Clinical outcomes of mammography in the National Breast and Cervical Cancer Early Detection Program, 2009–2012

Abstract

Purpose The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) enrolls asymptomatic women for cancer screening and symptomatic women for diagnostic services. Tiris study describes the results of mammograms provided by the NBCCEDP, by examination indication (screening or diagnostic), and by age group. Methods For the first NBCCEDP-funded mammogram received during 2009–2012, we calculated age-specific percentages of abnormal findings, rates of follow-up testing, and invasive and in situ breast cancer diagnoses per 1,000 mammograms. Logistic regression was used to estimate the odds for each of these outcomes by examination indication. Results The NBCCEDP provided 941,649 screening, 175,310 diagnostic, and 30,434 unknown indication mammograms to 1,147,393 women. The percentage with abnormal mammograms was higher for diagnostic mammograms (40.1 %) than for screening mammograms (15.5 %). Compared with women aged 40–49 years, fewer women aged 50–64 years had abnormal results for screening (13.7 vs. 19.7 %) and diagnostic mammograms (37.7 vs. 42.7 %). Follow-up rates per 1,000 mammograms were lower among women aged 50–64 compared to those aged 40–49 (screening: 143.9 vs. 207.5; diagnostic: 645.3 vs. 760.9); biopsy rates exhibited a similar pattern (screening: 24.1 vs. 32.9; diagnostic: 167.7 vs. 169.7). For screening mammograms, older women had more cancers detected than younger women (invasive: 3.6 vs. 2.2; in situ: 2.3 vs. 2.0). Similarly, for diagnostic mammograms, cancer detection was higher for older women (invasive: 67.8 vs. 36.6; in situ: 17.4 vs. 11.1). Conclusions Abnormal mammograms and diagnostic follow-up procedures were less frequent in women aged 50–64 years compared to women aged 40–49 years, while breast cancer detection was higher, regardless of indication for the mammogram. Some of these differences between age groups were greater for screening mammograms than for diagnostic mammograms. Cancer detection rates were higher for diagnostic mammograms compared with screen ing mammograms. These findings support the NBCCEDP's priority of serving women aged 50–64 years and providing both screening and diagnostic mammograms.

Breast cancer screening of underserved women in the USA: results from the National Breast and Cervical Cancer Early Detection Program, 1998–2012

“…The proportion of women aged 40–49 screened by NBCCEDP is sufficiently small that it is difficult to detect an impact of the revised 2009 USPSTF recommendation, if any. Many of the women aged 40–49 screened by NBCCEDP grantees are symptomatic [23], and so we would not necessarily expect to see a decline in the proportion screened.…”

Preventing premature deaths from breast and cervical cancer among underserved women in the United States: insights gained from a national cancer screening program

“…Benard et al [8] report that among women 40 years and older, those who had rarely or never been screened for cervical cancer had higher percentages of abnormal Pap tests and invasive disease compared to women who reported having a Pap test within the last 5 years. In addition, regardless of whether the mammogram was conducted for screening or diagnosis, White et al [9] found that breast cancer detection was higher among women 50 years and older compared to younger women. These findings lend support to the NBCCEDP’s focus on priority populations where disease is more evident.…”

“…For both breast and cervical cancer, the articles by White et al [9] and Benard et al [8] show that these referrals were more common among younger women. Ryerson et al [14] reported that the most common breast symptoms were pain or tenderness and breast lump.…”

The Reach and Health Impacts of the National Breast and Cervical Cancer Early Detection Program

“…Two articles in this special issue examine cancer detection rates among two of these populations. Benard et al [7] examine the effectiveness of targeting cervical cancer screening among women never or rarely screened for cervical cancer, while White et al [8] examine the clinical outcomes of mammography among women aged 50 years or older.…”