Frequency Of Mammography Screening Research Articles

Development and quality appraisal of a new English breast screening linked data set as part of the age, test threshold, and frequency of mammography screening (ATHENA-M) study.

To build a data set capturing the whole breast cancer screening journey from individual breast cancer screening records to outcomes and assess data quality. Routine screening records (invitation, attendance, test results) from all 79 English NHS breast screening centres between January 1, 1988 and March 31, 2018 were linked to cancer registry (cancer characteristics and treatment) and national mortality data. Data quality was assessed using comparability, validity, timeliness, and completeness. Screening records were extracted from 76/79 English breast screening centres, 3/79 were not possible due to software issues. Data linkage was successful from 1997 after introduction of a universal identifier for women (NHS number). Prior to 1997 outcome data are incomplete due to linkage issues, reducing validity. Between January 1, 1997 and March 31, 2018, a total of 11 262 730 women were offered screening of whom 9 371 973 attended at least one appointment, with 139 million person-years of follow-up (a median of 12.4 person years for each woman included) with 73 810 breast cancer deaths and 1 111 139 any-cause deaths. Comparability to reference data sets and internal validity were demonstrated. Data completeness was high for core screening variables (>99%) and main cancer outcomes (>95%). The ATHENA-M project has created a large high-quality and representative data set of individual women's screening trajectories and outcomes in England from 1997 to 2018, data before 1997 are lower quality. This is the most complete data set of English breast screening records and outcomes constructed to date, which can be used to evaluate and optimize screening.

Impact of Mammography Screening Frequency on Breast Cancer Mortality Rates.

The frequency of mammography screening remains a topic of ongoing debate. This meta-analysis aimed to investigate the impact of annual vs. biennial mammography screenings on breast cancer mortality rates. A comprehensive search of relevant literature published up to 2021 was performed, with the primary outcome being the difference in breast cancer mortality rates between annual and biennial screenings. The extracted data included relative risks and 95% confidence intervals (CIs), with studies selected based on predetermined inclusion and exclusion criteria, emphasizing the quality of methodology and minimization of bias. Of the included studies, thirteen met the criteria, covering diverse demographic cohorts and screening frequencies. The synthesized data revealed a pattern of lower relative risk in annual screenings compared to biennial screenings across all studies. Notably, subgroup analyses indicated that age and racial background might modulate the effectiveness of screening frequency. In conclusion, this meta-analysis offers strong evidence suggesting that annual mammography screenings could be more effective than biennial screenings in reducing breast cancer mortality rates, especially in certain high-risk demographics. The results emphasize the importance of personalized, evidence-based approaches to mammography, with a call for future research to validate these findings and delve deeper into optimizing breast cancer screening strategies.

The Association Between Mammography Screening Frequency and Breast Cancer Treatment and Outcomes: A Retrospective Cohort Study.

Guidelines for optimal frequency of screening mammography vary by professional society. Sparse evidence exists on the association between screening frequency and breast cancer treatment options. The main objective was to examine differences in cancer treatment rendered for U.S. women with different numbers of screenings prior to breast cancer diagnosis. Cancer stage at diagnosis and health care cost were assessed in secondary analyses. This IRB-exempt retrospective study used administrative claims data to identify women aged 44 or older with various numbers of mammographic screenings ≥11 months apart, during the four years prior to incident breast cancer diagnosis from January 2010 to December 2018. Outcomes were assessed over the six months following diagnosis. Generalized linear regression models were used to compare women with differing numbers of mammograms, adjusting for patient characteristics. Claims data review identified 25 492 women who met inclusion criteria. There was a stepwise improvement in each of these screening categories such that women with four screenings, compared to women with only one screening, experienced higher rates of lumpectomy (70% vs 55%) and radiation therapy (48% vs 36%), lower rates of mastectomy (27% vs 34%) and chemotherapy (28% vs 36%), less stage 3 or 4 cancer at diagnosis (15% vs 29%), and lower health care costs within six months postdiagnosis (P < 0.001). Results were similar in a subgroup limited to women aged 44 to 49 at diagnosis. Potential benefits of more frequent screening include less aggressive treatment and lower health care costs among women who develop breast cancer.

