Neglecting to Screen Women Between the Ages of 40 and 49 Years With Mammography: What Is the Impact on Breast Cancer Diagnosis?

Case Western Reserve University School of Medicine, Cleveland, OH, USA.
American Journal of Roentgenology (Impact Factor: 2.73). 05/2012; 198(5):1218-22. DOI: 10.2214/AJR.11.7200
Source: PubMed


The purpose of this study was to compare breast cancer stage at diagnosis in two groups of women between 40 and 49 years old: women undergoing screening mammography and women with a symptom needing diagnostic workup. This comparison is indicative of the impact of forgoing screening in this age group, as recommended by the United States Preventive Services Task Force.
A retrospective chart review was used to collect the results of imaging-guided core needle biopsies performed in women between the ages of 40 and 49 years from January 1, 2008, to December 31, 2009. In patients diagnosed with breast cancer or a high-risk lesion, the reason for presentation, pathology, tumor size, stage, and receptor characteristics were recorded. The chi-square test was used for statistical analysis.
Of 108 primary breast cancers, 71 were detected in the screened group and 37 in the unscreened group. The screened group was significantly more likely to be diagnosed with ductal carcinoma in situ than the unscreened group (22 vs 1, chi-square = 11.6, p = 0.001). Furthermore, screened patients with invasive carcinoma were significantly more likely to be diagnosed at earlier stages (chi-square = 5.02, p = 0.025). The size of invasive breast cancer in the screened group was significantly smaller as well (chi-square = 9.3, p = 0.002). Of the high-risk lesions, atypical ductal hyperplasia (n = 29) and lobular carcinoma in situ (n = 8) were most frequently seen.
Breast cancer patients undergoing screening mammography were diagnosed at earlier stages with smaller tumors. Screening also allows detection of high-risk lesions, which may prompt chemoprevention and lower subsequent breast cancer risk. We continue to support screening mammography in women between the ages of 40 and 49 years.

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    ABSTRACT: The literature on breast cancer inevitably includes age as a risk factor for the disease, and there is considerable controversy regarding the best age for women to start screening mammography. A woman's breast develops and changes over the course of her lifetime, and at various times is more or less susceptible to cancer. Developmental differences also affect breast imaging. This article focuses on the age groups outside the majority of women who receive breast cancer diagnoses, instead emphasizing effects of age on the very youngest and oldest women.
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    Preview · Article · Apr 2013 · Radiology
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