Journal of General Internal Medicine

, Volume 28, Issue 11, pp 1454–1462

Impact of Mammography Screening Interval on Breast Cancer Diagnosis by Menopausal Status and BMI

  • Kim Dittus
  • Berta Geller
  • Donald L. Weaver
  • Karla Kerlikowske
  • Weiwei Zhu
  • Rebecca Hubbard
  • Dejana Braithwaite
  • Ellen S. O’Meara
  • Diana L. Miglioretti
  • For the Breast Cancer Surveillance Consortium
Article

DOI: 10.1007/s11606-013-2507-0

Cite this article as:
Dittus, K., Geller, B., Weaver, D.L. et al. J GEN INTERN MED (2013) 28: 1454. doi:10.1007/s11606-013-2507-0

ABSTRACT

BACKGROUND

Controversy remains regarding the frequency of screening mammography. Women with different risks for developing breast cancer because of body mass index (BMI) may benefit from tailored recommendations.

OBJECTIVE

To determine the impact of mammography screening interval for women who are normal weight (BMI < 25), overweight (BMI 25–29.9), or obese (BMI ≥ 30), stratified by menopausal status.

DESIGN

Two cohorts selected from the Breast Cancer Surveillance Consortium. Patient and mammography data were linked to pathology databases and tumor registries.

PARTICIPANTS

The cohort included 4,432 women aged 40–74 with breast cancer; the false-positive analysis included a cohort of 553,343 women aged 40–74 without breast cancer.

MAIN MEASURES

Stage, tumor size and lymph node status by BMI and screening interval (biennial vs. annual). Cumulative probability of false-positive recall or biopsy by BMI and screening interval. Analyses were stratified by menopausal status.

KEY RESULTS

Premenopausal obese women undergoing biennial screening had a non-significantly increased odds of a tumor size > 20 mm relative to annual screeners (odds ratio [OR] = 2.07; 95 % confidence interval [CI] 0.997 to 4.30). Across all BMI categories from normal to obese, postmenopausal women with breast cancer did not present with higher stage, larger tumor size or node positive tumors if they received biennial rather than annual screening. False-positive recall and biopsy recommendations were more common among annually screened women.

CONCLUSION

The only negative outcome identified for biennial vs. annual screening was a larger tumor size (> 20 mm) among obese premenopausal women. Since annual mammography does not improve stage at diagnosis compared to biennial screening and false-positive recall/biopsy rates are higher with annual screening, women and their primary care providers should weigh the harms and benefits when deciding on annual versus biennial screening.

KEY WORDS

mammography BMI menopausal status 

Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Kim Dittus
    • 1
  • Berta Geller
    • 2
  • Donald L. Weaver
    • 3
  • Karla Kerlikowske
    • 4
  • Weiwei Zhu
    • 5
  • Rebecca Hubbard
    • 5
    • 6
  • Dejana Braithwaite
    • 4
  • Ellen S. O’Meara
    • 5
  • Diana L. Miglioretti
    • 5
    • 7
  • For the Breast Cancer Surveillance Consortium
  1. 1.Departments of Hematology/OncologyUniversity of Vermont, College of MedicineBurlingtonUSA
  2. 2.Family Medicine and Radiology DepartmentsUniversity of Vermont, College of MedicineBurlingtonUSA
  3. 3.Department of PathologyUniversity of Vermont, College of MedicineBurlingtonUSA
  4. 4.Departments of Medicine and Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoUSA
  5. 5.Group Health Research Institute, Group Health CooperativeSeattleUSA
  6. 6.Department of BiostatisticsUniversity of WashingtonSeattleUSA
  7. 7.Division of Biostatistics, Department of Public Health SciencesUniversity of California Davis School of MedicineDavisUSA

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