommendations [8] :
Clinical breast examinations every 1-3 years from age 25-39, then annually from age 40 on
Begin annual screening mammography at age 40 years.
Consider tomosynthesis (three-dimensional mammography)
Promote breast awareness; breast self-examination is not recommended
NCCN guidelines provide four separate sets of recommendations for women at increased risk, on the basis of personal or family history, These include earlier initiation of mammography, in some cases, and consideration or recommendation of annual MRI. Additional considerations include the following:
An upper age limit for screening is not yet established. Consider severe comorbid conditions limiting life expectancy (eg, ≤10 years) and whether therapeutic interventions are planned.
For women with heterogeneous dense breasts and dense breast tissue, recommend counseling on the risks and benefits of supplemental screening.
Dense breasts limit the sensitivity of mammography and are associated with an increased risk for breast cancer.
Full-field digital mammography appears to benefit young women and women with dense breasts.
Multiple studies show that tomosynthesis can decrease callback rates and appears to improve cancer detection. Most studies used double the dose of radiation, but the radiation dose can be minimized by using synthesized 2-D reconstruction.
Hand-held or automated ultrasound can increase cancer detection, but may increase recall and benign breast biopsies.
Current evidence does not support the routine use of molecular imaging (eg, breast-specific gamma imaging, sestamibi scan, or positron emission mammography) as screening procedures, but emerging evidence suggests that these tests may improve detection of early breast cancers in women with mammographically dense breasts. However, the whole-body effective radiation dose with these tests is 20 –30 times higher than that of mammography.
Current evidence does not support the routine use of thermography or ductal lavage as screening procedures.
Breast self-examination (BSE) and clinical breast examination (CBE) are inexpensive and noninvasive procedures for the regular examination of breasts (ie, monthly BSE and annual CBE). Even with appropriate training, however, BSE has not been found to reduce breast cancer mortality, and it has been found to increase the number of unnecessary breast biopsies. [11] Consequently, the majority of the expert groups have withdrawn their support for BSE and instead recommend discussions about the benefits and limitations of this technique or a more general education about breast self-awareness. [8]
For example, ACOG distinguishes between BSE, which it does not recommend, from breast self-awareness, which it endorses. [5] Unlike BSE, breast self-awareness does not involve routine or systematic breast self-examination for the purpose of detecting breast cancer. Rather, it is a woman's attunement to the normal appearance and feel of her breasts, so that she can notify her health care provider if she experiences breast changes such as pain, a mass, new onset of nipple discharge, or redness. [5]
With increasing improvements in treatment regimens for early, localized disease, CBE, particularly among women younger than 40 years, continues to be recommended by many groups, including ACOG and NCCN. Randomized clinical trial results support combining CBE with mammography to enhance screening sensitivity, particularly in younger women in whom mammography may be less effective and in women who receive mammograms every other year as opposed to annually.
Mammography is a special type of low-dose x-ray imaging used to create detailed images of the breast. Mammography is currently the best available population-based method to detect breast cancer at an early stage, when treatment is most effective. Mammography can demonstrate microcalcifications smaller than 100 µm; it often reveals lesions before they become palpable by clinical breast examination (CBE) and, on average, 1-2 years before being found by breast self-examination (BSE). An estimated 48 million mammograms are performed each year in the United States.
The US Preventive Services Task Force (USPSTF) estimates the benefit of mammography in women aged 50-74 years to be a 30% reduction in risk of death from breast cancer. For women aged 40-49 years, the risk of death is decreased by 17%.
There are 2 types of mammography examinations: screening and diagnostic. Screening mammography is done in asymptomatic women. Diagnostic mammography is performed in symptomatic women (eg, when a breast lump or nipple discharge is found during self-examination or an abnormality is found during screening mammography). This examination is more involved, time-consuming, and expensive than screening mammography and is used to determine the exact size and location of breast abnormalities and to image the surrounding tissue and lymph nodes. Women with breast implants or a personal history of breast cancer will usually require the additional views used in diagnostic mammography.
