Impact Of Screening Mammography Research Articles

Feasibility of Prospective Assignment of Initial Method of Detection of Breast Cancer: A Multicenter Pilot Study

ObjectiveTo determine the feasibility of standardized, prospective assignment of initial method of detection (MOD) of breast cancer by radiologists in diverse practice settings. MethodsThis multicenter, retrospective study analyzed the rate of assignment of MOD in four geographically varied health systems. A universal protocol for basic MOD assignment was agreed upon by the authors before start of the pilot study. Radiologists at each site were instructed how to assign MOD. Charts were then reviewed to determine the frequency and accuracy of MOD assignment for all cases subsequently diagnosed with breast cancer. When available, data regarding frequency of tumor registry abstraction were also reviewed for frequency and accuracy. ResultsA total of 2,328 patients with a new diagnosis of breast cancer were evaluated across the sites over the study period. Of these patients, initial MOD was prospectively assigned by the radiologist in 94% of cases. Of the cases in which MOD was assigned, retrospective review confirmed accurate assignment in 96% of cases. ConclusionsProspective, standardized assignment of initial MOD of breast cancer is feasible across different practice sites and can be accurately captured in tumor registries. Standard collection of MOD would provide critical data about the impact of screening mammography in the United States.

ASO Visual Abstract: Impact of Screening Mammography on Treatment in Young Women Diagnosed with Breast Cancer

ASO Visual Abstract: Impact of Screening Mammography on Treatment in Young Women Diagnosed with Breast Cancer

Mode of detection matters: Differences in screen-detected versus symptomatic breast cancers

ObjectiveAlthough extensive analyses evaluating screening mammography for breast cancer have been published, some utilized databases do not distinguish between modes of detection, which confounds the conclusions made about the impact of screening mammography. MethodsA retrospective cohort study of women at our institution with pathologically-proven breast cancer from January 2015 to April 2018 was conducted. Subjects were categorized by their mode of diagnosis: screening or non-screening. Patient demographics, tumor characteristics, and treatments were compared between detection methods using Wilcoxon rank-sum test for continuous variables and chi-squared or Fisher's exact test. Results1026 breast cancers were analyzed. 80.8% of screen-detected breast cancers were invasive. Compared to symptomatically detected cancers, screen-detected were smaller (median size 8 mm vs. 15 mm, p < 0.001), less invasive (80.8% vs. 94.3), had a lower pathologic grade (29% grade 3 vs. 45.7%, p < 0.001), a lower clinical stage, and less aggressive histology (51.9% low Ki67 vs. 30.5%, and 88.2% HER2 negative vs. 76.6%, p < 0.001). Screen-detected cancers were less likely to have extramammary disease (13.2% positive lymph nodes vs. 34.0% and 0.4% distant metastases vs. 6.9%, p < 0.001). Women with screen-detected cancers were more likely to undergo conservative treatment (74.8% underwent lumpectomy vs. 59.9%, and 80.0% received no chemotherapy vs. 51.3%, p < 0.001). ConclusionIn this study, while the vast majority of screen-detected cancers were invasive, they were more likely to be smaller, less aggressive, and a lower pathologic grade and clinical stage. Furthermore, women with screen-detected cancers were less likely to have extramammary disease and more likely to undergo conservative treatment.

Abstract A005: Would black women benefit from a screening mammography schedule that differs from that recommended for the overall population? A simulation modeling study