Barriers to Mammography Screening among Black Women at a Community Health Center in South Florida, USA.

In the United States (US), Black/African American women suffer disproportionately from breast cancer health disparities with a 40% higher death rate compared to White women. Mammography screening is considered a critical tool in mitigating disparities, yet Black women experience barriers to screening and are more likely to be diagnosed with advanced-stage breast cancer. The purpose of this study was to assess the relative frequency of mammography screening and to examine perceived and actual barriers to screening among women who receive care in our nurse-led community health center. We conducted a survey examining frequency of mammography screening and beliefs about breast cancer including perceived susceptibility, perceived benefits, and perceived barriers to mammography screening, guided by the Champion Health Belief Model. A total of 30 Black/African American women completed the survey. The mean age of the participants was 54.3 years ± 9.17 (SD); 43.3% had a high school education or less; 50% had incomes below $60,000 per year; 26.7% were uninsured; 10% were on Medicaid; and only 50% were working full-time. We found that only half of the participants reported having annual mammograms 16 (53.3%), 1 (3.3%) every 6 months, 8 (26.6%) every 2-3 years, and 5 (16.7%) never had a mammogram in their lifetime. Frequently cited barriers included: 'getting a mammogram would be inconvenient for me'; 'getting a mammogram could cause breast cancer'; 'the treatment I would get for breast cancer would be worse than the cancer itself'; 'being treated for breast cancer would cause me a lot of problems'; 'other health problems would keep me from having a mammogram'; concern about pain with having a mammogram would keep me from having one; and not being able to afford a mammogram would keep me from having one'. Having no health insurance was also a barrier. This study found suboptimal utilization of annual screening mammograms among low-income Black women at a community health center in Florida and women reported several barriers. Given the high mortality rate of breast cancer among Black/African American women, we have integrated a Patient Navigator in our health system to reduce barriers to breast cancer screening, follow-up care, and to facilitate timely access to treatment, thus ultimately reducing breast cancer health disparities and promoting health equity.

Breast Cancer Risk and Screening Mammography Frequency Among Multiethnic Women

In 2009, the U.S. Preventive Services Task Force updated recommended mammography screening frequency from annual to biennial for average-risk women aged 50-74 years. The association between estimated breast cancer risk and mammography screening frequency was evaluated. A single-center retrospective cohort study was conducted among racially/ethnically diverse women, aged 50-74 years, who underwent screening mammography from 2014 to 2018. Data on age, race/ethnicity, first-degree family history of breast cancer, previous benign breast biopsies, and mammographic density were extracted from the electronic health record to calculate Breast Cancer Surveillance Consortium 5-year risk of invasive breast cancer, with a 5-year risk ≥1.67% defined as high risk. Multivariable analyses were conducted to determine the association between breast cancer risk factors and mammography screening frequency (annual versus biennial). Data were analyzed from 2020 to 2022. Among 12,929 women with a mean age of 61±6.9 years, 82.7% underwent annual screening mammography, and 30.7% met high-risk criteria for breast cancer. Hispanic women were more likely to screen annually than non-Hispanic Whites (85.0% vs 79.8%, respectively), despite fewer meeting high-risk criteria. In multivariable analyses adjusting for breast cancer risk factors, high- versus low/average-risk women (OR=1.17; 95% CI=1.04, 1.32) and Hispanic versus non-Hispanic White women (OR=1.46; 95% CI=1.29, 1.65) were more likely to undergo annual mammography. A majority of women continue to undergo annual screening mammography despite only a minority meeting high-risk criteria, and Hispanic women were more likely to screen annually despite lower overall breast cancer risk. Future studies should focus on the implementation of risk-stratified breast cancer screening strategies.