The American College of Radiology (ACR) has established the Breast Imaging Reporting and Data System (BI-RADS) to guide the breast cancer diagnostic routine. BI-RADS is the product of a collaborative effort between members of various committees of the ACR in cooperation with the National Cancer Institute (NCI), the Centers for Disease Control and Prevention (CDC), the FDA, the American Medical Association (AMA), the American College of Surgeons (ACS), and the College of American Pathologists (CAP). [12]
The BI-RADS system includes categories or levels that are used to standardize interpretation of mammograms among radiologists. For referring physicians, the BI-RADS categories indicate the patient's risk of malignancy and recommend a specific course of action.
Of all of the screening mammograms performed annually, approximately 90% show no evidence of cancer. On necessary further diagnostic testing, approximately 2% of all screening mammograms are shown to be abnormal and require biopsy. Among cases referred for biopsy, approximately 80% of the abnormalities are shown to be benign, and 20% are shown to be cancerous.
See Mammography in Breast Cancer for more information.
Mammographic sensitivity for breast cancer declines significantly with increasing breast density, and the risk of breast cancer is higher in women with dense breasts. Hormonal status has no significant effect on the effectiveness of screening independent of breast density.
Although mammography remains the most cost-effective approach for breast cancer screening, it is far from a perfect screening test. The accuracy of screening mammography increases with increasing patient age, in tandem with the increasing incidence of breast cancer. Mammography has a sensitivity of 76.5% and a specificity of 87.1% for women younger than 40 years. [13] By comparison, in women 50 to 59 years old, the sensitivity of screening mammography is 77.3% and the specificity is 98.7%. [14] In women older than 80 years, mammography has a sensitivity of 86% and a specificity of 94%. [15]
A retrospective trend analysis compared rates of breast cancer mortality in pairs of neighboring European countries where mammography screening had been implemented at different times. Findings suggest that mammography screening has little detectable impact on mortality due to breast cancer. [16]
Mammography uses low-dose ionizing radiation, which may be harmful to the patient. Nevertheless, the benefits of mammography far outweigh the risks and inconvenience.
False-positive and false-negative results
False-positive results may arise when benign microcalcifications are regarded as malignant. Tissue summation shadows may appear as local parenchymal distortion; this may erroneously be called malignant tissue. A benign, circumscribed lesion may show signs suggestive of malignancy, along with other findings, such as an irregular border and no halo sign.
In the United States, approximately 9.5% of screening mammograms yield false-positive results; of US women screened annually for 10 years, approximately 50% will experience a false positive, and 7-17% of those will undergo breast biopsies. [17] False positives occur most commonly with first mammograms; when prior mammograms are available for comparison, the likelihood of a false positive decreases by about 50%. [18]
False-negative rates of screening mammography (ie, cases in which invasive breast cancer is present but undetected by mammography) range from 6% to 46%. [17] Possible causes for missed breast cancers include the following:
Dense parenchyma obscuring a lesion
Poor positioning or technique
Perception error
Incorrect interpretation of a suspect finding
Subtle features of malignancy
Slow growth of a lesion
Birdwell et al performed a multicenter study and found that on previous mammograms with missed cancers, 30% of the 115 lesions were calcifications, with 49% (17 of 35) clustered or pleomorphic. [19] Approximately 70% were mass lesions, with 40% spiculated or irregular. For calcifications and masses, the most frequently suggested reasons for possible miss were dense breasts (34%) and distracting lesions (44%).
Some cancers (eg, mucinous carcinomas) may have well-defined borders and mammographic features suggestive of a benign lesion.
Other uses of mammography in breast cancer
A ductogram, or galactogram, is sometimes helpful for determining the cause of nipple discharge. In this specialized examination, a fine plastic tube is placed into the opening of the duct in the nipple. A small amount of contrast medium is injected, which outlines the shape of the duct on a mammogram, and shows whether a mass is present inside the duct.
Women with breast implants
Women with breasts augmented by implants may pose a special challenge. Specific 4-view mammograms may be performed to evaluate the breasts; MRI may be especially useful for detecting breast cancer and silicon implant rupture in this group of patients.
