Feature | December 09, 2014

Risk-based Breast Cancer Screening Misses Cancers in Women in Their Forties

Study finds basing screenings on family history and dense breast tissue can miss more than 75 percent of cancers in women in their forties

RSNA 2014, risk-based cancer screenings, mammography

Bilateral MLO views from screening mammography.

RSNA 2014, risk-based cancer screenings, mammography

A spot magnification view demonstrates an irregular spiculated mass with associated calcifications in the upper outer left breast.

RSNA 2014, risk-based cancer screenings, mammography

This is a screening mammogram demonstrating calcifications in the upper outer left breast. Bilateral cranio-caudal views shown here.

December 9, 2014 — A study of breast cancers detected with screening mammography found that strong family history and dense breast tissue were commonly absent in women between the ages of 40 and 49 diagnosed with breast cancer. Results of the study were presented at the annual meeting of the Radiological Society of North America (RSNA).

"Screening recommendations for this age group continue to be debated," said Bonnie N. Joe, M.D., Ph.D., associate professor in residence and chief of women's imaging at University of California, San Francisco (UCSF). "Recent publications have suggested risk-based screening based on family history and breast density. However, our study shows that this approach would miss a significant percentage of invasive cancers and could potentially be dangerous."

The retrospective study, conducted at UCSF, included 136 women between the ages of 40 and 49 with breast cancer identified by screening mammography between 1997 and 2012. Symptomatic patients undergoing diagnostic mammography and those with a personal history of breast cancer were excluded from the study. Patient family history, breast density, type of malignancy, lymph node status and tumor receptor status were recorded.

"Notably, we found that almost 90 percent of the invasive cancers we would have missed using risk-based triage had positive receptor status, meaning they were very treatable and worth finding early," Joe said.

Of the 136 breast cancer cases identified, 50 percent were diagnosed as invasive, and 50 percent were diagnosed as ductal carcinoma in situ (DCIS), an early noninvasive form of breast cancer, although 88 percent of DCIS cases were intermediate or high grade.

A very strong family history was absent in 90 percent of patients, and extremely dense breast tissue was absent in 86 percent. Seventy-eight percent of patients had neither strong family history nor extremely dense breasts, including 79 percent of the cases of invasive disease.

"Our results show that by exclusively using a risk-based approach to screening mammography, we could potentially miss more than 75 percent of breast cancers in women in their 40s, thereby eliminating most of the survival benefit from screening mammography that has been previously shown in randomized controlled trials," Joe said.

She urges proponents of risk-based screening to continue research to find more effective means of risk-based triage.

Routine annual screening mammography has traditionally been recommended by organizations such as the American Cancer Society (ACS) and the American Medical Association (AMA) for all women beginning at age 40. In 2009, the United States Preventive Services Task Force (USPSTF) issued controversial new guidelines recommending screening with mammography every two years beginning at age 50.

"Based on our current knowledge and evidence shown in previous trials, it is still safest to get annual mammograms starting at age 40 in order to maximize the survival benefit of screening mammography," Joe said.

For more information: www.radiologyinfo.org

Related Content

high-intensity focused ultrasound, HIFU, prostate tissue ablation, after radiotherapy, EDAP TMS SA, Ablatherm, British Journal of Urology International study
News | Focused Ultrasound Therapy | March 29, 2017
EDAP TMS SA announced the publication of a peer-reviewed article that analyzed Ablatherm Robotic HIFU (high-intensity...
lung cancer recurrence, biomarker blood test, CT scans, 2017 Multidisciplinary Thoracic Cancers Symposium, clinical study
News | Lung Cancer | March 28, 2017
Results from a prospective clinical trial showed a blood test looking at specific biomarkers was able to detect lung...
iCAD, PowerLook Tomo Detection, computer-aided detection software, CAD, digital breast tomosynthesis, DBT, RSNA 2017
Technology | Computer-Aided Detection Software | March 27, 2017
March 27, 2017 — iCAD announced that PowerLook Tomo Detection received Premarket Approval (PMA) from the U.S.
VERT, virtual environment radiotherapy, radiation therapy, patient anxiety, Thomas Jefferson University study
News | Radiation Therapy | March 27, 2017
March 27, 2017 — Radiation therapists and physicians know that education can reduce anxiety before radiation treatmen
proton therapy, recurrent lung cancer, clinical study, IMPT, 2017 Multidisciplinary Thoracic Cancers Symposium
News | Proton Therapy | March 24, 2017
A new study offers hope for patients with recurrent lung cancer, who historically have been considered ineligible for...
GE Healthcare, Senographe Pristina mammography system, launch, RSNA 2017, patient comfort
News | Mammography | March 24, 2017
GE Healthcare announced the launch of its new Senographe Pristina mammography system, designed to make breast screening...
lung cancer, radiation therapy, immune checkpoint inhibitors, 2017 Multidisciplinary Thoracic Cancers Symposium, clinical study
News | Lung Cancer | March 22, 2017
An emerging approach for cancer treatment seeks to combine radiation therapy with immune checkpoint inhibitors (ICPIs)...
diffusion weighted MRI, children, traumatic brain injury, TBI recovery, Neurology journal study
News | Magnetic Resonance Imaging (MRI) | March 21, 2017
A new imaging biomarker may help predict which children will take longer to recover from a traumatic brain injury (TBI...
SBRT, stereotactic body radiation therapy, early-stage lung cancer, patients 80 and older, 2017 Multidisciplinary Thoracic Cancers Symposium, study
News | Stereotactic Body Radiation Therapy (SBRT) | March 20, 2017
Patients in their 80s and 90s who have early-stage lung cancer but cannot undergo an operation can be treated safely...
PET/CT, recurrent prostate cancer, fluciclovine F-18, Emory University

CTVPOST (red) = CTVPRE (yellow) union CTVPET (pink). Also shown (upper right corner) are the PRE (square) vs POST (triangle) dose volume histograms for PTV1, PTV2, rectum, bladder, and penile bulb, showing minimal impact on target coverage or organs at risk dose with the modified targets. Image courtesy of Ashesh B. Jani, M.D., and David Schuster, M.D., Emory University.

News | Radiopharmaceuticals and Tracers | March 16, 2017
The featured clinical investigation article of the March 2017 issue of the Journal of Nuclear Medicine demonstrates...
Overlay Init