Mammography in patients with history of early breast cancer

January 01, 0001

Mammography in patients with history of early breast cancer

Mammography as a screening tool has been a point of discussion, especially with the recent USPSTF recommendations. These Australian and US researched examined the mammography screening in women with a past history of breast cancer (PHBC) relative to screening for women no such history. They performed a cohort study of women with early breast cancer (in situ to Stage 2, n=19,078), mammogram matched to non-PHBC women (n=55,315), using the Breast Cancer Surveillance Consortium.

The researchers found: "Within 1 year after screening, 655 cancers were observed in PHBC women (499 invasive, 156 in situ) and 342 cancers (285 invasive, 57 in situ) in non-PHBC women. Screening accuracy and outcomes in PHBC relative to non-PHBC women were cancer rates of 10.5 per 1000 screens (vs 5.8 per 1000 screens, cancer detection rate of 6.8 per 1000 screens vs 4.4 per 1000 screens, interval cancer rate of 3.6 per 1000 screens vs 1.4 per 1000 screens, sensitivity 65.4% vs 76.5%, specificity 98.3% vs 99.0%, abnormal mammogram results in 2.3% vs 1.4%. Screening sensitivity in PHBC women was higher for detection of in situ cancer (78.7%) than invasive cancer, lower in the initial 5 years (60.2%) than after 5 years from first cancer (70.8%), and was similar for detection of ipsilateral cancer (66.3%) and contralateral cancer (66.1%). Screen-detected and interval cancers in women with and without PHBC were predominantly early stage."

The researchers concluded: "Mammography screening in PHBC women detects early-stage second breast cancers but has lower sensitivity and higher interval cancer rate, despite more evaluation and higher underlying cancer rate, relative to that in non-PHBC women."

Mammography is not as sensitive in women with history of early breast cancer, a population with higher rates of cancer.

For the full abstract, click here.

JAMA 305(8):790-799, 23 February 2011 © 2011 American Medical Association
Accuracy and Outcomes of Screening Mammography in Women With a Personal History of Early-Stage Breast Cancer. Nehmat Houssami, Linn A. Abraham, Diana L. Miglioretti, et al.

Category: X. Female Genital System, Breast. Keywords: breast cancer, mammography, screening, in situ, invasive, cohort study, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 11 March 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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