See Postsurgical Breast Imaging for more information.
Ultrasonography has become a widely available and useful adjunct to mammography in the clinical setting. Ultrasound is generally used to assist the clinical examination of a suspicious lesion detected on mammography or physical examination. As a screening device, ultrasonography is limited by a number of factors, most notably by a failure to detect microcalcifications and by poor specificity (34%).
Originally, ultrasonography was used primarily as a relatively inexpensive and effective method of differentiating cystic breast masses, which did not require sampling, from solid breast masses that were usually examined with biopsy; in many cases, the results of these biopsies were benign. However, it is now well established that ultrasonography also provides valuable information about the nature and extent of solid masses and other breast lesions.
This imaging technique is also useful in the guidance of biopsies and therapeutic procedures; research is currently under way to evaluate its role in cancer screening.
Although mammography is an effective screening tool, data suggest that it is often less sensitive in detecting cancer in mammographically dense breast tissue. Kolb et al and Buchberger et al found that when performed carefully, ultrasonography may be useful in detecting occult breast cancer in dense breasts. [20, 21]
Ultrasonography is generally acknowledged to be a highly operator-dependent modality that requires a skilled practitioner, high-quality examinations, and state-of-the-art equipment. In view of the results of these studies, a prospective, multicenter study is clearly needed to examine the role of this imaging modality in breast cancer screening.
A large multicenter study supported by the Avon Foundation and the National Institutes of Health (NIH) was created through the American College of Radiology Imaging Network (ACRIN). [22] In this project, a protocol to assess the efficacy of screening breast ultrasonography is being implemented in 14 imaging centers to better define the role of this modality in breast cancer screening. (More information is available on the ACRIN Web site.)
In 2012, the FDA approved the first ultrasound system, the somo-v Automated Breast Ultrasound System (ABUS), for breast cancer screening specifically in women with dense breast tissue. [23] ABUS is indicated as an adjunct to standard mammography for women with a negative mammogram, no breast cancer symptoms and no previous breast intervention such as surgery or biopsy.
Currently, it is recommended that ultrasonographic screening for breast disease be reserved for special situations, such as for highly anxious patients who request it and for women who have a history of mammographically occult carcinoma.
See Ultrasonography in Breast Cancer for more information.
In an effort to overcome the limitations of mammography and ultrasonography, MRI has been explored as a modality for detecting breast cancer in women at high risk, in younger women, and in women with dense breasts. A combination of T1, T2, and 3-D contrast-enhanced MRI techniques has been found to be highly sensitive (approximating 99% when combined with mammography and clinical breast examination) to malignant changes in the breast.
MRI has been demonstrated to be an important adjunct screening tool for women with BRCA1 or BRCA2 mutations, identifying cancers at earlier stages. However, breast MRI has limited use as a general screening tool, with a 10-fold higher cost than mammography and poor specificity (26%), resulting in significantly more false-positive reads that generate significant additional diagnostic costs and procedures. [24]
According to the only study conducted to date using a control group, annual MRI-based screening among BRCA1 and BRCA2 carriers resulted in a significant 70% reduction in the hazard of developing stage II-IV (large or node-positive) invasive breast cancers (HR, 0.30; 95% CI, 0.12-0.71) compared to BRCA1 and BRCA2 carriers not undergoing annual MRI examinations. [25] Importantly, while the comparison group was instructed to undergo routine mammography screening, the majority of cancers were reported as self-detected. While these findings are not from a randomized setting and may suffer from unmeasured confounding that impacted the estimated effect of MRI, they provide support from a large population of BRCA1 and BRCA2 carriers for the beneficial use of MRI for the earlier detection of cancers.
Remaining unclear is the overall impact of earlier detection in this patient population on survival; a question that could not be addressed due to short follow-up.