Abstract Background: For breast cancer, black women experience younger mean age at diagnosis, higher incidence of triple negative disease, and higher mortality compared to the overall population. These epidemiological differences raise the question of whether different screening mammography schedules for black women might produce similar benefit-to-harm ratio as those currently recommended for the overall population. Methods: We used the Georgetown-Einstein Cancer Intervention and Surveillance Modeling Network (CISNET) model to compare the benefit-to-harm ratios of a variety of digital mammography screening schedules for black women and white women. We updated the models with a variety of race-specific inputs, including non-breast cancer (competing) mortality, breast density, mammography sensitivity, breast cancer incidence with and without screening, estrogen (ER) and Her-2 receptor distributions, and stage distributions. Within age, stage, and ER/Her-2 receptor strata, we assumed that breast cancer biology was the same across races, as reflected by equal sojourn, stage dwell time and treatment efficacy. The objective of this study was to isolate the impact of screening mammography, not to quantify the impact of differences in screening or treatment completion on disparities. Therefore, in keeping with previously published methods, we assumed 100% dissemination of screening mammography and adjuvant treatment for all races. We investigated annual, biennial, and hybrid screening strategies beginning at age 40, 45, or 50 and concluding at age 74 (e.g. “A40-B50-74” means annually starting at age 40, then biennially at age 50, then stopping at age 74). We quantified the number of mammograms (M), overdiagnoses, false positives (FP), breast cancer deaths averted (BCDA), life years gained (LYG) and their benefit-to-harm ratios (LYG:M, BCDA:M, LYG:FP, BCDA:FP). Results: Biennial strategies (B50-74, B45-74, B40-74) have approximately equal incremental benefit:harm ratios and are superior to annual or hybrid strategies. Hybrid strategies A40B50-74 and B40A50-74 are sometimes efficient, depending on the metric, but have lower incremental benefit:harm ratios than the biennial strategies. Results were similar for black and white women. Conclusions: Despite the fact that black women have a younger mean age at diagnosis, higher incidence of triple negative disease, and higher breast cancer mortality, the relative benefits of different screening mammography schedules do not appear to differ between black and white women. These findings do not support different screening guidelines for black and white women. Future analyses will investigate whether potential racial differences in treatment efficacy might change the relative benefits of different screening mammography schedules. Citation Format: Christina H Chapman, Clyde Schechter, Amy Trentham, Ron Gangnon, Chris Cadham, Jeanne Mandelblatt. Would black women benefit from a screening mammography schedule that differs from that recommended for the overall population? A simulation modeling study [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A005.

Impact of Screening Mammography on 10-Year Overall Survival Based on Breast Cancer Subtypes in Västra Götaland, West Sweden

Impact of Screening Mammography on 10-Year Overall Survival Based on Breast Cancer Subtypes in Västra Götaland, West Sweden

Impact of Screening Mammography on Treatment in Women Diagnosed with Breast Cancer.

Screening mammography reduces breast cancer mortality; however, screening recommendations, ordering, and compliance remain suboptimal and controversies regarding the value of screening persist. We evaluated the influence of screening mammography on the extent of breast cancer treatment. Patients ≥ 40years of age diagnosed with breast cancer from September 2008 to May 2016 at a single institution were divided into two groups: those with screening 1-24 months prior to diagnosis, and those with screening at 25+ months, including patients with no prior mammography. The association between the two groups and various clinical factors were assessed using logistic regression models. Subgroup analysis was performed based on age groups. Analysis included 1125 patients, 819 (73%) with screening at 1-24 months, and 306 (27%) with screening at 25+ months, including 65 (6%) who never had mammography. Overall, patients in the 25+ months group were more likely to receive chemotherapy [odds ratio (OR) 1.51, p=0.0040], undergo mastectomy (OR 1.32, p=0.0465), and require axillary dissection (AD; OR 1.66, p=0.0045) than those in 1-24 months group. On subgroup analysis, patients aged 40-49years with no prior mammography were more likely to have larger tumors (p=0.0323) and positive nodes (OR 4.52, p=0.0058), undergo mastectomy (OR 3.44, p=0.0068), undergo AD (OR 4.64, p=0.0002), and require chemotherapy (OR 2.52, p=0.0287) than the 1-24 months group. Screening mammography is associated with decreased stage at diagnosis and receipt of less-extensive treatment. This was evident in all groups, including the 40-49years age group, where controversy exists on whether screening is even necessary.

