Less Favorable Characteristics for Breast CancerDiagnosed After Biennial vs Annual Screening in Premenopausal Women
Key Points: This is great fuel and fodder for the debate regarding how young to start a MMG practice routine for average risk women who are premenopausal and how often I have posted here and written and hold to yearly for average risk premenopausal between 40-45 ( I lean toward the younger) For those with adverse risk factors it is definitely yearly , possibly with more imaging tools although that is not clear and of course in the very high risk component of triple negative + family history, I have a long talk as did Angelina Jolie re preventive mastectomy and ovarian removal. The key is getting better tools to define risk with better sensitivity and specificity- they find it when it is there and when they say it is not cancer, they are right. We are not fully there yet and then this important study comes along. This is when you have the patient exercise their autonomy that I spoke so highly of- in formed autonomy .What do they understand, is it al they can or is there more they can grasp and then what do they and I encourage, their partners want to do Dr Ryan
- Among premenopausal women, biennial ( every 2 years) mammography screeners were more likely to have tumors with adverse prognostic features.
- Among postmenopausal women not taking hormone therapy, there was no difference in the risk for adverse prognostic features.
In a study reported in JAMA Oncology, Miglioretti et al found that diagnosis of breast cancer after biennial vs annual mammography screening was associated with a higher risk of less favorable tumor prognostic characteristics among premenopausal women. They also noted a nonsignificantly higher risk among postmenopausal women receiving hormone therapy and no difference among postmenopausal women not receiving hormone therapy.
The study involved data from 15,440 women aged 40 to 85 years with breast cancer diagnosed within 1 year (11–14 months) of an annual or 2 years (23–26 months) of a biennial screening mammogram in a prospective cohort from 1996 to 2012 at Breast Cancer Surveillance Consortium facilities. Less favorable prognostic characteristics were defined as tumors that were stage IIB or higher, tumor size > 15 mm, positive nodes, and any one or more of these characteristics.
In the cohort, most women were aged ≥ 50 years (85.4%), white (78.1%), and postmenopausal (63.6%). Overall, 12,070 were annual screeners, and 3,370 were biennial screeners. Biennial screeners were more likely to be in the youngest (40–49 years) and oldest age groups (70–85 years) and were less likely to have a family history of breast cancer.
For annual and biennial screeners, 12.6% and 14.9% were premenopausal, 42.5% and 40.1% were postmenopausal without hormone therapy use, 21.8% and 21.0% were postmenopausal with hormone therapy use, and 23.1% and 23.9% had surgical menopausal or unknown status. Screen-detected cancers accounted for 77.8% of cancers in annual screeners and 72.8% of those in biennial screeners.
Risk for Adverse Characteristics
In analysis adjusting for race/ethnicity, family history, and registry, among premenopausal women, biennial screeners had a higher risk of tumors of stage ≥ IIB (relative risk [RR] = 1.28, P = .04), size > 15 mm (RR = 1.21, P = .002), and any less favorable prognostic characteristic (RR = 1.11, P = .047). Among postmenopausal women currently taking hormone therapy, biennial screeners had a nonsignificantly higher risk of stage ≥ IIB tumors (RR = 1.14, P = .29), size > 15 mm (RR = 1.13, P = .09), node-positive disease (RR = 1.18, P = .09), and any less favorable characteristic (RR = 1.12, P = .053).
No significant differences were observed according to the type of hormone therapy. In addition, there were no significant differences in the risk for less-favorable prognostic factors for biennial vs annual screeners among women not receiving hormone therapy (eg, RR = 1.03, P = .45, for any characteristic). Overall, there was no significant difference between biennial and annual screeners in the risk for any less-favorable characteristic within any 10-year age group.
The investigators concluded: “Premenopausal women diagnosed as having breast cancer following biennial vs annual screening mammography are more likely to have tumors with less favorable prognostic characteristics. Postmenopausal women not using hormone therapy who are diagnosed as having breast cancer following a biennial or annual screen have similar proportions of tumors with less favorable prognostic characteristics.”
The American Cancer Society supported the study.
Diana L. Miglioretti, PhD, of the University of California–Davis School of Medicine, is the corresponding author of the JAMA Oncology article.