In a study of 475 asymptomatic women with dense breasts who had negative/benign digital breast tomosynthesis examinations who underwent supplementary screening with abbreviated breast MRI, 420 women (88.4%) had negative/benign findings, 13 (2.7%) were recommended for short-interval follow-up, and 42 (8.8%) were recommended for biopsy. Of 39 completed biopsies, 12 (38.9%) identified malignancies: 7 invasive carcinomas and 5 ductal carcinoma in situ. An additional patient was diagnosed with invasive ductal carcinoma by biopsy recommended at 6-month follow-up. The positive predictive value 2 (PPV2) was 28.6% (12 of 42 recommended biopsies); PPV3 was 30.8% (12 of 39 completed biopsies). The researchers concluded that additional evaluation is warranted. [26]
For more information, see Magnetic Resonance Mammography.
The American Cancer Society (ACS) has established criteria for using breast MRI screening. [27] Based on evidence from nonrandomized trials and observational studies, the ACS recommends annual breast MRI screening in addition to mammography in patients with the following risk factors:
BRCA mutation
First-degree relative of BRCA carrier but untested
Lifetime risk approximately 20-25% or greater, as defined by BRCAPRO or other risk models
The ACS found insufficient evidence to recommend for or against MRI screening in patients with the following risk factors:
Lifetime risk 15-20%, as defined by BRCAPRO or other risk models
Lobular carcinoma in situ (LCIS), atypical lobular hyperplasia (ALH), or atypical ductal hyperplasia (ADH)
Heterogeneously or extremely dense breast on mammography
Personal history of breast cancer, including ductal carcinoma in situ
The ACS does not recommend the use of breast MRI in women who have a less than 15% lifetime risk of breast cancer. For those with average risk, a combination of clinical breast examinations and yearly mammograms is recommended. For women who have a 15-20% lifetime risk of developing breast cancer, the ACS found insufficient evidence to recommend screening MRI.
The National Comprehensive Cancer Network (NCCN) guidelines on MRI screening differ from those of the ACS as follows [8] :
Annual MRI screening recommended in first-degree relatives of a BRCA carrier, but untested (encourage genetic testing before MRI)
Annual MRI screening is recommended for women with lifetime risk 20% or greater, as defined by models that are largely dependent on family history. Encourage genetic testing for first-degree relatives. If testing declined, recommend MRI.
Annual MRI screening is recommended for women who received radiation therapy to the chest when aged 10-30 years.
Annual MRI screening may be considered for women with a history of LCIS and ALH/ADH whose lifetime risk is ≥20%.
Advantages of MRI
The many advantages of breast MRI over conventional breast imaging for the detection of malignancy have become apparent with increasing clinical experience. These advantages include the following:
No ionizing radiation
All imaging planes possible
Capability of imaging the entire breast volume and chest wall
Superb 3-D lesion mapping with techniques such as maximum intensity projection (MIP) slab 3-D reconstruction
Greater than 90% sensitivity to invasive carcinoma
Detection of occult, multifocal, or residual malignancy
Accurate size estimation for invasive carcinoma
Good spatial resolution
Ability to image regional lymph nodes (although accurate staging remains problematic)
Disadvantages of MRI
The widespread use of breast MRI for the detection of breast malignancy also has many disadvantages, as follows:
High equipment and examination costs
Limited scanner availability
Need for the injection of a contrast agent
No standard technique
Poor throughput compared with that of ultrasonography or mammography
Large number of images
Long learning curve for interpretation
False-positive enhancement in some benign tissues (limited specificity)
Variable enhancement of in situ carcinoma
A 5% incidence of slowly or poorly enhancing invasive carcinomas
Contraindications to MRI
Conversely, in a number of situations, MRI is essentially contraindicated, usually because of physical constraints that prevent adequate patient positioning. These constraints include the following:
Contraindication to gadolinium-based contrast media (eg, allergy, pregnancy)
Patient's inability to lie prone
Marked kyphosis or kyphoscoliosis
Marked obesity
Extremely large breasts
Severe claustrophobia
What is breast cancer screening?
Which organizations have issued guidelines on breast cancer screening?
How are women screened for breast cancer?
What are the USPSTF guidelines for breast cancer screening?
What are the ACS guidelines on breast cancer screening?
What are the ACOG guidelines on breast cancer screening?
What are the NCCN guidelines on breast cancer screening?
