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Mammography continues to be beneficial in younger women
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ASCO 2011 Breast Cancer Symposium
SAN FRANCISCO - Mammography and self-breast exams continue to be an important tool to detect breast cancer, even among women aged 40 to 49 years, the age range in which the benefit of mammography has been called into question by the US Preventive Services Task Force.
Jamie Caughran, MD, medical director of the Comprehensive Breast Center at the Lacks Cancer Center in Grand Rapids, Mich., and colleagues used data from Michigan's breast cancer registry to examine how the 2009 US Preventive Services Task Force breast cancer screening recommendations could affect future breast cancer detection. They analyzed data on breast cancer diagnosis and treatment in 5,903 women between 2006 and 2009.
They found that 65.5% of breast cancers were detected by mammography, 29.8% were detected by palpation and 4.7% were detected by other methods. Most women with breast cancers detected by mammography were aged older than 50 years. Among women whose tumors were found by palpation, 40% were aged younger than 50 years. Among women aged younger than 50 years, cancers were detected by mammography in 48.3% of the women vs. 41.6% detected by palpation.
Patients with palpable presentations were younger than those diagnosed by mammography: 55.8 years vs. 61.2 years (P<.001). Patients also presented at later stages in the palpation group, and mastectomy was performed more often in the palpation group. Chemotherapy was also given more frequently to women in the palpation group.
"Women who have mammographically detected cancer present at earlier stages are more likely to undergo breast conservation and not require chemotherapy," Caughran said. "Annual screening mammograms and evaluation of palpable masses are important tools in breast cancer detection."
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Disclosure: Dr. Caughran reports no relevant financial disclosures.
This is a very important work for a number of reasons. There has been controversy regarding the screening of breast cancer using mammography in younger women. We certainly know that younger women have denser breast tissue, which can reduce the sensitivity of mammography compared to older women. But it doesn't negate the utility of mammography as a screening tool. A lot of the debate of the utility of mammography has been its impact on OS and breast cancer-specific survival. These are the most important endpoints. But this study raises another important issue, and that is the use of screening in younger populations has led to a lower rate of mastectomy because of the earlier detection of cancers, and also the lower likelihood of needing to use adjuvant chemotherapy. As a medical oncologist, this is a very important gain, independent of any potential survival benefit. Having less disfiguring surgery and the ability to deliver less chemotherapy based on the stage at diagnosis is a step forward. Undoubtedly, this area will continue to be an area of controversy for some, but certainly women in this age group would be well served to know about this data.
– Andrew D. Seidman, MD
Attending physician, Memorial Sloan-Kettering Cancer Center
Earn CME this spring at the HemOnc Today Breast Cancer Review & Perspective meeting to be held March 23-24, 2012 at the Hilton San Diego Bayfront. See details at HemOncTodayBreastCancer.com.
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