The impact of screening mammography in breast cancer patients age 40-49 at an urban city hospital.

Abstract

1598 Background: Recent recommendations by the U.S. Preventive Services Task Force were based on population-based studies and meta-analyses that did not specifically address minority women. A recognized disparity in health care delivery is the underutilization of screening services by minority patients. The purpose of this study was to characterize the clinico-pathologic features multi-ethnic breast cancer patients at an urban tertiary hospital who would not be screened under these new guidelines. Methods: A retrospective chart review of breast cancer cases diagnosed between 2005-09 at Bellevue Hospital was performed. Data included age, stage, presentation (palpable vs non-palpable), ethnicity, and mammographic findings. Results: Of 520 cases, 110 (21%) were 40-49 yrs old; data were available for 93. The majority were Chinese (n==36), Hispanic (n==31), or African-American (n==21). Only 5 were Caucasian. Fifty-two (56%) presented with palpable masses vs 41 (44%) with non-palpable cancers. The majority had heterogeneously dense tissue on mammography. Patients with non-palpable lesions were more likely to have been detected by screening mammography, more likely to have had a mammogram the prior year (p == <0.001), and were more likely to have had early-stage disease (p == 0.004) than those with palpable masses. Conclusions: Among minority women with breast cancer, we identified a significant percentage (21%) who would not have been screened under the new guidelines due to their age. Furthermore, most women presented with palpable masses and were not being screened regularly as recommended by current guidelines. Targeted interventions should continue to be directed at minority populations to increase participation in screening programs and narrow the disparities in mammography utilization and stage at presentation. Features of breast cancer patients age 40-49. Nonpalpable Palpable P value No. of patients 41 (44%) 52 (56%) Average mammographic density (BIRADs density categories 1-4) 2.8 2.9 AJCC stage 0 I II III IV 19 12 5 5 0 1 16 24 8 3 Early stage (0, I, II) Late stage (III, IV) 31 10 17 35 p = <0.001 Mammogram in prior year No mammogram in prior year 20 (48%) 21 13 (25%) 39 p = 0.004