Thermography Articles 5

© 2012

Frank words about breast screening

            (Baines 2011) Download

Ultrasound is now better than mammography for the detection of invasive breast cancer

            (Benson, Blue et al. 2004) Download

OBJECTIVE: This study investigated the use of ultrasound (US) as a first-line diagnostic tool. METHODS: All women attending our breast center underwent bilateral whole-breast US in addition to all other investigations, and results were documented prospectively and preoperatively. RESULTS: Of 796 patients with breast cancer, US was positive in 710 (89%) and mammography in 706 (89%) (P = not significant). Either US or mammogram was positive in 770 (97%). Of 537 (67%) symptomatic patients, US was positive in 497 (93%) and mammography in 465 (87%). Either US or mammography was positive in 515 (96%). Of 259 (33%) screening patients, 220 (85%) had invasive cancer. US was positive in 195 (89%) and mammography in 203 (92%) (P = not significant). Either US or mammography was positive in 217 (99%). Of 39 screening patients with ductal carcinoma in situ (5% of all patients), US was positive in 18 (46%) and mammography in 38 (97%). CONCLUSIONS: US is significantly better than mammography for detecting invasive breast cancer (92% patients). The combination of US and mammography is significantly better than either modality used alone, together resulting in 9% more breast cancers detected.

Flawed inferences about screening mammography's benefit based on observational data

            (Berry, Baines et al. 2009) Download


The overdiagnosis nightmare: a time for caution

            (Ciatto 2009) Download

Overdiagnosis (and overtreatment) of cancers not bound to become symptomatic during lifetime is an unavoidable drawback of mammography screening. The magnitude of overdiagnosis has been estimated to be in the range of 5-10%, and thus acceptable in view of screening benefits as to reduced mortality. In a recent research article in BMC Women's Health, Jorgensen, Zahl and Gotzsche suggest that overdiagnosis may be as high as 33%, based on their analysis of breast cancer incidence in screened and non-screened areas in Denmark. Here we consider how reliable such analyses can be, why it might have been useful to adjust comparisons between screened and non-screened areas for early detection lead time, and what further evidence might be needed to build on or confirm these results.

Population-based mammography screening below age 50: balancing radiation-induced vs prevented breast cancer deaths

            (de Gelder, Draisma et al. 2011) Download

INTRODUCTION: Exposure to ionizing radiation at mammography screening may cause breast cancer. Because the radiation risk increases with lower exposure age, advancing the lower age limit may affect the balance between screening benefits and risks. The present study explores the benefit-risk ratio of screening before age 50. METHODS: The benefits of biennial mammography screening, starting at various ages between 40 and 50, and continuing up to age 74 were examined using micro-simulation. In contrast with previous studies that commonly used excess relative risk models, we assessed the radiation risks using the latest BEIR-VII excess absolute rate exposure-risk model. RESULTS: The estimated radiation risk is lower than previously assessed. At a mean glandular dose of 1.3 mGy per view that was recently measured in the Netherlands, biennial mammography screening between age 50 and 74 was predicted to induce 1.6 breast cancer deaths per 100,000 women aged 0-100 (range 1.3-6.3 extra deaths at a glandular dose of 1-5 mGy per view), against 1121 avoided deaths in this population. Advancing the lower age limit for screening to include women aged 40-74 was predicted to induce 3.7 breast cancer deaths per 100,000 women aged 0-100 (range 2.9-14.4) at biennial screening, but would also prevent 1302 deaths. CONCLUSION: The benefits of mammography screening between age 40 and 74 were predicted to outweigh the radiation risks.


Dangers and unreliability of mammography: breast examination is a safe, effective, and practical alternative

            (Epstein, Bertell et al. 2001) Download

Mammography screening is a profit-driven technology posing risks compounded by unreliability. In striking contrast, annual clinical breast examination (CBE) by a trained health professional, together with monthly breast self-examination (BSE), is safe, at least as effective, and low in cost. International programs for training nurses how to perform CBE and teach BSE are critical and overdue.

