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

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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.

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Acknowledgements

Contributors

Breast Cancer Surveillance Consortium Grand Opportunity Steering Committee.

Funders

This work was funded by a Grand Opportunity grant from the National Cancer Institute 1 RC2 CA148577 and a program project funded by the National Cancer Institute (PO1 CA154292). Data collection was supported by the National Cancer Institute-funded Breast Cancer Surveillance Consortium co-operative agreement (U01CA63740, U01CA86076, U01CA86082, U01CA63736, U01CA70013, U01CA69976, U01CA63731, U01CA70040, HHSN261201100031C). False positive recall/ biopsy analysis was also supported by NCI grant R03CA150007. The collection of cancer and vital status data used in this study was supported in part by several state public health departments and cancer registries throughout the U.S. For a full description of these sources, please see: http://breastscreening.cancer.gov/work/acknowledgement.html. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. We thank the participating women, mammography facilities, and radiologists for the data they have provided for this study. A list of the BCSC investigators and procedures for requesting BCSC data for research purposes are provided at: http://breastscreening.cancer.gov/.

Conflict of Interest

Authors declare: no support from any organization other than NCI for the submitted work, no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years, and no other relationships or activities that could appear to have influenced the submitted work.

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Authors and Affiliations

  1. Departments of Hematology/Oncology, University of Vermont, College of Medicine, Given E-214 89, Beaumont Ave, Burlington, VT, 05405, USA

    Kim Dittus MD, PhD

  2. Family Medicine and Radiology Departments, University of Vermont, College of Medicine, Burlington, VT, USA

    Berta Geller EdD

  3. Department of Pathology, University of Vermont, College of Medicine, Burlington, VT, USA

    Donald L. Weaver MD

  4. Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA

    Karla Kerlikowske MD & Dejana Braithwaite PhD

  5. Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA

    Weiwei Zhu MS, Rebecca Hubbard PhD, Ellen S. O’Meara PhD & Diana L. Miglioretti PhD

  6. Department of Biostatistics, University of Washington, Seattle, WA, USA

    Rebecca Hubbard PhD

  7. Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA

    Diana L. Miglioretti PhD

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  1. Kim Dittus MD, PhD
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Correspondence to Kim Dittus MD, PhD.

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Dittus, K., Geller, B., Weaver, D.L. et al. Impact of Mammography Screening Interval on Breast Cancer Diagnosis by Menopausal Status and BMI. J GEN INTERN MED 28, 1454–1462 (2013). https://doi.org/10.1007/s11606-013-2507-0

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  • DOI: https://doi.org/10.1007/s11606-013-2507-0

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