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Accuracy of screening mammography in women with a history of lobular carcinoma in situ or atypical hyperplasia of the breast

  • Epidemiology
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Abstract

Women with lobular carcinoma in situ (LCIS), atypical lobular hyperplasia (ALH), atypical ductal hyperplasia (ADH), or atypical hyperplasia (AH) are at increased breast cancer (BC) risk. We investigated the accuracy and outcomes of mammography screening in women with histology-proven LCIS, ALH, ADH, or AH history who had screening through Breast Cancer Surveillance Consortium-affiliated mammography facilities. Screens from two cohorts, defined by LCIS/ALH or ADH/AH history, were compared to two cohorts without such history mammogram-matched for age-group, breast density, family history, screen-year, and mammography registry. Overall 359 BCs (277 invasive BC) occurred within 1 year from screening among 52,380 screens. In the LCIS/ALH cohort [versus comparator screens] cancer incidence rates, cancer detection rates (CDR), and interval cancer rates (ICR) were significantly higher (all P < 0.001); although ICR was 4.4/1,000 screens [versus 0.9/1,000; P < 0.001] the proportion that were interval cancers did not differ between compared cohorts (P = 0.43); screening sensitivity was 76.1 % [versus 82.3 %; P = 0.43], however, specificity was significantly lower at 85.1 % [versus 90.7 %; P < 0.0001]. In the ADH/AH cohort [versus comparator] cancer rates and CDR were significantly higher (P < 0.001); although ICR was 2.6/1,000 screens [versus 0.9/1,000; P = 0.002] the proportion that were interval cancers did not differ between cohorts (P = 0.74); screening sensitivity was 81.0 % [versus 82.6 %; P = 0.74] and specificity was lower at 86.2 % [versus 90.2 %; P < 0.0001]. Mammography screening sensitivity in LCIS/ALH and ADH/AH cohorts did not significantly differ from that of matched screens, however, specificity was lower, and ICRs were higher (reflecting underlying cancer rates). Adjunct screening may be of value in these women if it reduces ICR without substantially reducing specificity.

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Acknowledgments

Data and analytic support were provided by the National Cancer Institute-funded BCSC (HHSN261201100031C, P01CA154292). Collection of cancer data was supported by several state public health departments and cancer registries throughout the US. These sources are described at: http://www.breastscreening.cancer.gov/work/acknowledgement.html. We thank the participating women, mammography facilities, and radiologists for data provided for this study. A list of the BCSC investigators and procedures for requesting data for research are available at: http://breastscreening.cancer.gov/. N. Houssami receives research support from the National Breast Cancer Foundation (NBCF Australia).

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Authors and Affiliations

  1. Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia

    Nehmat Houssami

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

    Linn A. Abraham & Diana L. Miglioretti

  3. Department of Community and Family Medicine, Norris Cotton Cancer Center, and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA

    Tracy Onega

  4. Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA

    Laura C. Collins

  5. Department of Surgery and Office of Health Promotion Research, University of Vermont, Burlington, VT, USA

    Brian L. Sprague

  6. Department of Internal Medicine and Cancer Research and Treatment Center, University of New Mexico, Albuquerque, NM, USA

    Deirdre A. Hill

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

    Diana L. Miglioretti

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  1. Nehmat Houssami
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  2. Linn A. Abraham
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  3. Tracy Onega
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  4. Laura C. Collins
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  5. Brian L. Sprague
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  6. Deirdre A. Hill
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  7. Diana L. Miglioretti
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Correspondence to Nehmat Houssami.

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Houssami, N., Abraham, L.A., Onega, T. et al. Accuracy of screening mammography in women with a history of lobular carcinoma in situ or atypical hyperplasia of the breast. Breast Cancer Res Treat 145, 765–773 (2014). https://doi.org/10.1007/s10549-014-2965-z

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  • DOI: https://doi.org/10.1007/s10549-014-2965-z

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