Abstract C81: A systematic review of breast cancer screening strategies for African American women

Abstract BACKGROUND: Breast cancer mortality is higher among African American women (AAW) in comparison to any other racial/ethnic group. This disparity is reflective of multiple factors including health care access, biological factors and participation in screening mammography. Currently there is a scarcity of literature on evidence-based interventional strategies to increase AAW's participation in screening mammography. Our study aims to: 1) Identify the literature from 2009-2015 on interventional strategies to increase the participation of AAW ≥40 years old in screening mammography and 2) Summarize the evidence from this literature including any impact of these interventions on breast cancer outcomes. METHODS: We conducted a systematic review of published and grey literature on breast cancer screening interventions from 2009-2015. The literature search was conducted in PubMed, Embase (Elsevier), CINAHL (Ebsco), PsycINFO (Ebsco) and the Cochrane Central Register of Controlled Trials (Wiley). Grey literature was searched for using ClinicalTrials.gov, National Cancer Institute's clinical trials database and ProQuest Dissertations and Theses database. Queries utilized a combination of keywords and database-specific terminology derived from pre-determined eligibility criteria. The four reviewers were divided into two teams to balance expertise in public health, primary care, cancer disparities, breast oncology and breast cancer basic science research. The review protocol was developed with guidance from PRISMA standards. Methodological quality of the studies will be determined by examination of study design, theoretical framework and quality of data reporting. RESULTS: Our literature search yielded a total of 1,83O studies. After removal of duplicates, 1,274 studies were screened for inclusion. Twenty studies met all criteria and were designated for abstraction and data analysis. Nineteen studies presented original data from a US based intervention and had a population which included AAW ≥ 40 years old. Study designs included: randomized control trials, quasi-experimental, pre/post study, non-randomized with controls, cohort and case-control studies. The common interventional strategies employed were reminder systems; trained volunteers; media campaigns; telephone and DVD coaching; and patient navigation/case management. Reported outcome measures included: demographics, pre- and post-intervention mammography participation, and intervention retention rates. Study limitations stemmed from limited sample size, lack of generalizability, absence of theoretical framework, attrition rate and utilization of self-reported data. CONCLUSION: Despite knowledge of disparities in breast cancer mortality for AAW and the impact of screening mammography on breast cancer mortality, there is a paucity of evidence on interventional strategies to increase the participation of AAW in screening mammography. The limited evidence available suggests that interventional strategies that incorporate mass media communication, family and social support networks, and nurse navigation increased the number of AAW who participate in screening mammography. Citation Format: Shana O. Ntiri, Laundette P. Jones, Gonca Kocoglu, Emilie Ludeman, Paula Y. Rosenblatt. A systematic review of breast cancer screening strategies for African American women. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C81.

Impact of screening mammography on breast cancer mortality.

The degree to which observed reductions in breast cancer mortality is attributable to screening mammography has become increasingly controversial. We examined this issue with three fundamentally different approaches: (i) Chronology--the temporal relationship of the onset of breast cancer mortality decline and the national implementation of screening mammography; (ii) Magnitude--the degree to which breast cancer mortality declined relative to the amount (penetration) of screening mammography; (iii) Analogy--the pattern of mortality rate reductions of other cancers for which population screening is not conducted. Chronology and magnitude were assessed with data from Europe and North America, with three methods applied to magnitude. A comparison of eight countries in Europe and North America does not demonstrate a correlation between the penetration of national screening and either the chronology or magnitude of national breast cancer mortality reduction. In the United States, the magnitude of the mortality decline is greater in the unscreened, younger women than in the screened population and regional variation in the rate of breast cancer mortality reduction is not correlated with screening penetrance, either as self-reported or by the magnitude of screening-induced increase in early-stage disease. Analogy analysis of United States data identifies 14 other cancers with a similar distinct onset of mortality reduction for which screening is not performed. These five lines of evidence from three different approaches and additional observations discussed do not support the hypothesis that mammography screening is a primary reason for the breast cancer mortality reduction in Europe and North America.

The contribution of mammography screening to breast cancer incidence trends in the United States: an updated age-period-cohort model.

