Screening and Treatment of DCIS Reduces Number of Invasive Breast Cancers

Prof Stephen Duffy BSc MSc CStat Professor Of Cancer Screening Wolfson Institute Of Preventive Medicine Queen Mary University of London

Prof. Stephen W. Duffy

MedicalResearch.com Interview with:
Prof Stephen Duffy BSc MSc CStat
Professor Of Cancer Screening
Wolfson Institute Of Preventive Medicine
Queen Mary University of London

Medical Research: What is the background for this study? What are the main findings?

Prof. Duffy: There is debate on the value of diagnosing and treating ductal carcinoma in situ (DCIS) of the breast, depending mainly on different theories about the risk of progression to invasive breast cancer if DCIS were untreated. No-one asserts that no DCIS is progressive and no-one asserts that all DCIS is progressive. There is, however, a range of opinions on the proportion of progressive disease.

We found that those mammography screening units in the UK with higher detection rates of DCIS had lower subsequent rates of invasive cancers in the three years after screening.

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Should Breast Cancer Screening Be Different For Pre vs Post Menopausal Women?

Diana Miglioretti, PhD

Diana Miglioretti, PhD

MedicalResearch.com Interview with:
Diana L. Miglioretti, PhD
Dean’s Professor in Biostatistics
Department of Public Health Sciences
UC Davis School of Medicine
Davis, CA  95616

Medical Research: What is the background for this study? What are the main findings?

Dr. Miglioretti: Screening mammography intervals remain under debate in the United States. The US Preventive Services Task Force recommends biennial (every other year) screening, whereas other organizations recommend annual screening. To help inform their updated screening guidelines, the American Cancer Society guideline development group requested that the US Breast Cancer Surveillance Consortium conduct a study comparing cancer outcomes among women screened annually vs. biennially. Prior studies conducted by the consortium used wide intervals for defining annual and biennial mammograms. We wanted to evaluate cancer outcomes for women who more closely adhere to screening intervals. Our goal was to determine if women diagnosed with cancer following biennial screening have tumors with less favorable prognostic characteristics compared to women diagnosed after annual screening. We evaluated outcomes separately by age and by menopausal status because evidence suggests that younger women and premenopausal women may have more aggressive tumors and thus may benefit from more frequent screening.

We found from this study that premenopausal women diagnosed with invasive breast cancer following biennial versus annual screening mammography were more likely to have tumors with less-favorable prognostic characteristics (e.g., later stage, larger size). For example, women with an invasive breast cancer diagnosed after a biennial screen had a 28% increased risk of a stage IIB or higher tumor, a 21% increased risk of being diagnosed with a tumor >15 mm, and an 11% higher risk of being diagnosed with a tumor with any less-favorable prognostic characteristic compared women diagnosed with breast cancer following an annual mammogram.

In contrast, we found postmenopausal women not using hormone therapy and women 50 years of age or older had similar proportions of tumors with less-favorable prognostic characteristics regardless of screening interval. Relative risk estimates were close to one with no significant differences between biennial and annual screeners.

Among postmenopausal women using hormone therapy at the time of the mammogram and women age 40-49, results were less clear. Relative risk estimates for biennial versus annual screeners were consistently above one, but were not as large as for premenopausal women and were not statistically significant.

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Annual Mammograms Did Not Save Lives in 25 Year Study

Anthony Miller, MD Director, Canadian National Breast Screening Study Professor Emeritus, Dalla Lana School of Public Health University of TorontoMedicalResearch.com Interview with:
Anthony Miller, MD
Director, Canadian National Breast Screening Study
Professor Emeritus, Dalla Lana School of Public Health
University of Toronto

MedicalResearch.com: What are the main findings of the study?

Prof. Miller:  The study involved 89,835 women aged 40 to 59. All underwent an annual physical breast examination, while half were randomly assigned to undergo annual mammograms for five years, beginning in 1980.

During the five-year screening period, 666 invasive breast cancers were diagnosed in the mammography arm and 524 in the controls.  Over the 25 year follow-up 180 women in the mammography arm and 171 women in the control arm died of breast cancer.  The overall hazard ratio for death from breast cancer diagnosed during the screening period associated with mammography was 1.05 (95% CI: 0.85 – 1.30).  The findings for women aged 40-49 and aged 50-59 were almost identical.

After 15 years of follow-up an excess of 106 cancers was observed in the mammography arm, attributable to over-diagnosis, i.e. 22% of screen-detected invasive breast cancers, half of those detected by mammography alone. This represents one over-diagnosed breast cancer for every 424 women screened by mammography.

By 2005, 3,250 of the 44,925 women in the mammography arm of the study were diagnosed with breast cancer, and 500 had died of it. The control group of 44,910 women had 3,133 breast cancer diagnoses and 505 breast cancer deaths.

We conclude that annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care when adjuvant therapy for breast cancer is freely available.

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Trends in mammography screening rates after publication of the 2009 US Preventive Services Task Force recommendations

Nancy L. Keating MD, MPH  Harvard Medical School Department of Health Care Policy 180 Longwood Avenue Boston, MA 02115-5899MedicalResearch.com eInterview with
Nancy L. Keating MD, MPH

Harvard Medical School
Department of Health Care Policy
180 Longwood Avenue
Boston, MA 02115-5899

MedicalResearch.com: What are the main findings of the study?

Dr. Keating: We examined data from the 2005, 2008 and 2011 waves of the National Health Interview Survey (NHIS) a national population-based in person survey to assess whether mammography rates changed following the Nov 2009 USPSTF recommendations.   Prior to 2009 the USPSTF recommended routine screening every 1-2 years for all women older than 40 years old. In 2009, the USPSTF advised against routine mammography screening in women under 50, and recommended biennial screening for women 50-74.
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More immigrant women are getting mammograms now than a decade ago.

Fewer immigrant women receive mammograms than native-born American women, according to Penn State researchers, who note that more immigrant women are getting mammograms now than a decade ago.

“Lack of access to health care persistently contributes to mammography screening disparities among immigrants,” said Nengliang Aaron Yao, graduate student in health policy and administration.

Yao, working with Marianne Hillemeier, associate professor of health policy and administration, reviewed data on women over 40 who received mammograms in the United States from the years 2000 and 2008. He reported these statistics to attendees at the American Association for Cancer Research conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved today (Sept. 19) in Washington, D.C. The data came from the National Health Interview Survey.

“More recent immigrants, those with poor access to health care, and those who were younger and less educated had lower mammography rates at both time points,” said Yao.

Yao found the number of immigrant women who received mammograms rose by almost 10 percent from 2000 to 2008. While the percentage of immigrant women receiving mammograms is less than U.S.-born women, the gap has shrunk. In 2000, the gap between immigrants and U.S.-born women was 11.2 percent, while in 2008 the gap was only 3.4 percent. In 2000 60.2 percent of immigrant women over 40 received mammograms while in 2008, 65.5 percent received them.

“Mammography rates among immigrant women remain lower than the native-born,” Yao said. “Increasing access to health insurance and a usual source of care will further diminish disparities in mammography receipt.”