Thermography as a screening and diagnostic tool: a systematic review

            (Fitzgerald and Berentson-Shaw 2012) Download

AIMS: To determine the effectiveness of digital infrared thermography for the detection of breast cancer in a screening population, and as a diagnostic tool in women with suspected breast cancer. METHODS: A comprehensive search of electronic databases together with a search of international websites was conducted. Diagnostic studies comparing thermography with mammography for screening in asymptomatic populations; or comparing thermography with histology in women with suspected breast cancer; were eligible for inclusion. Quality of included studies was appraised using the QUADAS criteria. RESULTS: One study reported results for thermography in screening population and five studies reported diagnostic accuracy of thermography in women with suspected breast cancer. Overall, studies were of average quality. Sensitivity for thermography as a screening tool was 25% (specificity 74%) compared to mammography. Sensitivity for thermography as a diagnostic tool ranged from 25% (specificity 85%) to 97% (specificity 12%) compared to histology. CONCLUSIONS: Currently there is not sufficient evidence to support the use of thermography in breast cancer screening, nor is there sufficient evidence to show that thermography provides benefit to patients as an adjunctive tool to mammography or to suspicious clinical findings in diagnosing breast cancer.

Breast thermography review--and author response

            (Godfrey 2012) Download


Screening for breast cancer with mammography

            (Gotzsche and Nielsen 2009) Download

BACKGROUND: A variety of estimates of the benefits and harms of mammographic screening for breast cancer have been published and national policies vary. OBJECTIVES: To assess the effect of screening for breast cancer with mammography on mortality and morbidity. SEARCH STRATEGY: We searched PubMed (November 2008). SELECTION CRITERIA: Randomised trials comparing mammographic screening with no mammographic screening. DATA COLLECTION AND ANALYSIS: Both authors independently extracted data. Study authors were contacted for additional information. MAIN RESULTS: Eight eligible trials were identified. We excluded a biased trial and included 600,000 women in the analyses. Three trials with adequate randomisation did not show a significant reduction in breast cancer mortality at 13 years (relative risk (RR) 0.90, 95% confidence interval (CI) 0.79 to 1.02); four trials with suboptimal randomisation showed a significant reduction in breast cancer mortality with an RR of 0.75 (95% CI 0.67 to 0.83). The RR for all seven trials combined was 0.81 (95% CI 0.74 to 0.87). We found that breast cancer mortality was an unreliable outcome that was biased in favour of screening, mainly because of differential misclassification of cause of death. The trials with adequate randomisation did not find an effect of screening on cancer mortality, including breast cancer, after 10 years (RR 1.02, 95% CI 0.95 to 1.10) or on all-cause mortality after 13 years (RR 0.99, 95% CI 0.95 to 1.03).Numbers of lumpectomies and mastectomies were significantly larger in the screened groups (RR 1.31, 95% CI 1.22 to 1.42) for the two adequately randomised trials that measured this outcome; the use of radiotherapy was similarly increased. AUTHORS' CONCLUSIONS: Screening is likely to reduce breast cancer mortality. As the effect was lowest in the adequately randomised trials, a reasonable estimate is a 15% reduction corresponding to an absolute risk reduction of 0.05%. Screening led to 30% overdiagnosis and overtreatment, or an absolute risk increase of 0.5%. This means that for every 2000 women invited for screening throughout 10 years, one will have her life prolonged and 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily. Furthermore, more than 200 women will experience important psychological distress for many months because of false positive findings. It is thus not clear whether screening does more good than harm. To help ensure that the women are fully informed of both benefits and harms before they decide whether or not to attend screening, we have written an evidence-based leaflet for lay people that is available in several languages on www.cochrane.dk.