The impact of screening mammography on breast cancer incidence is difficult to disentangle from cohort- and age-related effects on incidence. We developed an age-period-cohort model of ductal carcinoma in situ (DCIS) and invasive breast cancer incidence in U.S. females using cancer registry data. Five functions were included in the model to estimate stage-specific effects for age, premenopausal birth cohorts, postmenopausal birth cohorts, period (for all years of diagnosis), and a mammography period effect limited to women ages ≥ 40 years after 1982. Incidence with and without the mammography period effect was calculated. More recent birth cohorts have elevated underlying risk compared with earlier cohorts for both pre- and postmenopausal women. Comparing models with and without the mammography period effect showed that overall breast cancer incidence would have been 23.1% lower in the absence of mammography in 2010 (95% confidence intervals, 18.8-27.4), including 14.7% (9.5-19.3) lower for invasive breast cancer and 54.5% (47.4-59.6) lower for DCIS. Incidence of distant-staged breast cancer in 2010 would have been 29.0% (13.1-48.1) greater in the absence of mammography screening. Mammography contributes to markedly elevated rates of DCIS and early-stage invasive cancers, but also contributes to substantial reductions in the incidence of metastatic breast cancer. Mammography is an important tool for reducing the burden of breast cancer, but future work is needed to identify risk factors accounting for increasing underlying incidence and to distinguish between indolent and potentially lethal early-stage breast cancers that are detected via mammography.

Highlights of This Issue

The impact of screening mammography on breast cancer incidence is difficult to disentangle from cohort- and age-related effects. Gangnon and colleagues developed an age–period–cohort model of ductal carcinoma in situ (DCIS) and invasive breast cancer incidence in U.S. females using cancer registry data. Incidence with and without the mammography period effect was calculated. The authors report that mammography contributes to markedly elevated rates of DCIS and early-stage invasive cancers, but also contributes to substantial reductions in the incidence of metastatic breast cancer. While mammography is an important tool for reducing breast cancer burden, the challenge is to distinguish between indolent and potentially lethal early-stage breast cancers via mammography.Breast density assessment improves 5-year breast cancer risk prediction, but the value of sequential breast density measures is unknown. Kerlikowske and colleagues determined if two breast density measures improve the predictive accuracy, compared to one measure. The two-measure model had greater discriminatory accuracy than the one-measure model. Also, the two-measure model improves risk classification for women with a decrease in breast density.In observational studies, aspirin use has been associated with significant reductions in breast cancer mortality; however, it is unclear whether initiating aspirin use after diagnosis is associated with similar reductions in mortality. Barron and colleagues studied associations between de-novo post-diagnostic aspirin use and all-cause, breast cancer–specific mortality. The authors found no association between de-novo aspirin use and breast cancer–specific mortality. Similar null associations were found in women initiating aspirin use after breast cancer diagnosis.Recent studies have identified several putative low-penetrance susceptibility loci for melanoma. Using data from the population-based Genes, Environment, and Melanoma (GEM) Study, Gibbs and colleagues sought to determine the genetic predisposition for multiple primary melanoma. Eleven SNPs in 6 gene neighborhoods (TERT/CLPTM1L, TYRP1, MTAP, TYR, NCOA6, and MX2) were associated with multiple primary melanoma. The authors also identified several SNPs that are significantly associated with multiple primary melanoma. The GEM Study provides additional evidence for the relevance of these genetic regions to melanoma risk.

Impact of screening mammography on mortality from breast cancer before age 60 in women 40 to 49 years of age.

Whether screening mammography programs should include women in their 40s is controversial. In Canada, screening of women aged 40-49 years has not been shown to reduce mortality from breast cancer. Given that screening mammography reduces mean tumour size and that tumour size is inversely associated with survival, the lack of benefit seen with screening is puzzling and suggests a possible adverse effect on mortality of mammography or subsequent treatment (or both) that counterbalances the expected benefit derived from downstaging. We followed 50,436 women 40-49 years of age until age 60 for mortality from breast cancer. Of those women, one half had been randomly assigned to annual mammography and one half to no mammography. The impact of mammography on breast cancer mortality was estimated using a left-censored Cox proportional hazards model. Of 256 deaths from breast cancer recorded in the study cohort, 134 occurred in women allocated to mammography, and 122 occurred in those receiving usual care and not allocated to mammography. The cumulative risk of death from breast cancer to age 60 was 0.53% for women assigned to mammography and 0.48% for women not so assigned. The hazard ratio for breast cancer-specific death associated with 1 or more screening mammograms before age 50 was 1.10 (95% confidence interval: 0.86 to 1.40). Mammography in women 40-49 years of age is associated with a small but nonsignificant increase in the risk of dying of breast cancer before age 60. Caution should be exercised when recommending mammographic screening to women before age 50.

