, Volume 18, Issue 11, pp 3066-3071
Date: 24 Aug 2011

Mammography in 40-Year-Old Women: What Difference Does It Make? The Potential Impact of the U.S. Preventative Services Task Force (USPSTF) Mammography Guidelines

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Abstract

Background

This 10-year retrospective chart review evaluates the potential impact the most recent U.S. Preventative Services Task Force (USPSTF) report recommending against annual mammographic screening of women aged 40–49 years.

Methods

The medical record database was systematically searched to discover all women aged 40–49 years treated for breast cancer over a 10-year period. These women were separated into 2 cohorts—mammographically detected cancer (MDC) and nonmammographically detected cancer (NMDC). Statistical analysis of the cohorts was performed for family history (FH), sentinel lymph node (SLN) status, tumor size at presentation, and disease-free and overall survival.

Results

A total of 1581 women were treated for breast cancer; of these, 311 were between the ages of 40 and 49 years with complete diagnostic information, 145 were MDC, and 166 were NMDC. The average tumor diameter of the MDC group was 20.68 mm, which was significantly smaller than that of the NMDC group at 30.38 mm (P < .0001). Women with MDC had a significantly lower incidence of SLN positive cancer than the NMDC group, 28 of 113 (24.78%) vs. 85 of 152 (55.92%; P < .0001), respectively. The 5-year disease-free survival for both groups was MDC 94% (95% confidence interval [95% CI], 87–97%) and NMDC 71% (95% CI 62–78%). The overall 5-year survival estimates were MDC 97% (95% CI 92–99%) and NMDC 78% (95% CI 69–85%), respectively.

Conclusion

This review demonstrates the significance of mammographic screening for early detection and treatment of breast cancer. Mammographic screening in women aged 40–49 detected smaller tumors with less nodal metastasis, resulting in improved survival, which supports annual mammographic screening in this age group.