Screening for breast cancer with mammography

            (Gotzsche and Nielsen 2011) Download

BACKGROUND: A variety of estimates of the benefits and harms of mammographic screening for breast cancer have been published and national policies vary. OBJECTIVES: To assess the effect of screening for breast cancer with mammography on mortality and morbidity. SEARCH STRATEGY: We searched PubMed (November 2008). SELECTION CRITERIA: Randomised trials comparing mammographic screening with no mammographic screening. DATA COLLECTION AND ANALYSIS: Both authors independently extracted data. Study authors were contacted for additional information. MAIN RESULTS: Eight eligible trials were identified. We excluded a biased trial and included 600,000 women in the analyses. Three trials with adequate randomisation did not show a significant reduction in breast cancer mortality at 13 years (relative risk (RR) 0.90, 95% confidence interval (CI) 0.79 to 1.02); four trials with suboptimal randomisation showed a significant reduction in breast cancer mortality with an RR of 0.75 (95% CI 0.67 to 0.83). The RR for all seven trials combined was 0.81 (95% CI 0.74 to 0.87). We found that breast cancer mortality was an unreliable outcome that was biased in favour of screening, mainly because of differential misclassification of cause of death. The trials with adequate randomisation did not find an effect of screening on cancer mortality, including breast cancer, after 10 years (RR 1.02, 95% CI 0.95 to 1.10) or on all-cause mortality after 13 years (RR 0.99, 95% CI 0.95 to 1.03).Numbers of lumpectomies and mastectomies were significantly larger in the screened groups (RR 1.31, 95% CI 1.22 to 1.42) for the two adequately randomised trials that measured this outcome; the use of radiotherapy was similarly increased. AUTHORS' CONCLUSIONS: Screening is likely to reduce breast cancer mortality. As the effect was lowest in the adequately randomised trials, a reasonable estimate is a 15% reduction corresponding to an absolute risk reduction of 0.05%. Screening led to 30% overdiagnosis and overtreatment, or an absolute risk increase of 0.5%. This means that for every 2000 women invited for screening throughout 10 years, one will have her life prolonged and 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily. Furthermore, more than 200 women will experience important psychological distress for many months because of false positive findings. It is thus not clear whether screening does more good than harm. To help ensure that the women are fully informed of both benefits and harms before they decide whether or not to attend screening, we have written an evidence-based leaflet for lay people that is available in several languages on www.cochrane.dk.


Breast cancer screening controversies

         (Green and Taplin 2003) Download

BACKGROUND: The Cochrane Collaborative, a respected independent review body, recently published a meta-analysis of the effectiveness of screening mammography in decreasing breast cancer mortality. Based on the results of two controlled trials they judged to be of medium validity, they concluded that screening mammography was unjustified. In contrast, the US Preventive Services Task Force recently updated their screening recommendations, and based on a meta-analysis of the same randomized controlled trials, they recommended screening mammography for all women starting at age 40 years. Additionally the Canadian Task Force on Preventive Health Care no longer recommends breast self-examination (BSE). This article reviews the controversies regarding breast cancer screening. METHODS: We performed a systematic review of the literature using keywords and cross-referencing articles. We also used automated data from the Breast Cancer Screening Program at Group Health Cooperative to determine the sensitivity of the clinical breast examination (CBE) at our institution. For the latter we included all cancers diagnosed within 1 year of a screening examination and then determined which of those had been found by CBE. RESULTS: Although most screening studies have shown that mammography decreases breast cancer death, there are controversies about the validity of some of the randomized controlled screening mammography trials. These controversies have led to different conclusions about the efficacy of screening mammography. Evidence is limited about the optimal interval for screening mammography. No studies have directly tested the efficacy of the CBE in decreasing breast cancer mortality. At Group Health Cooperative, 8% of all diagnosed breast cancers were found by the CBE alone (negative mammogram). Whether this 8% incremental increase in case finding leads to decreased breast cancer deaths is unknown. There is good evidence that training women to perform BSE does not increase breast cancer diagnoses or decrease breast cancer deaths. CONCLUSION: There are limitations to randomized controlled trials and meta-analyses. The balance of the evidence still favors screening mammography in women aged 40 years and older at least every 2 years. The independent incremental benefit of the CBE, when added to mammography, in decreasing breast cancer mortality is unknown. Population-based education and training to do BSE are unlikely to lead to decreased breast cancer deaths. Many women find their own breast cancers, so women need to pay attention to symptoms or changes in their breasts.