The impact of screening mammography in women age 40-49 as a function of tumor biology.

113 Background: Mammographic screening for women 40-49 years of age remains controversial based on results from earlier large scale, controlled mammography trials. Methods: From 2002-2006, 871 women aged 40-49 were diagnosed with breast cancer at Intermountain. The charts of all patients without a record of a screening mammogram at Intermountain (n= 436) were reviewed to confirm that they had not had a screening mammogram in the prior two years at any facility (Interval Cancers) and their survival was compared to 435 women who had their cancer diagnosed on a screening exam (Screen Detected). All patients were followed for at least 5 years via the tumor registry. Results: Stage distribution for Screen Detected/Interval cancers was 25.3/6.4% stage 0, 36.8/24.8% stage I, 24.6/35.6% stage II, 6.9/20.4% stage III and 0.5/3.4% stage IV. Overall, 67 patients (7.7%) did not have complete staging data. Overall survival was significantly better (p&lt;.0001) for 40-49 year old women with Screen Detected compared to those with Interval cancers. 702 (79.6%) had ER/PR status recorded (83.5% ER/PR positive). Women with DCIS or LCIS did not have tissue sent for markers. 679 patients (76.9%) had HER2 status recorded (78.8% HER2 neg). Of the patients with both HER2 and ER/PR status recorded 10.4% were “triple negative.” Survival following screening mammography was significantly enhanced for women who were ER/PR positive (p&lt;0.0001), HER2 negative (p=0.0065), or HER2 positive (p=0.0013). Survival was not improved by screening mammography for women who were ER/PR negative (p=0.3818) or for women who were triple negative (p=0.416). Conclusions: A minority of women age 40-49 who develop breast cancer (13%) have biologic features suggestive of aggressive disease and, after 5 years of follow up, they are not benefitted by screening mammography. The remaining 87% are clearly benefitted by screening mammography. Our results suggest that the discrepancies noted in the screening mammography trials in 40-49 year old women may have resulted from population variations in the proportion of women with unfavorable biology. Based in part on these results, we continue to recommend regular screening in the 40-49 year old cohort.

Mammographic screening has failed to improve pathohistological characteristics of breast cancers in Split region of Croatia

The national breast cancer screening program has been introduced in Croatia in the second half of 2006 with mammography as the screening method. We investigated the impact of screening mammography on the basic pathohistological characteristics of breast cancers retrieved from the database of large community hospital. The data were collected in the period following the initiation of national mamographic screening program (2007-2011), and compared with the data collected in the period before the program introduction (2002-2006) to explore the possible changing trends. In the screening period 1,320 breast cancers were diagnosed, while in the prescreening period 1,204 breast cancers were diagnosed (p=0.02). We found the reduction of mean tumor size (p=0.039), decrease of the diagnosed non-invasive cancers (p=0.001), and the higher percentage of the diagnosed ductal (p=0.0003) and grade 3 (p=0.038) invasive cancers in the screening period. We also noticed higher percentage of diagnosed advanced breast cancers with unknown tumor size in the screening period (p=0.027). We concluded that the implementation of national screening program did not improve the pathohistological features of breast cancers in our region probably due to low response rate to screening invitation.

