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

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