Radiation doses and cancer risks from breast imaging studies

            (Hendrick 2010) Download

PURPOSE: To compare radiation doses and lifetime attributable risks (LARs) of radiation-induced cancer incidence and mortality from breast imaging studies involving the use of ionizing radiation. MATERIALS AND METHODS: Recent literature on radiation doses from radiologic procedures and organ doses from nuclear medicine procedures, along with Biologic Effects of Ionizing Radiation (BEIR) VII age-dependent risk data, is used to estimate LARs of radiation-induced cancer incidence and mortality from breast imaging studies involving ionizing radiation, including screen-film mammography, digital mammography, digital breast tomosynthesis, dedicated breast computed tomography, breast-specific gamma imaging (BSGI), and positron emission mammography (PEM). RESULTS: Two-view digital mammography and screen-film mammography involve average mean glandular radiation doses of 3.7 and 4.7 mGy, respectively. According to BEIR VII data, these studies are associated, respectively, with LARs of fatal breast cancer of 1.3 and 1.7 cases per 100,000 women aged 40 years at exposure and less than one case per one million women aged 80 years at exposure. Annual screening digital or screen-film mammography performed in women aged 40-80 years is associated with an LAR of fatal breast cancer of 20-25 cases in 100,000. A single BSGI study involving a label-recommended dose of 740-1100 MBq (20-30 mCi) of technetium 99m-sestamibi is estimated to involve an LAR of fatal cancer that is 20-30 times that of digital mammography in women aged 40 years. A single PEM study involving a labeled dose of 370 MBq (10 mCi) of fluorine 18 fluorodeoxyglucose is estimated to involve an LAR of fatal cancer that is 23 times higher than that of digital mammography in women aged 40 years. CONCLUSION: A single BSGI or PEM study is associated with a fatal radiation-induced cancer risk higher than or comparable to that of annual screening mammography in women aged 40-80 years.

Advantages and Disadvantages of Mammography Screening

            (Heywang-Kobrunner, Hacker et al. 2011) Download

Mammography screening is the only method presently considered appropriate for mass screening of asymptomatic women. Its frequent use, however, warrants diligent analysis of potential side effects. Radiation risk is far below the natural yearly risk of breast cancer and should not be used as an argument against screening. False-positive calls lead to additional imaging or histopathological assessment, mainly percutaneous breast biopsy. These measures are tolerated and accepted fairly well. Their number is limited by strict quality assurance and constant training. Interval cancers represent a limitation of breast screening that should prompt further research for optimization. Evaluation of overdiagnosis is a highly debated topic in the literature. According to the probably most realistic available calculations, overdiagnosis is acceptable as it is compensated by the potential mortality reduction. Nonetheless, this potential side effect warrants optimal adjustment of therapy to the patient's individual risk. The mortality reduction seen in randomized studies was confirmed by results from national screening programs. A recent case referent study indicated that improvements in mortality reduction run parallel to improved mammographic techniques. Use of less aggressive therapies is another valuable effect of screening. Awareness of potential problems, strict quality assurance, and further research should help to further develop screening programs.

Are benefits and harms in mammography screening given equal attention in scientific articles? A cross-sectional study

