© 2004 by Oxford University Press
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© 2004 Oxford University Press
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Biennial Versus Annual Mammography and the Risk of Late-Stage Breast Cancer
Affiliations of authors: School of Public Health, University of Washington (EW, DLM, DSMB, NO, WB), Center for Health Studies, Group Health Cooperative (DLM, DSMB, WB), and Cancer Research and Biostatistics (WB), Seattle, WA; Health Promotion Research (BMG) and Department of Medical Biostatistics (PMV), University of Vermont, College of Medicine, Burlington, VT; Department of Radiology, University of New Mexico, Health Sciences Center, Albuquerque (RDR); Applied Research Program, Department of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (RB-B, SHT); Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Department of Community and Family Medicine, Dartmouth Medical School, Lebanon, NH (PAC); Department of Radiology, University of North Carolina, Chapel Hill, NC (BCY); Department of Biostatistics, The Cooper Institute, Golden, CO (LS); General Internal Medicine Section, Department of Veterans Affairs and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA (KK)
Correspondence to: Emily White, PhD, Fred Hutchinson Cancer Research Center, MY-B402, P.O. Box 19034, Seattle, WA 98109-1024 (ewhite{at}fhcrc.org)
Background: Mammography screening may reduce breast cancer mortality by detecting cancers at an earlier stage. However, certain questions remain, including the ideal interval between mammograms. Methods: We conducted an observational study using information collected by seven mammography registries across the United States to investigate whether women diagnosed with breast cancer after having screening mammograms separated by a 2-year interval (n = 2440) are more likely to be diagnosed with late-stage disease (positive lymph nodes or metastases) than women diagnosed with breast cancer after having screening mammograms separated by a 1-year interval (n = 5400). Analyses were stratified by age and breast density to clarify whether groups that have the poorest mammography sensitivity (i.e., women under age 50 years and those with mammographically dense breasts) would benefit most from annual screening. The subjects were women diagnosed with breast cancer between 1996 and 2001 who were 40–89 years old at their index mammographic examination (i.e., the most recent screen at or before breast cancer diagnosis). Data were analyzed by logistic regression, adjusting for race, ethnicity, family history of breast cancer, and mammography registry. Results: Among women age 40–49 years at the index mammogram, those with a 2-year screening interval were more likely to have late-stage disease at diagnosis than those with a 1-year screening interval (28% versus 21%; odds ratio [OR] = 1.35, 95% confidence interval [CI] = 1.01 to 1.81). There was no increase in late-stage disease for women 50 years or older with a 2-year versus a 1-year screening interval (women age 50–59 years at index mammogram: OR = 0.97, 95% CI = 0.75 to 1.25; women age 60–69 years at index mammogram: OR = 0.99, 95% CI = 0.72 to 1.35; women age 70 years or older at index mammogram: OR = 0.88, 95% CI = 0.64 to 1.19). There was no indication that women with dense breasts would benefit more from a 1-year versus 2-year screening interval than women with fatty breasts. Conclusion: These findings may be useful for policy decisions about appropriate screening intervals and for use in statistical models that estimate the costs and benefits of mammography by age and screening interval.
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Related Memo to the Media
- Press Release: Study Examines Impact of Two-Year Screening Interval for Breast Cancer
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J Natl Cancer Inst 2004 96: 1799.[Extract] [Full Text]
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