Mammography in women with sickle cell disease.

Abstract

e22509 Background: Sickle cell disease (SCD) is an inherited blood disorder affecting 100,000 people in the US with a median life expectancy of 54 years. As this population ages, it is important to focus on wellness screenings. Literature review has mixed results on the prevalence of malignancies in SCD. Initiation of BC screening is recommended between age 40-50. Patients with SCD have risk factors for breast cancer (BC) including radiation exposure, nulliparity/decreased parity, dense breasts, African American race, lack of physical activity, and use of allogenic Hematopoietic Stem Cell Transplant with total body irradiation and alkylating agent conditioning regimens. This study's purpose is to determine if these patients are being adequately screened and if guidelines for the general population are appropriate for SCD patients given their potential increased risk. Methods: This is a single center retrospective study of women with SCD who are >40 with an encounter between 2018-2022. Data collection included: screening age, recent mammogram date, American College of Radiology (ACR) category for breast density (BD), family history of cancer, type of SCD, menopausal status, and Body Mass Index (BMI). Ordinal logistical regression model was used for statistical analysis. Results: A total of 156 patients were identified and 71% screened for BC; however only 56% had screening in the last 2 years. With a binomial test, the difference between CDC 2019 African American women and SCD regarding screen is not significant (P=1). The average age for screening was 44. Over half of our patients (53%) have dense breasts. Younger age at screen and lower BMI are both related to a higher density score (Table). Conclusions: As per guidelines, breast awareness (age 25) and mammography (age 40) should be offered to ensure early detection in the general population. The question arises if there should be earlier screening with an alternative imaging modality in SCD patients given increased breast density, potential risk factors, and lower life expectancy. However, it is important to consider the risks versus benefits of early screening. Screening can provide better outcomes, as SCD patients might not tolerate standard treatments for advanced disease. Our findings present a new challenge regarding BD. Increased BD decreases the accuracy of mammograms and requires additional imaging. Higher BD is found in younger women with lower BMI, but here fertility may be an additional factor as it differs in patients with SCD. The limitation of our study is that it is a retrospective, single institution study during a pandemic. Future studies are needed to closely examine if SCD patients are at increased risk given density findings and if there is a need for earlier or alternative modality of screening other than mammography. [Table: see text]