What are the roles of breast self-exam (BSE) and clinical breast exam (CBE) in breast cancer screening?
What is the role of mammography in breast cancer screening?
What are the limitations of mammography for breast cancer screening?
What is the prevalence of false-positive and false-negative mammography results in breast cancer screening?
What is the role of ductograms, or galactograms, in breast cancer screening?
How are women with breast implants screened for breast cancer?
What is the role of ultrasonography in breast cancer screening?
What is the role of MRI in breast cancer screening?
What are the ACS criteria for MRI in breast cancer screening?
What are the NCCN guidelines MRI in breast cancer screening?
What are the advantages of MRI for breast cancer screening?
What are the disadvantages of MRI for breast cancer screening?
When is MRI contraindicated in breast cancer screening?
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Anatomy of the breast.
Intrinsic subtypes of breast cancer.
Breast cancer. Intraductal carcinoma, comedo type. Distended duct with intact basement membrane and central tumor necrosis
Anatomy of the breast. Courtesy of Wikimedia Commons (Patrick J Lynch, medical illustrator).
Table. Guideline Recommendations for Breast Cancer Screening in Women at Average Risk
Erin V Newton, MD Assistant Professor of Clinical Medicine, Division of Hematology/Oncology, IU Simon Cancer Center, Indiana University School of Medicine; Staff Physician in Palliative Care, VA Medical Center
Erin V Newton, MD is a member of the following medical societies: American Society of Clinical Oncology, Multinational Association of Supportive Care in Cancer
Sara J Grethlein, MD, MBA, FACP Executive Medical Director and Medical Oncologist, Swedish Cancer Institute
Sara J Grethlein, MD, MBA, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Women's Association, American Society of Clinical Oncology, American Society of Hematology, Gold Humanism Honor Society, Leukemia and Lymphoma Society
Marie Catherine Lee, MD, FACS Associate Professor, Department of Oncologic Sciences, Department of Surgery (Joint Appointment), University of South Florida Morsani College of Medicine; Associate Member, Comprehensive Breast Program, Moffitt McKinley Outpatient Center
Marie Catherine Lee, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society of Clinical Oncology, Association for Academic Surgery, Association of Women Surgeons, Florida Society of Clinical Oncology, Society of Surgical Oncology, Society of University Surgeons
Disclosure: Received research grant from: National Cancer Institute/National Institutes of Health; Department of Defense.
Robert C Shepard, MD, FACP Associate Professor of Medicine in Hematology and Oncology at University of North Carolina at Chapel Hill; Vice President of Scientific Affairs, Therapeutic Expertise, Oncology, at PRA International
Robert C Shepard, MD, FACP is a member of the following medical societies: American Association for Cancer Research, American Association for Physician Leadership, European Society for Medical Oncology, Association of Clinical Research Professionals, American Federation for Clinical Research, Eastern Cooperative Oncology Group, Society for Immunotherapy of Cancer, American Medical Informatics Association, American College of Physicians, American Federation for Medical Research, American Medical Association, American Society of Hematology, Massachusetts Medical Society
Leona Downey, MD Assistant Professor of Internal Medicine, Section of Oncology and Hematology, University of Arizona, Arizona Cancer Center
Leona Downey, MD is a member of the following medical societies: American Geriatrics Society, American Society of Clinical Oncology, and Southwest Oncology Group
Julie Lang, MD Associate Professor of Surgery, Norris Comprehensive Cancer Center, Keck School of Medicine of the University of Southern California
Julie Lang, MD is a member of the following medical societies: American College of Surgeons, American Society of Breast Surgeons, American Society of Clinical Oncology, Association for Academic Surgery, and Society of Surgical Oncology
Disclosure: Genomic Health, Grant/research funds, Speaking and teaching; Agendia, Grant/research funds, Speaking and teaching; Surgical Tools, Grant/research funds, Research; Sysmex, Grant/research funds, Research
Robert B Livingston, MD Professor of Clinical Medicine and Director, Clinical Research Shared Services, Arizona Cancer Center
Robert B Livingston, MD is a member of the following medical societies: American Association for Cancer Research, American Federation for Clinical Research, and American Society of Clinical Oncology
