Breast cancer detection: Age-related significance of findings on physical exam and mammography

Abstract

Data of 909 consecutive patients who underwent physical exam (PE), mammography (MG), and breast biopsy were analyzed in a retrospective study. Preoperative findings of PE and MG were classified as (1) suspicious for malignancy, (2) probably benign lesion, (3) normal and correlated with histology of the biopsy and the patient's age. Sensitivity of PE remained on a 0.9 level approximately up to age 50 and dropped to 0.78 and 0.85 respectively thereafter. Sensitivity of MG was slightly lower and was 0 in the age group 30 years and younger. Specificity of PE rose from 0.52 to 0.84 and dropped to 0.55 in women above 70 years. Specificity of MG decreased from 0.9 to 0.4 over the age groups. The relatively low positive predictive value of both PE and MG—particularly in the lower age groups—leads to an excessive rate of benign biopsies up to the age of 60. Due to suboptimal sensitivity PE and MG have to be used as a combined diagnostic modality if a reduction of breast cancer mortality is to be accomplished. Screening programs are of particular efficacy in women over 45 years of age due to age-dependent incidence figures and diagnostic sensitivity of PE and MG in this age group.