Patient, primary care provider, and stakeholder perspectives on mammography screening frequency: lessons learned from a qualitative study

BackgroundU.S. professional organizations have provided conflicting recommendations on annual vs. biennial mammography screening. Potential harms of more frequent screening include increased anxiety and costs of false positive results, including unnecessary breast biopsies and overdiagnosis.ObjectiveTo characterize current practices and beliefs surrounding mammography screening frequency and perspectives on using risk-based screening to inform screening intervals.DesignSemi-structured interviews informed by the Consolidated Framework for Implementation Research (CFIR).ParticipantsPatients, primary care providers (PCPs), third-party stakeholders (breast radiologists, radiology administrators, patient advocates).Main measuresQualitative data, with a codebook developed based upon prespecified implementation science constructs.Key resultsWe interviewed 25 patients, 11 PCPs, and eight key stakeholders, including three radiologists, two radiology administrators, and three patient advocates. Most patients reported having annual mammograms, however, half believed having mammograms every two years was acceptable. Some women were worried early breast cancer would be missed if undergoing biennial screening. PCPs were equally split between recommending annual and biennial mammograms. Although PCPs were interested in using breast cancer risk models to inform screening decisions, concerns raised include time burden and lack of familiarity with breast cancer risk assessment tools. All breast radiologists believed patients should receive annual mammograms, while patient advocates and radiology administrators were split between annual vs. biennial. Radiologists were worried about missing breast cancer diagnoses when mammograms are not performed yearly. Patient advocates and radiology administrators were more open to biennial mammograms and utilizing risk-based screening.ConclusionsUncertainty remains across stakeholder groups regarding appropriate mammogram screening intervals. Radiologists recommend annual mammography, whereas patients and PCPs were evenly split between annual vs. biennial screening, although both favored annual screening among higher-risk women. Breast cancer risk assessment tools may help facilitate decisions about screening intervals, but face barriers to widespread implementation in the primary care setting. These results will inform future implementation strategies to adopt risk-stratified breast cancer screening.

Evaluation of breast stiffness pathology based on breast compression during mammography: Proposal for novel breast stiffness scale classification

Breast cancer is diagnosed through a patient's Breast Self-Examination (BSE), Clinical Breast Examination (CBE), or para-clinical methods. False negativity of PCM in breast cancer diagnostics leads to a persisting problem associated with breast tumors diagnosed only in advanced stages. As the tumor volume/size at which it becomes invasive is not clear, BSE and CBE play an exceedingly important role in the early diagnosis of breast cancer. The quality and effectiveness of BSE and CBE depend on several factors, among which breast stiffness is the most important one. In this study, the authors present four methods for evaluating breast stiffness pathology during mammography examination based on the outputs obtained during the breast compression process, id est, without exposing the patient to X-Ray radiation. Based on the subjective assessment of breast stiffness by experienced medical examiners, a novel breast stiffness classification was designed, and the best method of its objective measurement was calibrated to fit the scale. Hence, this study provides an objective tool for the identification of patients who, being unable to perform valid BSE, could benefit from an increased frequency of mammography screening. Dum vivimus servimus.

Demographic variables affecting participation in mammography screening: a cross-sectional study

Breast cancer is one of the most common cancers among women. There are three commonly used diagnostic methods in this cancer type, in which the survival rate can be quite high with early diagnosis. Compared to breast self-examination and clinical examination, mammography stands out as a more accurate diagnostic method. Although there are health policies regarding mammography screening in many countries, mammography screening behavior has not reached the desired level worldwide. In this study, we tried to reveal the demographic factors affecting the frequency of women getting mammograms in Turkey. The frequency of mammography screening was estimated with a generalized logit model using the microdata of TURKSTAT Turkey Health Survey. As a result of the model, it was observed that mammography screening differentiated in different age and income groups. It was determined that the disease status increased the frequency of mammography screening, however, marital status and employment status did not have a significant effect.

Effect of mammography screening frequency on false-positive biopsy rates and detection of local recurrence among breast cancer survivors.

