All Title Author
Keywords Abstract

Screening prior to Breast Cancer Diagnosis: The More Things Change, the More They Stay the Same

DOI: 10.1155/2013/327567

Full-Text   Cite this paper   Add to My Lib


Purpose. In November 2009, the U.S. Preventative Service Task Force (USPSTF) revised their breast cancer screening guidelines. We evaluated the pattern of screening subsequent to the altered guidelines in a cohort of women. Methods. Our database was queried for the following variables: age, race, method of diagnosis, mass palpability, screening frequency, histology, and stage. Statistical analyses were performed using Pearson’s chi-square and Fisher’s exact tests. Results. 1112 women were diagnosed with breast cancer from January 2010 to 2012. The median age at diagnosis was 60 years. Most cancers were detected on mammography (61%). The majority of patients had invasive ductal carcinoma (59%), stage 0 (23%), and stage 1 (50%) cancers. The frequency of screening did not change significantly over time ( ). However, nonregular screeners had an increased risk of being diagnosed with later stage breast cancer ( ) and were more likely to present with a palpable mass compared to regular screeners (56% versus 21%; ). Conclusions. In our study, screening behavior did not significantly change in the years following the USPSTF guidelines. These results suggest that women who are not screened annually are at increased risk of a delay in breast cancer diagnosis, which may impact treatment options and outcomes. 1. Introduction Breast cancer is the most common invasive cancer in women, with upwards of 1 in 8 women being affected during their lifetime. In 2013, it is estimated that over 230,000 women will be diagnosed with breast cancer. While the incidence rate for invasive breast cancer has increased slightly from 2005 to 2009, the death rate continues to steadily decline [1]. The consistent reduction in breast cancer mortality began in the 1990s, around the time medicare approved coverage for screening mammography [2], and is largely a reflection of improvements in early detection and/or treatment [3]. Despite years of clinical research that demonstrate a reduction in breast cancer mortality attributable to screening mammography [3–6], in November 2009, the United States Preventative Services Task Force (USPSTF) published updated guidelines for breast cancer screening that markedly differed from their last update in 2002 and significantly decreased recommended screening. These updates recommended against routine mammographic screening for women aged 40–49 suggested biennial rather than annual screening for women aged 50 to 74 and opposed screening for women aged 75 and older. These revised guidelines led to a great deal of controversy as they are divergent from


[1]  R. Siegel, D. Naishadham, and A. Jemal, “Cancer statistics, 2012,” CA Cancer Journal for Clinicians, vol. 62, no. 1, pp. 10–29, 2012.
[2]  B. R. Hirsch and G. H. Lyman, “Breast cancer screening with mammography,” Current Oncology Reports, vol. 13, no. 1, pp. 63–70, 2011.
[3]  D. A. Berry, K. A. Cronin, S. K. Plevritis et al., “Effect of screening and adjuvant therapy on mortality from breast cancer,” The New England Journal of Medicine, vol. 353, no. 17, pp. 1784–1792, 2005.
[4]  P. C. G?tzsche and M. Nielsen, “Screening for breast cancer with mammography,” Cochrane Database of Systematic Reviews, no. 1, Article ID CD001877, 2011.
[5]  B. Cady, J. S. Michaelson, and M. A. Chung, “The “tipping point” for breast cancer mortality decline has resulted from size reductions due to mammographic screening,” Annals of Surgical Oncology, vol. 18, no. 4, pp. 903–906, 2011.
[6]  L. Tabár, B. Vitak, H. H. Chen, M. F. Yen, S. W. Duffy, and R. A. Smith, “Beyond randomized controlled trials: organized mammographic screening substantially reduces breast carcinoma mortality,” Cancer, vol. 91, no. 9, pp. 1724–1731, 2001.
[7]  R. A. Smith, V. Cokkinides, and O. W. Brawley, “Cancer screening in the United States, 2012: a review of current American Cancer Society guidelines and current issues in cancer screening,” CA Cancer Journal for Clinicians, vol. 62, no. 2, pp. 129–142, 2012.
[8]  S. Mook, L. J. Van 'T Veer, E. J. Rutgers et al., “Independent prognostic value of screen detection in invasive breast cancer,” Journal of the National Cancer Institute, vol. 103, no. 7, pp. 585–597, 2011.
[9]  H. D. Nelson, K. Tyne, A. Naik et al., “Screening for breast cancer: an update for the U.S. Preventive Services Task Force,” Annals of Internal Medicine, vol. 151, no. 10, pp. 727–737, 2009.
[10]  J. S. Mandelblatt, K. A. Cronin, S. Bailey et al., “Effects of mammography screening under different screening schedules: model estimates of potential benefits and harms,” Annals of Internal Medicine, vol. 151, no. 10, pp. 738–747, 2009.
[11]  N. G. Coburn, M. A. Chung, J. Fulton, and B. Cady, “Decreased breast cancer tumor size, stage, and mortality in Rhode Island: an example of a well-screened population,” Cancer Control, vol. 11, no. 4, pp. 222–230, 2004.
[12]  A. C. Society, Breast Cancer Facts & Figures 2011-2012, American Cancer Society, Atlanta, Ga, USA, 2012.
[13]  P. Autier, C. Héry, J. Haukka, M. Boniol, and G. Byrnes, “Advanced breast cancer and breast cancer mortality in randomized controlled trials on mammography screening,” Journal of Clinical Oncology, vol. 27, no. 35, pp. 5919–5923, 2009.
[14]  J. A. Malmgren, J. Parikh, M. K. Atwood, and H. G. Kaplan, “Impact of mammography detection on the course of breast cancer in women aged 40-49 years,” Radiology, vol. 262, no. 3, pp. 797–806, 2012.
[15]  E. S. Hwang, D. Y. Lichtensztajn, S. L. Gomez, B. Fowble, and C. A. Clarke, “Survival after lumpectomy and mastectomy for early stage invasive breast cancer: the effect of age and hormone receptor status,” Cancer, vol. 119, no. 7, pp. 1402–1411, 2013.
[16]  W. A. Berg, “Benefits of screening mammography,” The Journal of the American Medical Association, vol. 303, no. 2, pp. 168–169, 2010.


comments powered by Disqus

Contact Us


微信:OALib Journal