Alison T Stopeck, MD Professor of Medicine, Arizona Cancer Center, University of Arizona Health Sciences Center; Director of Clinical Breast Cancer Program, Arizona Cancer Center; Medical Director of Coagulation Laboratory, University Medical Center; Director of Arizona Hemophilia and Thrombosis Center
Alison T Stopeck, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, American Society of Clinical Oncology, American Society of Hematology, Hemophilia and Thrombosis Research Society, and Southwest Oncology Group
Disclosure: Genentech Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; AstraZeneca Grant/research funds Other
Rachel Swart, MD, PhD Assistant Professor of Medicine, Department of Hematology and Oncology, Arizona Cancer Center, University of Arizona
Rachel Swart, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Society of Clinical Oncology, Arizona Medical Association, and Southwest Oncology Group
Disclosure: Roche Grant/research funds Other
Patricia A Thompson, PhD Assistant Professor, Department of Pathology, University of Arizona College of Medicine
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Federal Human Trafficking Report
Labor Trafficking
Posted on October 1, 2020 by Victoria Tiedemann
The Federal Human Trafficking Report was released earlier in the year and we almost missed seeing the information. The TIP report highlighted much of it. The actual Federal report and its information may be insightful for those interested in the justice system and want to know more insights within the US involving human trafficking (both sex and labor trafficking).
This post is mainly going to be a list of new statistics:
There has been a 14.7% decline in new human trafficking cases.
Domestic work, restaurant, and farm work were top industries for labor trafficking.
There are 31 active cases of forced labor using coercion (threats of deportation, withholding immigration documents, and using language barriers against victims).
575 active sex trafficking cases mostly through online buyers. A third of defendants were controlled without use of violence. Most were trafficked through usage of withholding pay, physical abuse, or threats of physical abuse.
Just over half of the victims were children targeted mainly through drug and substance dependency, being runaways, or having irregular immigration status.
145 new cases were made
There were 339 new convictions
There were 271 new defendants
143 months prison sentence on average
27 months to resolve charges on average
59.6% new human trafficking cases in 94 federal districts charged at least one defendant under the Trafficking Victims Protection Act
A 21% increase of forced labor federal court convicted cases occurred, 93.3% had sentencing of 42 to 336 months.
93.5% of convicted defendants were sentenced to 1 month to life in prison for sex trafficking cases, with 39.9% of court ordered mandatory restitution given to victims.
Prosecutions declined for the second year, while civil human trafficking suits rose by 125.6%. This is due to a spike in sex trafficking cases.
Out of criminal defendants in human trafficking, 79.4% were male, 20.6% were female. All buyer defendants were male. In labor trafficking cases, 41.5% were female, 58.5% male. In sex trafficking cases, 19.2% were female, 80.8% were male.
The youngest defendant was 18, the oldest 80, and the average age is 35.
Entity defendants in new civil human trafficking suits included 125 hotels, 16 technology companies, government contractors, and 10 educational or research institutes.
246 civil plaintiffs were sued in federal court (74.4% sex trafficking, 25.6% forced labor).
Out of 1,592 victims who had primary cases, 8.2% were victims in forced labor, while 91.8% were sex trafficking victims. 2.1% males were in sex trafficking cases. In forced labor cases 50.6% were male, and 49.4% female.
Out of all the victims involved in federal cases, 47.9% were adults, 52.1% were children. In sex trafficking cases 55.4% were children, while 44.6% were adults. In forced labor cases, 15.4% were children, 84.6% were adults.
Many people who have survived human trafficking within the federal cases had previously been vulnerable with one or more of the following: Drug dependence or substance abuse, being runaways, having irregular immigration status, being homeless, previously were trafficking, were in the foster care system, or had child abuse or neglect.
In the cases reviewed, victims came from 24 countries in addition to the US.
Traffickers in sex trafficking are often called "pimps". 67.5% of sex trafficking cases involved those who coerced victims for sexual exploitative purposes. 4.5% were gang directed and 3.5% were directed by organized crime situations. The cases were unable to go to 100% due to multiple types of enterprises mixing them all together.