7016 Background: Current guidelines recommend that women with a history of early-stage breast cancer treated with breast-conserving therapy (BCT) continue screening mammography after treatment. One strategy is semi-annual ipsilateral mammography for the first 3 years after diagnosis, when risk of local recurrence is highest. However, a potential harm of more frequent screening is false-positive breast biopsy. We examined the association between screening frequency and rates of false-positive biopsy and local recurrence among breast cancer survivors. Methods: We conducted a retrospective cohort study at Columbia University Irving Medical Center (CUIMC) in New York, NY, of women diagnosed with stage 0-III breast cancer from 2007 to 2017, who were treated with BCT and had at least 2 screening mammograms at CUIMC within the first 3 years after diagnosis. Demographic and clinical information were collected from the electronic health record. Frequency of mammography screening was defined as the median interval between two consecutive mammograms (every 6 months vs. yearly). False-positive biopsy and local recurrence were identified by review of breast pathology reports. A false-positive biopsy was defined as a breast biopsy without evidence of invasive or non-invasive cancer. Descriptive statistics and logistic regression models were conducted to examine relationships between covariates and either false-positive biopsy or local recurrence. Results: In our study cohort (n = 1404), the median age at breast cancer diagnosis was 61 years (range, 24-94), including 45% white, 14% black, 32% Hispanic, and 8% Asian. Eighty percent of women had screening mammography of the ipsilateral breast every 6 months during the first 3 years after diagnosis. Comparing women who screened every 6 months vs. yearly, there was no difference in local recurrence rates (4.0% vs. 4.1%), including screen-detected and invasive recurrences, but a higher rate of false-positive biopsy (13.5% vs. 7.5%). In multivariable analysis, women who screened every 6 months had about a 2-fold increased risk of having a false-positive biopsy (OR 1.93; 95% CI 1.17-3.19); no other factors were significantly associated with false-positive biopsy. Conclusions: We observed that women with early-stage breast cancer treated with BCT who underwent more frequent screening mammography had more false-positive breast biopsies, but no difference in local recurrence rates. Future studies are needed to determine optimal screening strategies for breast cancer survivors.

Factors associated with ever use of mammography in a limited resource setting. A mixed methods study.

To evaluate facilitators and barriers influencing mammography screening participation among women. Mixed methods study. Three hospital catchment areas in Hidalgo, Mexico. Four hundred and fifty-five women aged 40-69 years. Three hundred and eighty women completed a survey about knowledge, beliefs and perceptions about breast cancer screening, and 75 women participated in semi-structured, in-person interviews. Survey data were analyzed using logistic regression; semi-structured interviews were transcribed and analyzed using elements of the grounded theory method. Women were categorized as never having had mammography or having had at least one mammogram in the past. From survey data, having had a Pap in the past year was associated with ever having had breast screening (odds ratio = 2.15; 95% confidence interval 1.30-3.54). Compared with never-screened women, ever-screened women had better knowledge of Mexican recommendations for the frequency of mammography screening (49.5% vs 31.7% P < 0.001). A higher percentage of never-screened women perceived that a mammography was a painful procedure (44.5% vs 33.8%; P < 0.001) and feared receiving bad news (38.4% vs 22.2%; P < 0.001) compared with ever-screened women. Women who participated in semi-structured, in-person interviews expressed a lack of knowledge about Mexican standard mammographic screening recommendations for age for starting mammography and its recommended frequency. Women insured under the 'Opportunities' health insurance program said that they are referred to receive Pap tests and mammography. Local strategies to reduce mammogram-related pain and fear of bad news should work in tandem with national programs to increase access to screening.

Abstract PD2-15: Effect of mammography screening frequency on false-positive biopsy rates and detection of local recurrence among breast cancer survivors