            (Jorgensen, Klahn et al. 2007) Download

BACKGROUND: The CONSORT statement specifies the need for a balanced presentation of both benefits and harms of medical interventions in trial reports. However, invitations to screening and newspaper articles often emphasize benefits and downplay or omit harms, and it is known that scientific articles can be influenced by conflicts of interest. We wanted to determine if a similar imbalance occurs in scientific articles on mammography screening and if it is related to author affiliation. METHODS: We searched PubMed in April 2005 for articles on mammography screening that mentioned a benefit or a harm and that were published in 2004 in English. Data extraction was performed by three independent investigators, two unblinded and one blinded for article contents, and author names and affiliation, as appropriate. The extracted data were compared and discrepancies resolved by two investigators in a combined analysis. We defined three groups of authors: (1) authors in specialties unrelated to mammography screening, (2) authors in screening-affiliated specialties (radiology or breast cancer surgery) who were not working with screening, or authors funded by cancer charities, and (3) authors (at least one) working directly with mammography screening programmes. We used a data extraction sheet with 17 items described as important benefits and harms in the 2002 WHO/IARC-report on breast cancer screening. RESULTS: We identified 854 articles, and 143 were eligible for the study. Most were original research. Benefits were mentioned more often than harms (96% vs 62%, P < 0.001). Fifty-five (38%) articles mentioned only benefits, whereas seven (5%) mentioned only harms (P < 0.001). Overdiagnosis was mentioned in 35 articles (24%), but was more often downplayed or rejected in articles that had authors working with screening, (6/15; 40%) compared with authors affiliated by specialty or funding (1/6; 17%), or authors unrelated with screening (1/14; 7%) (P = 0.03). Benefits in terms of reduced breast cancer mortality were mentioned in 109 (76%) articles, and was more often provided as a relative risk reduction than an absolute risk reduction, where quantified (45 articles (31%) versus 6 articles (3%) (P < 0.001)). CONCLUSION: Scientific articles tend to emphasize the major benefits of mammography screening over its major harms. This imbalance is related to the authors' affiliation.

What is the point: will screening mammography save my life?

            (Keen and Keen 2009) Download

BACKGROUND: We analyzed the claim "mammography saves lives" by calculating the life-saving absolute benefit of screening mammography in reducing breast cancer mortality in women ages 40 to 65. METHODS: To calculate the absolute benefit, we first estimated the screen-free absolute death risk from breast cancer by adjusting the Surveillance, Epidemiology and End Results Program 15-year cumulative breast cancer mortality to account for the separate effects of screening mammography and improved therapy. We calculated the absolute risk reduction (reduction in absolute death risk), the number needed to screen assuming repeated screening, and the survival percentages without and with screening. We varied the relative risk reduction from 10%-30% based on the randomized trials of screening mammography. We developed additional variations of the absolute risk reduction for a screening intervention, including the average benefit of a single screen, as well as the life-saving proportion among patients with earlier cancer detection. RESULTS: Because the screen-free absolute death risk is approximately 1% overall but rises with age, the relative risk reduction from repeated screening mammography is about 100 times the absolute risk reduction between the starting ages of 50 and 60. Assuming a base case 20% relative risk reduction, repeated screening starting at age 50 saves about 1.8 (overall range, 0.9-2.7) lives over 15 years for every 1000 women screened. The number needed to screen repeatedly is 1000/1.8, or 570. The survival percentage is 99.12% without and 99.29% with screening. The average benefit of a single screening mammogram is 0.034%, or 2970 women must be screened once to save one life. Mammography saves 4.3% of screen-detectable cancer patients' lives starting at age 50. This means 23 cancers must be found starting at age 50, or 27 cancers at age 40 and 21 cancers at age 65, to save one life. CONCLUSION: The life-saving absolute benefit of screening mammography increases with age as the absolute death risk increases. The number of events needed to save one life varies depending on the prospective screening subset or reference class. Less than 5% of women with screen-detectable cancers have their lives saved.


Re: Digital infrared thermal imaging (DITI) of breast lesions: sensitivity and specificity of detection of primary breast cancers

            (Kolaric, Antonini et al. 2012) Download

Risks of online advertisement of direct-to-consumer thermography for breast cancer screening

            (Lovett and Liang 2011) Download

Direct-to-consumer online advertising for thermography as a sole agent with which to diagnose breast cancer is misleading and exploits women who are seeking preventive health care for breast cancer. Regulatory action should be taken against companies who continue to mislead the public to ensure patient safety and evidence-based public health information.