In regards to criminal sex trafficking cases having recruitment purposes, 36.6% of victims were preyed upon through online situations, 23.3% were in pre-existing relationships, 19.7% were offered jobs that were fraudulent, 8.4% were found off the street, and 2.1% were offered shelter before trafficked.
Violence is intertwined with human trafficking situations on a regular basis. In all the criminal sex trafficking cases, 29.1% were nonviolent while 64.1% had an overlap of sometimes violent and nonviolent, while 6.8% were full on violent. The overlap explains that threats were usually put in place and punishments for those who didn't do what they were told were sometimes harmed.
Coercion leads most sex trafficking victims into being trafficked. Out of 398 active cases, many of these types of coercion were used, often several in one shot. Here are the ways that they were coerced into their exploitation. 72.9% withheld pay, 59% involved physical abuse, 43.7% used threats of physical abuse, 39.9% used substance dependence, 27.1% used sexual violence, 24.6% used physical isolation, 22.6% used verbal or emotional abuse, 21.3% involved weapon use to threaten, 5.3% used actual cells, cages, or locked rooms.
The number one way that adult victims are coerced is through physical abuse. With child victims it was withholding pay.
Involving criminal solicitation of buyers in criminal sex trafficking methods, 83.7% used the internet, 5.6% used the street "track", 4.7% used ways that are varied, 2.4% used brothels, 1.9% were in existing relationships, 1.7% used massage parlors.
Hotels are a major source of criminal activity for sex trafficking and sexual exploitation. Criminal cases included 68 small/non-chain hotels, 28 were at Motel 6, 24 were from Super 8 Motels, 18 were at Days Inn, and 16 from Red Roof Inn.
Labor trafficking cases including industries that were active included 32.1% domestic work, 17.9% Restaurant or food industries, 17.9% agricultural, 14.3% various types, 7.1% bars/clubs, 7.1% construction, and 3.6% forced panhandling. The highest methods used to recruit these victims were through fraudulent job offers 39.3%, 27.7% fraudulent drug rehab programs, 26.8% pre-existing relationships.
In labor trafficking there is the use of violence to control workers. 24.1% of victims stated there was no violence involved, 72.4% stated they had a mixture of violent and non-violent situations, and 3.4%. are violent. These coercive means were with withholding pay 69%, physical isolation 65.5%, threats of physical abuse 62.1%, physical abuse 51.7%, and verbal or emotional abuse 48.3%.
Foreign Nationals who are targeted by traffickers often are coerced through means such as threats of deportation 44.8%, withholding immigration documents 44.8%, and 17.2% were exploitative through language barriers.
Many investigation agencies work towards seeking freedom for those who are put through human trafficking. 71.6% were rescued through operations by the FBI, 25.5% through HSI, and 2.9% other. 77.7% of child-only sex trafficking case rescues are rescued through the FBI, 21.1% HSI, 57.8% of adult sex trafficking cases were found through FBI, 36.1% HSI, and of forced labor cases, 48.1% through the FBI, 44.4% through HSI.
In regards to human trafficking cases resolved through criminal appeals, 56.3% were affirmed, 28.2% were dismissed, 9.9% affirmed in part but reserved in part, and 5.6% are reserved. The average length of the resolution for criminal defendants found guilty after trial is 40 months. All defendant is 27 months, and defendants who plead guilty were 26 months.
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package hyweb.jo.model.field;

import hyweb.jo.annotation.IAProxyClass;
import hyweb.jo.org.json.JSONObject;
import hyweb.jo.type.JOStringType;

/**
 *
 * @author william
 * 要查詢的欄位如果沒有會使用 "*"
 */
@IAProxyClass(id = "field.qf")
public class JOQFField extends JOBaseField<String>{

    @Override
    public void __init__(JSONObject cfg) throws Exception {
        super.__init__(cfg);
        type = new JOStringType();
    }
}


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Document for developer
=================

How to release new version
--------------------------

```sh
rake build
rake release
```