2011 Breast Cancer Symposium
SAN FRANCISCO - Mammography and self-breast
exams continue to be an important tool to detect breast cancer, even among
women aged 40 to 49 years, the age range in which the benefit of mammography
has been called into question by the US Preventive Services Task Force.
Jamie Caughran, MD, medical director of
the Comprehensive Breast Center at the Lacks Cancer Center in Grand Rapids,
Mich., and colleagues used data from Michigan's breast cancer registry to
examine how the 2009 US Preventive Services Task Force breast cancer screening
recommendations could affect future breast cancer detection. They analyzed data
on breast cancer diagnosis and treatment in 5,903 women between 2006 and
They found that 65.5% of breast cancers were
mammography, 29.8% were detected by palpation and 4.7% were
detected by other methods. Most women with breast cancers detected by
mammography were aged older than 50 years. Among women whose tumors were found
by palpation, 40% were aged younger than 50 years. Among women aged younger
than 50 years, cancers were detected by mammography in 48.3% of the women vs.
41.6% detected by palpation.
Patients with palpable presentations were
younger than those diagnosed by mammography: 55.8 years vs. 61.2 years
(P<.001). Patients also presented at later stages in the palpation
group, and mastectomy was performed more often in the palpation group.
Chemotherapy was also given more frequently to women in the
"Women who have mammographically detected
cancer present at earlier stages are more likely to undergo breast conservation
and not require chemotherapy," Caughran said. "Annual screening mammograms and
evaluation of palpable masses are important tools in breast cancer
For more information:
Disclosure: Dr. Caughran reports no relevant financial
This is a very important work for a number of reasons. There
has been controversy regarding the screening of breast cancer using mammography
in younger women. We certainly know that younger women have denser breast
tissue, which can reduce the sensitivity of mammography compared to older
women. But it doesn't negate the utility of mammography as a screening tool. A
lot of the debate of the utility of mammography has been its impact on OS and
breast cancer-specific survival. These are the most important endpoints. But
this study raises another important issue, and that is the use of screening in
younger populations has led to a lower rate of mastectomy because of the
earlier detection of cancers, and also the lower likelihood of needing to use
adjuvant chemotherapy. As a medical oncologist, this is a very important gain,
independent of any potential survival benefit. Having less disfiguring surgery
and the ability to deliver less chemotherapy based on the stage at diagnosis is
a step forward. Undoubtedly, this area will continue to be an area of
controversy for some, but certainly women in this age group would be well
served to know about this data.
– Andrew D. Seidman, MD
Attending physician, Memorial Sloan-Kettering Cancer Center
Earn CME this spring at the HemOnc Today Breast Cancer Review & Perspective meeting to be held March 23-24, 2012 at the Hilton San Diego Bayfront. See details at HemOncTodayBreastCancer.com.