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Abstract 1754: Mammography in 40 Year Old Women: The Potential Impact of the U.S. Preventative Services Task Force (USPSTF) Mammography Guidelines.

Paul Dale, Nicole Shen, Linda Sue Hammonds, Dick Madsen

University of Missouri-Columbia, Columbia, MO

Purpose: Recently, the USPSTF recommended against annual mammography screening for 40 year old women, unless the patient had a genetic mutation (BRCA1, BRCA2) or known chest radiation exposure. This ten-year retrospective chart review evaluates the potential impact these recommendations could have on women diagnosed with breast in the 40-49 age group. 

Methods: The medical record database of our tertiary referral center was systematically reviewed to identify those women aged 40- 49 treated for breast cancer over a ten-year period (1998- 2008). The women were divided according to their method of diagnosis either mammographically detected cancers (MDC) or cancers that were detected clinically not by mammographic screening (Non-MDC) Statistical analysis was performed determine if there was a difference in tumor size, stage at presentation, family history, disease free and overall survival between the two groups. 

Findings: During the ten year time period 1581women were treated for breast cancer at our institution. Of these 320 (20%) were between the ages of 40-49, 9 patients were excluded from the study due to incomplete records. Of the remaining 311 women, 145 (47%) underwent mammographic screening and were diagnosed with a mammographically detected cancer (MDC), the other 166 (53%) were diagnosed by clinical symptoms or non-mammographically detected cancer (NMDC). The median tumor diameter of the MDC group was 20 mm. significantly smaller than the NMDC group 30 mm (p<0.0001). Women with MDC had a significantly lower incidence of lymph node positive cancer than the NMDC group, 28/113 (24.78%) vs. 85/130 (55.92%), (p<0.0001). Women with MDC had a significantly higher incidence of a family history of breast cancer than the than NMDC group, 14.62% and 25% respectively (p=0.0304). Five year disease free and overall survival rates were determined for both groups. Five year disease free survival was 94% (87%, 97%) for the MDC group and 71% (62%, 78%) for the Non-MDC group. Five year overall survival rates for each group were 97% (92%, 99%) for the MDC and 78% (69%, 85%) for the Non-MDC. In multivariate analysis mammographic detection, node negativity and smaller tumor size were found to be associated with a significant increase in survival.

Conclusion: This 10 year retrospective review demonstrates the importance of early detection and treatment of breast cancer to improve overall and disease free survival. Mammographic screening in women aged 40-49 detected smaller tumors with less nodal metastasis resulting in improved survival supporting annual mammographic screening in this age group.

Source: The American Society of Breast Surgeons