Annals of Surgical Oncology

, 18:3066 | Cite as

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

  • Nicole Shen
  • Linda Sue Hammonds
  • Dick Madsen
  • Paul Dale
American Society of Breast Surgeons

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.

References

  1. 1.
    American Cancer Society. What are the key statistics about breast cancer? 2011. Available: www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-key-statistics [accessed January 3, 2011].
  2. 2.
    Tabar L, Vitak B, Chen HH, Yen MF, Duffy SW, Smith RA. Beyond randomized controlled trials: organized mammographic screening substantially reduces breast carcinoma mortality. Cancer. 2001;91:1724–31.PubMedCrossRefGoogle Scholar
  3. 3.
    Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L. Screening for breast cancer: an update for the U.S. Preventive Services Task Force. Ann Intern Med. 2009;151:727–37, W237–742.Google Scholar
  4. 4.
    Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151:716–726, W-236.Google Scholar
  5. 5.
    Screening for breast cancer: recommendations and rationale. Ann Intern Med. 2002;137(5 Part 1):344–6.Google Scholar
  6. 6.
    Briss P, Rimer B, Reilley B, Coates RC, Lee NC, Mullen P, et al. Promoting informed decisions about cancer screening in communities and healthcare systems. Am J Prev Med. 2004;26:67–80.PubMedCrossRefGoogle Scholar
  7. 7.
    Ichikawa LE, Barlow WE, Anderson ML, Taplin SH, Geller BM, Brenner RJ. Time trends in radiologists’ interpretive performance at screening mammography from the community-based Breast Cancer Surveillance Consortium, 1996–2004. Radiology. 2010;256:74–82.PubMedCrossRefGoogle Scholar
  8. 8.
    Yaffe MJ, Mainprize JG. Risk of radiation-induced breast cancer from mammographic screening. Radiology. 2011;258:98–105.PubMedCrossRefGoogle Scholar
  9. 9.
    Gibson CJ, Weiss J, Goodrich M, Onega T. False-positive mammography and depressed mood in a screening population: findings from the New Hampshire Mammography Network. J Public Health (Oxf). 2009;31:554–60.CrossRefGoogle Scholar
  10. 10.
    Hendrick RE, Helvie MA. United States Preventive Services Task Force screening mammography recommendations: science ignored. AJR Am J Roentgenol. 2011;196:W112–116.PubMedCrossRefGoogle Scholar
  11. 11.
    Cady B, Michaelson JS, Chung MA. The “tipping point” for breast cancer mortality decline has resulted from size reductions due to mammographic screening. Ann Surg Oncol. 2011;18:903–6.PubMedCrossRefGoogle Scholar
  12. 12.
    American Cancer Society. Breast Cancer Facts and Figures 2009–2010. Atlanta, GA: American Cancer Society, Inc. 2009.Google Scholar
  13. 13.
    Spencer DB, Potter JE, Chung MA, Fulton J, Hebert W, Cady B. Mammographic screening and disease presentation of breast cancer patients who die of disease. Breast J. 2004;10:298–303.PubMedCrossRefGoogle Scholar
  14. 14.
    Jorgensen KJ, Zahl PH, Gotzsche PC. Breast cancer mortality in organised mammography screening in Denmark: comparative study. BMJ. 2010;340:c1241.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Nicole Shen
    • 1
  • Linda Sue Hammonds
    • 2
  • Dick Madsen
    • 3
  • Paul Dale
    • 2
  1. 1.University of Missouri School of MedicineColumbiaUSA
  2. 2.Surgical OncologyUniversity of Missouri School of MedicineColumbiaUSA
  3. 3.BiostatisticsUniversity of Missouri School of MedicineColumbiaUSA

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