Improving size, lymph node metastatic rate, breast conservation, and mortality of invasive breast cancer in Rhode Island women, a well-screened population

The beneficial impact of screening mammography on breast cancer outcome continues to be debated as demonstrated by guidelines published by the United States Preventive Services Task Force. A previous report from Rhode Island, which has a very high rate of mammographic screening, demonstrated significant improvements in invasive breast cancer presentation and mortality through 2001. This report updates data through 2008 to determine whether previous favorable trends continued. Rhode Island Cancer Registry data regarding invasive breast cancer presentation and mortality in 17,522 female residents diagnosed between 1987 and 2008, inclusive, were analyzed for demographic and pathological factors. Data were analyzed by four time periods: 1987-1992, 1993-1998, 1999-2003, and 2004-2008 and overall. Statistically significant improvements occurred over the four successive time periods, in mean cancer size (23.7, 20.9, 19.6, and 19.3 mm, p < 0.0001), pathologic grade (Grade I: 12, 15, 19, and 17 %; Grade III 57, 41, 36, and 35 %, p < 0.0001), breast conserving surgery (38, 56, 67, and 71 %, p < 0.0001) and mortality (37.3, 31.4, 25.1, and 22.6 per 100,000/year, p < 0.0001). The results showed that high screening rates favorably impacted presentation of and mortality from invasive breast cancer in Rhode Island. From 1987 to 2008, there has been a 39 % decline in breast cancer mortality considering 5 year periods (37.3 vs. 22.6 deaths per 100,000) and 41 % comparing the period from 1990 to 2008, which may exceed the goal of 50 % mortality reduction by 2015 established by the American Cancer Society.

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

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

Reducing the effects of lead-time bias, length bias and over-detection in evaluating screening mammography: a censored bivariate data approach

Measuring the benefit of screening mammography is difficult due to lead-time bias, length bias and over-detection. We evaluated the benefit of screening mammography in reducing breast cancer mortality using observational data from the SEER-Medicare linked database. The conceptual model divided the disease duration into two phases: preclinical (T(0)) and symptomatic (T(1)) breast cancer. Censored information for the bivariate response vector ( T(0), T(1)) was observed and used to generate a likelihood function. However, the contribution to the likelihood function for some observations could not be calculated analytically, thus, censoring boundaries for these observations were modified. Inferences about the impact of screening mammography on breast cancer mortality were made based on maximum likelihood estimates derived from this likelihood function. Hazard ratios (95% confidence intervals) of 0.54 (0.48-0.61) and 0.33 (0.26- 0.42) for single and regular users (vs. non-users), respectively, demonstrated a protective effect of screening mammography among women 69 years and older. This method reduced the impact of lead-time bias, length bias and over-detection, which biased the estimated hazard ratios derived from standard survival models in favour of screening.

Screening mammography in old women saves lives: A simulation model

10561 Background: Screening mammography has shown to decrease breast cancer specific death rate by 20–25% and has been recommended in women aged 40 and above, nevertheless, some country service screen programs stop screening in women older than 69, even though the sensitivity and specificity of screening mammography is highest in older women, especially those older than 80 years. The size of the older population is growing exponentially and old women have the highest incidence of breast cancer; one third of breast cancer diagnosis and half the deaths of breast cancer in USA occurred in women aged 70 and above in the year 2000. The aim of this study is to estimate the impact of mammographic screening in women aged 70 and above on breast cancer mortality. Methods: US Census, SEER, CISNET, CDC, HMD, ULTD databases were searched to obtain population data and rates of incidence and mortality of breast cancer by age. In addition, mammography screening bibliography from randomized clinical trials, meta-analysis, and service health programs publications were reviewed to estimate the impact of screening mammography on results for different strata. Analytical and simulation methods were applied for modeling the data with the aid of Mathematica to calculate breast cancer reduction rate. Results: A reduction in breast cancer mortality was observed with a magnitude proportional to age, even after taking into account competing risks of death by other causes in the aging population. Simulation of different scenarios revealed a decrease in breast cancer mortality in the range of 5 to15% for women younger than 50 years, 15 to 25% in the group of women aged 50 to 69, and 25 to 35% in women older than 69. Factors such as population life expectancy, breast cancer incidence, attrition rate in screening or cross-over, overall specificity of mammographic detection, interval of screening, impact the estimations, explaining in part some of the negative results of prevention trials. Conclusions: Reduction of breast cancer mortality by mammographic screening is proportional to age. Women aged 70 and above benefit more from mammographic screening than younger women. No significant financial relationships to disclose.