Risks of online direct-to-consumer tumor markers for cancer screening

            (Lovett, Liang et al. 2012) Download

Role of Breast Ultrasound for the Detection and Differentiation of Breast Lesions

            (Madjar 2010) Download

Diagnosis of breast cancer has been widely improved since the development of high-resolution ultrasound equipment. In the past, ultrasound was only considered useful for the diagnosis of cysts. Meanwhile, it improves the differential diagnosis of benign and malignant lesions, local preoperative staging and guided interventional diagnosis. In dense breasts, mammography has limited sensitivity. Furthermore, women with dense parenchyma have a highly increased risk of breast cancer development. Ultrasound is useful to examine dense breast tissue. Recent studies have shown that the detection of small cancers with high-resolution ultrasound is increased by 3-4 cancers per 1,000 women without clinical or mammographic abnormalities. Furthermore, stage distribution is similar between mammographically and sonographically detected carcinomas. Ultrasound is routinely used for curative diagnosis, to overcome the limitations of mammography. However, within the mammographic screening in Germany, breast density is not considered as important. Ultrasound is only used if a suspicious lesion is detected by mammography. Interestingly, 2 years ago, a screening project started in Austria in which ultrasound is always added in cases of dense breasts. Preliminary data show that the detection of additional carcinomas is increased in the same order as shown in previous studies. Therefore, an improved cancer detection and differentiation can be expected with high-resolution ultrasound.


Accuracy of screening mammography varies by week of menstrual cycle

            (Miglioretti, Walker et al. 2011) Download

PURPOSE: To investigate sensitivity, specificity, and cancer detection rate of screening mammography according to week of menstrual cycle among premenopausal women. MATERIALS AND METHODS: In this institutional review board-approved HIPAA-compliant study, sensitivity, specificity, and cancer detection rate of 387,218 screening mammograms linked to 1283 breast cancers in premenopausal women according to week of menstrual cycle were studied by using prospectively collected information from the Breast Cancer Surveillance Consortium. Logistic regression analysis was used to test for differences in mammography performance according to week of menstrual cycle, adjusting for age and registry. RESULTS: Overall, screening mammography performance did not differ according to week of menstrual cycle. However, when analyses were subdivided according to prior mammography, different patterns emerged. For the 66.6% of women who had undergone regular screening (mammography had been performed within the past 2 years), sensitivity was higher in week 1 (79.5%) than in subsequent weeks (week 2, 70.3%; week 3, 67.4%; week 4, 73.0%; P = .041). In the 17.8% of women who underwent mammography for the first time in this study, sensitivity tended to be lower during the follicular phase (week 1, 72.1%; week 2, 80.4%; week 3, 84.6%; week 4, 93.8%; P = .051). Sensitivity did not vary significantly by week in menstrual cycle in women who had undergone mammography more than 3 years earlier. There were no clinically meaningful differences in specificity or cancer detection rate. Conclusion: Premenopausal women who undergo regular screening may benefit from higher sensitivity of mammography if they schedule screening mammography during the 1st week of their menstrual cycle. Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100974/-/DC1.

Sorting through the recent controversies in breast cancer screening

            (Moore, Budd et al. 2010) Download


A close call: the role of screening mammography in the fight against breast cancer: health and medicine for women: a multidisciplinary, evidence-based review of mid-life health concerns

            (Sadeghpour 2011) Download

A multidisciplinary panel debated the role of screening mammography in fighting breast cancer during the Health and Medicine for Women continuing medical education (CME) conference at Yale Medical School in September 2010. Different guidelines from professional societies have presented conflicting recommendations for patients regarding both the benefits of mammography and the appropriate age and frequency of screening. In addition, a recent longitudinal study argues that screening mammography may only offer a modest benefit in terms of reducing cancer mortality. In light of these considerations, the panel debated whether mammography should be an informed decision that must be discussed and individualized for each patient based on the context of risk factors such as family history, age, and genetic dispositions.