Abstract Introduction: Current guidelines are for yearly mammograms in women with early-stage breast cancer. Among breast cancer survivors treated with lumpectomy, semi-annual compared to annual screening mammography of the ipsilateral breast has been associated with early detection of local recurrence. However, a potential harm of more frequent screening is false-positive breast biopsies that may lead to negative psychosocial effects and increased costs. Our objective was to investigate how frequency of screening mammograms affects rates of false-positive biopsy results and local recurrences among breast cancer survivors. Methods: We conducted a retrospective cohort study at Columbia University Medical Center (CUMC) in New York, NY of women diagnosed with stage 0-III breast cancer between 2007 and 2015, who were treated with lumpectomy and had at least 2 screening mammograms at CUMC within the first 3 years after diagnosis. Demographic and clinical information, including tumor characteristics and breast cancer treatments, were collected from the electronic health record. Frequency of mammography screening was defined as the median interval between 2 consecutive mammograms (every 6 months vs. yearly). Both false-positive biopsy results and local recurrences were identified by review of breast pathology reports. A false-positive biopsy was defined as a diagnostic breast biopsy without evidence of invasive or non-invasive cancer. Descriptive statistics and logistic regression models were conducted to examine relationships between covariates and either false-positive biopsy or local recurrence. Results: In our sample (n=1257), the median age at breast cancer diagnosis was 60 years (range, 24-93), including 47% non-Hispanic white, 14% non-Hispanic black, 31% Hispanic, and 7% Asian. Nearly 80% of women had semi-annual screening mammography of the ipsilateral breast during the first 3 years after breast cancer diagnosis. In univariate analysis, higher body mass index, more advanced stage disease, higher tumor grade, and receipt of chemotherapy, hormonal therapy, and radiation therapy were associated with more frequent screening. Comparing women who screened every 6 months vs. yearly, there was no difference in local recurrence rates (4.1% vs. 3.9%), including screen-detected or invasive/non-invasive breast cancer recurrences. In multivariable analysis, women who screened every 6 months compared to yearly had a greater than 2-fold increased risk of having a false-positive biopsy (OR: 2.40; 95% CI: 1.50-3.86). Also, younger age at diagnosis, higher tumor grade, and receipt of chemotherapy were associated with higher false positive rates, adjusting for covariates. Conclusions: We observed that women with early-stage breast cancer treated with lumpectomy who underwent semi-annual vs. annual screening mammography had more false-positive breast biopsies, but no difference in local recurrence rates. To date, there is no evidence that more frequent screening in breast cancer patients is associated with improved survival. Future studies are needed to determine optimal screening strategies for breast cancer survivors, including frequency of screening and use of supplemental breast imaging with ultrasound, MRI, or tomosynthesis. Citation Format: Yuan S, Manley HJ, Ha R, Yu A, Genkinger JM, Crew KD. Effect of mammography screening frequency on false-positive biopsy rates and detection of local recurrence among breast cancer survivors [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD2-15.

Geographic access to mammography facilities and frequency of mammography screening

PurposeTo assess the association between geographic access to mammography facilities and women's mammography utilization frequency. MethodsUsing data from the population-based 1995–2007 Wisconsin Women's Health study, we used proportional odds and logistic regression to test whether driving times to mammography facilities and the number of mammography facilities within 10 km of women's homes were associated with mammography frequency among women aged 50–74 years and whether associations differed between Rural-Urban Commuting Areas and income and education groups. ResultsWe found evidence for nonlinear relationships between geographic access and mammography utilization (nonlinear effects of driving times and facility density, P-values .01 and .005, respectively). Having at least one nearby mammography facility was associated with greater mammography frequency among urban women (1 vs. 0 facilities, odds ratio 1.26, 95% confidence interval, 1.09–1.47), with similar effects among rural women. Adding more facilities had decreasing marginal effects. Long driving times tended to be associated with lower mammography frequency. We found no effect modification by income, education, or urbanicity. In rural settings, mammography nonuse was higher, facility density smaller, and driving times to facilities were longer. ConclusionsHaving at least one mammography facility near one's home may increase mammography utilization, with decreasing effects per each additional facility.