Ductal Lavage for Early Detection--What Doesn't Come Out in the Wash

Ductal Lavage for Early Detection--What Doesn't Come Out in the Wash

Abstract 44 impact of screening mammography on the size and staging of breast cancer at diagnosis among women with social security disability insurance. Mabel Caban, MD (UTMB, Houston, TX); Jean Freeman, PhD; Jonathan Mahnken, PhD; Margaret Nosek, PhD, e-mail: macaban@utmb.edu

Abstract 44 impact of screening mammography on the size and staging of breast cancer at diagnosis among women with social security disability insurance. Mabel Caban, MD (UTMB, Houston, TX); Jean Freeman, PhD; Jonathan Mahnken, PhD; Margaret Nosek, PhD, e-mail: macaban@utmb.edu

Changes in management techniques and patterns of disease recurrence over time in patients with breast carcinoma treated with breast-conserving therapy at a single institution.

The authors reviewed changes in the initial clinical presentation, management techniques, and patterns of disease recurrence over time (1981-1996) in patients with breast carcinoma treated with breast-conserving therapy (BCT) at a single institution. The goals of the current study were to determine the frequency and use of optimal local and systemic therapy techniques and to evaluate the impact of these changes on treatment efficacy. Six hundred seven patients with American Joint Committee on Cancer Stage I or II invasive breast carcinomas treated with BCT at William Beaumont Hospital (Royal Oak, MI) constituted the study population. All patients received at least an excisional biopsy of the primary tumor, an axillary lymph node staging procedure, and postoperative radiotherapy (RT) (a median tumor bed dose of 61 Gray [Gy] was administered). All sides were reviewed by one pathologist. Numerous clinicopathologic and treatment-related factors were analyzed to monitor changes that occurred over time. Changes in patterns of disease recurrence and treatment efficacy over time also were analyzed. Over the time period analyzed, changes at initial presentation included an increase in the mean age at diagnosis (age 56.1 years vs. 61.4 years; P < 0.001), a decrease in the number of patients with clinically palpable tumors (78% vs. 36%; P < 0.001), a decrease in the mean tumor size (2.2 cm vs. 1.6 cm; P < 0.001), but no change in the percentage of patients with negative lymph nodes (79% vs. 78%; P = 0.83). No differences over time were observed in mean tumor grade (2.0 vs. 1.9; P = 0.2) or the presence of angiolymphatic invasion (27% vs. 26%; P = 0.25). Changes in surgical management and pathologic assessment included the more frequent use of reexcision (46% vs. 81%; P < 0.001), larger mean total volumes of breast tissue specimens excised (115 cm3 vs. 189 cm3; P = 0.001), a larger percentage of patients with final negative surgical margins (74% vs. 97%; P < 0.001), and a small increase in the mean number of lymph nodes excised (13.8 lymph nodes vs. 14.1 lymph nodes; P = 0.01). The only other significant change in the pathologic management of patients over time included a doubling in the mean number of slides examined (10.6 slides vs. 21.1 slides; P < 0.001). Changes in adjuvant local and systemic therapy included an increase in the percentage of patients treated with > 60 Gy to the tumor bed (66% vs. 95%; P < 0.001), a doubling in the mean number of days from the last surgery to the start of RT (24 days vs. 50 days; P < 0.001), and a decrease in the use of regional lymph node RT (24% vs. 8%; P < 0.001). The use of adjuvant tamoxifen increased from 10% to 61% (P < 0.001). Finally, improvements were observed in the 5-year and 12-year actuarial rates of local disease recurrence (8% vs. 1% and 21% vs. 9%, respectively; P = 0.001) and distant metastases (12% vs. 4% and 22% vs. 9%, respectively; P = 0.006). No changes in the mean number of years to ipsilateral (6.5 years vs. 6.4 years; P = 0.59) or distant disease recurrence (4.6 years vs. 3.8 years; P = 0.73) were observed. The impact of screening mammography and substantial changes in surgical, pathologic, RT, and systemic therapy recommendations were observed over time in the study population. These changes were associated with improvements in 5-year and 12-year local and distant control rates and suggested that improvements in outcome can be realized through adherence to best practice guidelines and continuous monitoring of treatment outcome data.