Evaluation of thermography as a screening and diagnostic tool for breast cancer

            (Scott 2012) Download

Risk of radiation-induced breast cancer from mammographic screening

         (Yaffe and Mainprize 2011) Download

PURPOSE: To assess a schema for estimating the risk of radiation-induced breast cancer following exposure of the breast to ionizing radiation as would occur with mammography and to provide data that can be used to estimate the potential number of breast cancers, cancer deaths, and woman-years of life lost attributable to radiation exposure delivered according to a variety of screening scenarios. MATERIALS AND METHODS: An excess absolute risk model was used to predict the number of radiation-induced breast cancers attributable to the radiation dose received for a single typical digital mammography examination. The algorithm was then extended to consider the consequences of various scenarios for routine screening beginning and ending at different ages, with examinations taking place at 1- or 2-year intervals. A life-table correction was applied to consider reductions of the cohort size over time owing to nonradiation-related causes of death. Finally, the numbers of breast cancer deaths and woman-years of life lost that might be attributable to the radiation exposure were calculated. Cancer incidence and cancer deaths were estimated for individual attained ages following the onset of screening, and lifetime risks were also calculated. RESULTS: For a cohort of 100 000 women each receiving a dose of 3.7 mGy to both breasts and who were screened annually from age 40 to 55 years and biennially thereafter to age 74 years, it is predicted that there will be 86 cancers induced and 11 deaths due to radiation-induced breast cancer. CONCLUSION: For the mammographic screening regimens considered that begin at age 40 years, this risk is small compared with the expected mortality reduction achievable through screening. The risk of radiation-induced breast cancer should not be a deterrent from mammographic screening of women over the age of 40 years.

Performance of first mammography examination in women younger than 40 years

         (Yankaskas, Haneuse et al. 2010) Download

BACKGROUND: Few data have been published on mammography performance in women who are younger than 40 years. METHODS: We pooled data from six mammography registries across the United States from the Breast Cancer Surveillance Consortium. We included 117 738 women who were aged 18-39 years when they had their first screening or diagnostic mammogram during 1995-2005 and followed them for 1 year to determine accuracy of mammography assessment. We measured the recall rate for screening examinations and the sensitivity, specificity, positive predictive value, and cancer detection rate for all mammograms. RESULTS: For screening mammograms, no cancers were detected in 637 mammograms for women aged 18-24 years. For women aged 35-39 years who had the largest number of screening mammograms (n = 73 335) in this study, the recall rate was 12.7% (95% confidence interval [CI] = 12.4% to 12.9%), sensitivity was 76.1% (95% CI = 69.2% to 82.6%), specificity was 87.5% (95% CI = 87.2% to 87.7%), positive predictive value was 1.3% (95% CI = 1.1% to 1.5%), and cancer detection rate was 1.6 cancers per 1000 mammograms (95% CI = 1.3 to 1.9 cancers per 1000 mammograms). Most (67 468 [77.7%]) of the 86 871 women screened reported no family history of breast cancer. For diagnostic mammograms, the age-adjusted rates across all age groups were: sensitivity of 85.7% (95% CI = 82.7% to 88.7%), specificity of 88.8% (95% CI = 88.4% to 89.1%), positive predictive value of 14.6% (95% CI = 13.3% to 15.8%), and cancer detection rate of 14.3 cancers per 1000 mammograms (95% CI = 13.0 to 15.7 cancers per 1000 mammograms). Mammography performance, except for specificity, improved in the presence of a breast lump. CONCLUSIONS: Younger women have very low breast cancer rates but after mammography experience high recall rates, high rates of additional imaging, and low cancer detection rates. We found no cancers in women younger than 25 years and poor performance for the large group of women aged 35-39 years. In a theoretical population of 10 000 women aged 35-39 years, 1266 women who are screened will receive further workup, with 16 cancers detected and 1250 women receiving a false-positive result.


References

Baines, C. J. (2011). "Frank words about breast screening." Open Med 5(3): e134-6.