Informing Women and Their Physicians about Recommendations for Adjunct Breast MRI Screening: A Cohort Study

ABSTRACTIt is unclear how best to communicate recommendations for breast cancer screening with MRI as an adjunct to mammography for women at high risk. This study compares the rates of breast MRI screening for two different methods of communication. The retrospective IRB-approved cohort study was conducted at Invision Sally Jobe Breast Centers (ISJBC). ISJBC provided Gail model risk assessment to all women presenting for screening mammography. Women with scores ≥ 19.6% were considered to be high risk. Over 2 years, ISJBC used two different methods to inform women at elevated lifetime risk and their physicians about recommendations for adjunct MRI screening (N = 561, mean age = 52 years, s.d. = 8.7). During Window A, information was sent to referring physicians as a part of the dictated imaging report, while later, in Window B, the information was sent to referring physicians as well as to the women themselves in a letter. Analyses were stratified by mammography screening frequency. One-time screeners presented in only Window A or Window B. Repeat screeners came both in Window A and in Window B. Breast MRI screening rates were significantly higher in Window B than in Window A (one-time screeners, N = 459, 9.8% vs. 14.4%, p = 0.047; repeat screeners, N = 102, 0% vs. 6.9%, p = 0.016). Although an observational study cannot assess causality, direct communication of risk-based recommendations for adjunct breast MRI screening to women and to their referring physicians was associated with an increased rate of screening breast MRI completion at the same clinic at which the women underwent mammography.

The WISDOM study pilot: Evaluating a preference-tolerant RCT of risk-based vs. annual breast cancer screening.

e13035Background: The goal of the WISDOM study (Women Informed to Screen Depending on Measures of risk) is to examine the effectiveness of a personalized approach to breast cancer screening and to bring clarity and objective recommendations to the current debate regarding mammography screening frequency. The WISDOM study, funded by PCORI, is a randomized trial with a preference-tolerant design that aims to determine if risk-based (RBS), vs. annual screening, is as safe, less morbid, enables prevention and is preferred by women. A pilot was conducted to test the logistics and examine the acceptance of the study. Methods: Women were recruited from the UCSF site of the Athena Breast Health Network, a clinical care-research cohort including 100,000 women from the 5 UC Medical Centers and Sanford Health. We recruited women 40 -74 years of age that had no history of breast cancer and had a normal mammogram in the past year. The Breast Cancer Surveillance Consortium model (standard risk factors, ethnicity, breas...

Adjusting the frequency of mammography screening on the basis of genetic risk: Attitudes among women in the UK

PurposeTo explore public attitudes towards modifying frequency of mammography screening based on genetic risk. MethodsHome-based interviews were carried out with a population-based sample of 942 women aged 18–74 years in the UK. Demographic characteristics and perceived breast cancer (BC) risk were examined as predictors of support for risk-stratified BC screening and of the acceptability of raised or lowered screening frequency based on genetic risk, using multivariate logistic regression. ResultsOver two-thirds of respondents (65.8%) supported the idea of varying screening frequency on the basis of genetic risk. The majority (85.4%) were willing to have more frequent breast screening if they were found to be at higher risk, but fewer (58.8%) were willing to have less frequent screening if at lower risk (t (956) = 15.6, p < 0.001). Ethnic minority status was associated with less acceptability of more frequent screening (OR = 0.40, 95% CI = 0.21–0.74), but there were no other significant demographic correlates. Higher perceived risk of BC was associated with greater acceptability of more frequent screening (OR = 1.71, 95%CI = 1.27–2.30). ConclusionWomen were positive about adjusting the frequency of mammography screening in line with personal genetic risk, but it will be important to develop effective communication materials to minimise resistance to reducing screening frequency for those at lower genetic risk.

Recommended age groups and frequency of mammography screening: a systematic review

The scope of this review was to assess the strength of evidence for the current Portuguese performance indicator on breast cancer screening with mammography in order to determine the recommended age group and periodicity for screening. A search for articles was conducted in the main international databases of medical literature. Articles published between January 2006 and January 2012 addressing the objectives of this review were included. The SORT taxonomy was used to classify the results. Of the 253 articles, five articles met the inclusion criteria and were selected for review. These included three systematic reviews, one meta-analysis and one clinical guideline based on a systematic review. A reduction in breast cancer mortality with mamography screening was the outcome in all articles selected. Mammography screening between 50 and 69 years was recommended in all articles that assess this age group. The clinical guidelines recommended screening every two years. In conclusion, the current literature recommends mammography for women every two years between the ages of 50 and 69 years. This is consistent with the current performance indicator for breast cancer screening in Portugal.

