Study Supports Palpation, Mammography Regardless of Age

Lindissima · September 2011

Study Supports Palpation, Mammography Regardless of Age SAN FRANCISCO (EGMN) - Many breast cancer patients would have more advanced disease at diagnosis and face harsher treatment if recently updated screening guidelines of the U.S. Preventive Services Task Force were widely adopted, suggests a retrospective cohort study of more than 5,000 women with breast cancer in Michigan.Study results, being reported this week at a breast cancer symposium sponsored by the American Society of Clinical Oncology, show that nearly a third of the women's cancers were detected by palpation. The guidelines do not advocate for self-exams at all and question the usefulness of clinical breast exams after age 40.Additionally, nearly half of the cancers in women younger than 50 years were detected by mammography, while the guidelines now recommend against this practice in the 40- to 49-year age group.Women with palpation-detected cancers had later-stage disease and were significantly more likely to undergo mastectomy and receive chemotherapy than were those with mammography-detected cancers."Annual screening mammograms and evaluation of palpable breast masses are important tools in breast cancer detection," second author Dr. Jamie Caughran said during a premeeting press briefing from the American Society of Clinical Oncology (ASCO).She declined to say whether the study's results contradict the U.S. Preventive Services Task Force (USPSTF) guidelines, as the investigators did not have adequate information on the women's screening history.But "we take this data to conclude that you're better off if you can ... have your cancer detected by mammography - that you are more likely to have options and less likely to need aggressive treatment. So ... we would support the rest of the societies that continue to recommend annual screening mammography starting at age 40," she said.Additionally, this study "highlights the still-significant number of women who present with a palpable mass that shouldn't be overlooked by physicians even if they have a negative mammogram," pointed out Dr. Caughran, medical director of the Comprehensive Breast Center at the Lacks Cancer Center in Grand Rapids, Mich. "So it just continues to reinforce what we believe is inherently true."Dr. Andrew Seidman, moderator of the press briefing and a medical oncologist at the Memorial Sloan-Kettering Cancer Center in New York City, commented that the appropriate age for starting screening mammography remains controversial."A lot of the debate and focus regarding the utility of mammography have been on overall survival and breast cancer-specific survival, and I certainly think that is the most important end point," he said, noting that the study speaks to another important end point - reduced intensity of treatment."As a medical oncologist or chemotherapist, I think this is a very important gain, independent of any potential survival benefit," he said. "Having less disfiguring surgery and the ability to deliver less chemotherapy based on the stage at diagnosis are for me a step forward."This newest study will not quell the debate, according to Dr. Seidman. "Undoubtedly, this area will continue to remain an area of controversy for some," he said. "But certainly, women in this age group would be well served to know about this data."In the study, Dr. Caughran and her colleagues analyzed data from a statewide breast cancer registry managed by the Michigan Breast Oncology Quality Initiative, identifying 5,628 women who received a diagnosis of stage 0 to III breast cancer between 2006 and 2009. Their average age was 59.4 years.In the cohort overall, 65.5% of breast cancers were detected by mammography, 29.8% by palpation, and 4.7% by other means.Fully 90% of the cancers detected by palpation were detected by the patient herself, although "it's unclear if the patients ... were practicing regular breast self-examination or if these were incidental findings," noted Dr. Caughran.When analyses were restricted to women younger than 50 years of age, 48.3% of breast cancers were detected by mammography, 46.1% by palpation, and 5.6% by other means.Palpation-detected cancers were of later stages (P less than .0001) - two-thirds were stage II or higher - and were more often treated with mastectomy (45.8% vs. 27.1%, P less than .0001) and with chemotherapy (22.7% vs. 15.7%, P less than .0001).Dr. Caughran and Dr. Seidman reported that they had no relevant conflicts of interest.

lisa-e · September 2011

for another point of view about this study read this Blog by Dr. Len, the Deputy Cheif Medical Officer for the ACS:

http://www.cancer.org/AboutUs/DrLensBlog/post/2011/09/08/Extrapolated-Science-Headlines-Dont-Reflect-The-Science-In-Recent-Report-On-Screening-Mammography.aspx

joy121 · September 2011

I had an abnormal Mammogram- 2 areas in one breast and 1 in the other. I had the needle biopsies for all 3 areas and all 3 revealed atypical Hyperplasia. It was then recommended to have an excisional biopsy on all 3 areas. I did and one area revealed atypical hyperplasia- No cancer. I am very grateful for today's technology; however, I am reluctant to go for annual mammograms. In fact I don't think I will do the 6 month after the biopsy follow up. Once you are told you have an abnormal mammogram you really don't have a choice but to follow up- at least you won't be able to relax until you know for sure. My point I am trying to make is today's technology is picking up everything and I don't want to keep having biopsies. The needle biopsies weren't fun (I was left with a huge hematoma in one breast) but if I didn't have to do the excisional biopsies; that would be fine but I did and it is too much. I believe over 75% of the abnormal mammograms are benign. I don't want to scare someone from doing their annual mammograms. I have no other major risk factors other than the atypical hyperplasia and this increases my chances of breast cancer slightly. These biopsies from start (first biopsies) to finish (healing from surgery) have consumed 6 months of my year and it just would be too much to have done every year. I have tried to find some facts or percentages of women having several biopsies at different times to evaluate whether I will have less chance of abnormal mammograms in the future. If anyone has some statistics to convince me otherwise; I would love to review the information.

Study Supports Palpation, Mammography Regardless of Age

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