Benson, S. R., J. Blue, et al. (2004). "Ultrasound is now better than mammography for the detection of invasive breast cancer." Am J Surg 188(4): 381-5.

Berry, D. A., C. J. Baines, et al. (2009). "Flawed inferences about screening mammography's benefit based on observational data." J Clin Oncol 27(4): 639-40; author reply 641-2.

Ciatto, S. (2009). "The overdiagnosis nightmare: a time for caution." BMC Womens Health 9: 34.

de Gelder, R., G. Draisma, et al. (2011). "Population-based mammography screening below age 50: balancing radiation-induced vs prevented breast cancer deaths." Br J Cancer 104(7): 1214-20.

Epstein, S. S., R. Bertell, et al. (2001). "Dangers and unreliability of mammography: breast examination is a safe, effective, and practical alternative." Int J Health Serv 31(3): 605-15.

Fitzgerald, A. and J. Berentson-Shaw (2012). "Thermography as a screening and diagnostic tool: a systematic review." N Z Med J 125(1351): 80-91.

Godfrey, M. E. (2012). "Breast thermography review--and author response." N Z Med J 125(1354): 105-7; author reply 107-9.

Gotzsche, P. C. and M. Nielsen (2009). "Screening for breast cancer with mammography." Cochrane Database Syst Rev(4): CD001877.

Gotzsche, P. C. and M. Nielsen (2011). "Screening for breast cancer with mammography." Cochrane Database Syst Rev(1): CD001877.

Green, B. B. and S. H. Taplin (2003). "Breast cancer screening controversies." J Am Board Fam Pract 16(3): 233-41.

Hendrick, R. E. (2010). "Radiation doses and cancer risks from breast imaging studies." Radiology 257(1): 246-53.

Heywang-Kobrunner, S. H., A. Hacker, et al. (2011). "Advantages and Disadvantages of Mammography Screening." Breast Care (Basel) 6(3): 199-207.

Jorgensen, K. J., A. Klahn, et al. (2007). "Are benefits and harms in mammography screening given equal attention in scientific articles? A cross-sectional study." BMC Med 5: 12.

Keen, J. D. and J. E. Keen (2009). "What is the point: will screening mammography save my life?" BMC Med Inform Decis Mak 9: 18.

Kolaric, D., S. Antonini, et al. (2012). "Re: Digital infrared thermal imaging (DITI) of breast lesions: sensitivity and specificity of detection of primary breast cancers." Clin Radiol 67(3): 295; author reply 295-6.

Lovett, K. M. and B. A. Liang (2011). "Risks of online advertisement of direct-to-consumer thermography for breast cancer screening." Nat Rev Cancer 11(12): 827-8.

Lovett, K. M., B. A. Liang, et al. (2012). "Risks of online direct-to-consumer tumor markers for cancer screening." J Clin Oncol 30(13): 1411-4.

Madjar, H. (2010). "Role of Breast Ultrasound for the Detection and Differentiation of Breast Lesions." Breast Care (Basel) 5(2): 109-114.

Miglioretti, D. L., R. Walker, et al. (2011). "Accuracy of screening mammography varies by week of menstrual cycle." Radiology 258(2): 372-9.

Moore, H. C., G. T. Budd, et al. (2010). "Sorting through the recent controversies in breast cancer screening." Cleve Clin J Med 77(2): 76-9.

Sadeghpour, M. (2011). "A close call: the role of screening mammography in the fight against breast cancer: health and medicine for women: a multidisciplinary, evidence-based review of mid-life health concerns." Yale J Biol Med 84(1): 43-5.

Scott, B. (2012). "Evaluation of thermography as a screening and diagnostic tool for breast cancer." N Z Med J 125(1351): 11-2.

Yaffe, M. J. and J. G. Mainprize (2011). "Risk of radiation-induced breast cancer from mammographic screening." Radiology 258(1): 98-105.

Yankaskas, B. C., S. Haneuse, et al. (2010). "Performance of first mammography examination in women younger than 40 years." J Natl Cancer Inst 102(10): 692-701.