Outcomes of Screening Mammography by Frequency, Breast Density, and Postmenopausal Hormone Therapy Outcomes of Screening Mammography

Kerlikowske K, Zhu W, Hubbard RA, et al. — Mon, 13 May 2013 00:00:00 GMT

Importance

Controversy exists about the frequency women should undergo screening mammography and whether screening interval should vary according to risk factors beyond age.

Objective

To compare the benefits and harms of screening mammography frequencies according to age, breast density, and postmenopausal hormone therapy (HT) use.

Design

Prospective cohort.

Setting

Data collected January 1994 to December 2008 from mammography facilities in community practice that participate in the Breast Cancer Surveillance Consortium (BCSC) mammography registries.

Participants

Data were collected prospectively on 11 474 women with breast cancer and 922 624 without breast cancer who underwent mammography at facilities that participate in the BCSC.

Main Outcomes and Measures

We used logistic regression to calculate the odds of advanced stage (IIb, III, or IV) and large tumors (>20 mm in diameter) and 10-year cumulative probability of a false-positive mammography result by screening frequency, age, breast density, and HT use. The main predictor was screening mammography interval.

Results

Mammography biennially vs annually for women aged 50 to 74 years does not increase risk of tumors with advanced stage or large size regardless of women's breast density or HT use. Among women aged 40 to 49 years with extremely dense breasts, biennial mammography vs annual is associated with increased risk of advanced-stage cancer (odds ratio [OR], 1.89; 95% CI, 1.06-3.39) and large tumors (OR, 2.39; 95% CI, 1.37-4.18). Cumulative probability of a false-positive mammography result was high among women undergoing annual mammography with extremely dense breasts who were either aged 40 to 49 years (65.5%) or used estrogen plus progestogen (65.8%) and was lower among women aged 50 to 74 years who underwent biennial or triennial mammography with scattered fibroglandular densities (30.7% and 21.9%, respectively) or fatty breasts (17.4% and 12.1%, respectively).

Conclusions and Relevance

Women aged 50 to 74 years, even those with high breast density or HT use, who undergo biennial screening mammography have similar risk of advanced-stage disease and lower cumulative risk of false-positive results than those who undergo annual mammography. When deciding whether to undergo mammography, women aged 40 to 49 years who have extremely dense breasts should be informed that annual mammography may minimize their risk of advanced-stage disease but the cumulative risk of false-positive results is high.

Womb to Grow Womb to Grow

Mu EW. — Mon, 13 May 2013 00:00:00 GMT

I first met Emily during my third year of medical school, and she deeply impressed upon me that in matters of the womb, patient wishes define when less is more. Emily was a 33-year-old woman (gravida 0, para 0) admitted for fever and right flank pain lasting several weeks. Emily's diagnosis was initially elusive. She had received a full course of antibiotics to treat suspected pyelonephritis. However, when her pain, leukocytosis, and fever persisted, we searched for another source of infection. A transvaginal ultrasound examination ultimately revealed extensive endometriosis and 2 large cystic masses in the right ovary that were the likely source of her infection.

JAMA Internal Medicine: Obstetrics/Gynecology Topic Collection

Outcomes of Screening Mammography by Frequency, Breast Density, and Postmenopausal Hormone Therapy Outcomes of Screening Mammography

Womb to Grow Womb to Grow