Screening Mammography: Revisiting Assumptions About Early Detection

Recommendations for the frequency of mammography screening vary across several professional advisory groups. In 2009, the United States Preventive Services Task Force Guidelines reduced screening to biennially for women 50-74 years old. Drivers of this change were false-positive results and unnecessary biopsies, exposure to radiation, and treatment of cancers that would never develop. Despite the recommendation, surveys show that screening has actually increased since the change. A review of the individual woman's risk and a more balanced approach addressing both the benefits and harms of screening is required so that patients can make an informed choice.

The Breast Cancer Overdiagnosis Conundrum: An Oncologist's Viewpoint

Ongoing controversy surrounds the appropriate age to begin and the frequency of mammography screening for breast cancer. The authors of this commentary argue that we need to develop more accurate, ...

Clinical presentation of breast cancer: Age, stage, and treatment modalities in a contemporary cohort of Michigan women.

1 Background: The U.S. Preventative Services Task Force (USPSTF) revised their breast cancer screening recommendations in 2009 changing their stance on age and frequency of mammography screening to biannual exams starting at age 50. The purpose of this study is to analyze data from a statewide breast cancer registry managed by the Michigan Breast Oncology Quality Initiative (MiBOQI) to determine the impact of these new recommendations on diagnosing and treating breast cancer. Methods: De-identified data were collected on women participating in the MiBOQI registry at seventeen statewide institutions from 2006-2009. Data included method of detection, cancer stage, age at detection, treatment type, and patient demographics. Participants were stratified based on age, and data analyzed using NCSS software (chi-square and t-tests). Results:5903 women with breast cancer with an average age at diagnosis of 59.4 years were included. 65.5% of breast cancers were detected via mammography, 29.8% by palpation, and 4.7% by other methods. In women under 50 years of age, cancers were detected by mammography in 48.3% (69.3% &gt;50yr) and by palpation in 46.1% (24.1% &gt;50yr). Patients with palpable presentations were younger (55.8 yr vs. 61.2 yr; p &lt;0.001). Cancers with a palpable presentation were diagnosed at higher stages (50.0% stage II) than with mammography (52.5% stage I; p&lt;0.001). Breast conservation surgery occurred more frequently than mastectomy (palpation 54.2%; mammography 72.9%, p&lt;0.001) but cancers detected through palpation were more likely to undergo mastectomy procedures. Conclusions: Results of this study validate the importance of annual screening mammography in women older than 50 years, and women aged 40 to 49 years recently omitted from screening guidelines. There was an increased prevalence of palpation for the method of detection in women less than 50 years of age. If screening mammography is omitted in this group, cancers when detected may be of a more advanced stage and result in more mastectomies. This study also supports the use of palpation as a method of detection despite recent recommendations against teaching self breast exams by USPSTF.

Quality varies across clinical practice guidelines for mammography screening in women aged 40–49 years as assessed by AGREE and AMSTAR instruments

Objective To assess the quality of clinical practice guidelines providing recommendations on the frequency of mammography screening in asymptomatic, average-risk women 40–49 years of age. Study Design and Setting We searched the National Guideline Clearinghouse and MEDLINE for guidelines published from 2005 to 2010. Five independent assessors rated the quality of each guideline and its underlying evidence review using the Appraisal of Guidelines for Research and Evaluation (AGREE) and Assessment of Multiple Systematic Reviews (AMSTAR) instruments, respectively. Results Eleven guidelines were appraised. Ten referenced an underlying evidence review; two referenced the same review. Three reviews were rated good, one was moderate, and five were rated poor quality. On overall assessment of the quality of the guidelines, two were strongly recommended, two were recommended with provisos, and seven were either not recommended or the assessors were unsure whether to recommend it. Most guidelines clearly presented their recommendations, but the rigor of development, applicability, and stakeholder involvement varied. Seven guidelines recommended mammography screening as part of a periodic health examination and four recommended individualized screening in the target population. The latter four guidelines were based on good-quality reviews and three were recommended by the assessors. Conclusion Guideline users need to be aware of the variability in quality and identify the high-quality guidelines that meet their needs.