Factors Contributing to Mammography Failure in Women Aged 40-49 Years

Buist, Diana S.M.; Porter, Peggy L.; Lehman, Constance D.; Taplin, Stephen H.; White, Emily

doi:10.1093/jnci/djh269

Cited by 280 publications

(210 citation statements)

References 33 publications

(45 reference statements)

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“…15,16 Test sensitivity of mammography and positive predictive value (PPV) of a screening mammogram are therefore likely to be lower for younger women. Recent Dutch data on What's new?…”

Section: Model Parameters and Assumptionsmentioning

confidence: 99%

“…Women aged 40 to 49 have been shown to have higher interval cancer rates than older women, due to greater mammographic breast density and higher tumour Epidemiology growth rates. 16,35 Therefore, we considered both biennial and annual screening for women aged 40 to 49. The following strategies were simulated: (i) biennial screening from age 50 to 74 (current strategy), (ii) one screen at age 49 and biennial screening from age 50 to 74, (iii) biennial screening from age 48 to 74, (iv) biennial screening from age 45 to 74, (v) annual screening from age 45 to 49 and biennial screening from age 50 to 74, (vi) biennial screening from age 40 to 74, (vii) annual screening from age 40 to 49 and biennial screening from age 50 to 74.…”

Section: Screening Strategiesmentioning

confidence: 99%

“…14 Younger women may benefit less from mammography screening because of factors associated with younger age, including a lower breast cancer incidence 1 and a lower test sensitivity of mammography due to higher breast density and, possibly, faster growing tumours. 15,16 However, results from the DMIST trial show that digital mammography improves test sensitivity for younger women with dense breasts compared to film mammography. 17 Due to the controversy over screening before age 50 there is no consensus on whether or not to offer screening to women aged 40 to 49.…”

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confidence: 99%

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Cost‐effectiveness of digital mammography screening before the age of 50 in The Netherlands

Sankatsing

Heijnsdijk

Luijt

et al. 2015

Intl Journal of Cancer

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In the Netherlands, routine mammography screening starts at age 50. This starting age may have to be reconsidered because of the increasing breast cancer incidence among women aged 40 to 49 and the recent implementation of digital mammography. We assessed the cost-effectiveness of digital mammography screening that starts between age 40 and 49, using a microsimulation model. Women were screened before age 50, in addition to the current programme (biennial 50-74). Screening strategies varied in starting age (between 40 and 50) and frequency (annual or biennial). The numbers of breast cancers diagnosed, life-years gained (LYG) and breast cancer deaths averted were predicted and incremental cost-effectiveness ratios (ICERs) were calculated to compare screening scenarios. Biennial screening from age 50 to 74 (current strategy) was estimated to gain 157 life years per 1,000 women with lifelong follow-up, compared to a situation without screening, and cost e3,376/ LYG (3.5% discounted). Additional screening increased the number of LYG, compared to no screening, ranging from 168 to 242. The costs to generate one additional LYG (i.e., ICER), comparing a screening strategy to the less intensive alternative, were estimated at e5,329 (biennial 48-74 vs. current strategy), e7,628 (biennial 45-74 vs. biennial 48-74), e10,826 (biennial 40-74 vs. biennial 45-74) and e18,759 (annual 40-49 1 biennial 50-74 vs. biennial 40-74). Other strategies (49 1 biennial 50-74 and annual 45-49 1 biennial 50-74) resulted in less favourable ICERs. These findings show that extending the Dutch screening programme by screening between age 40 and 49 is cost-effective, particularly for biennial strategies.Breast cancer is the most commonly diagnosed form of cancer among women aged 30 and older in the Netherlands. 1 Mammography screening allows for early detection and early treatment of breast cancer, with the aim of averting breast cancer death. In the Netherlands, women aged 50 to 74 are invited biennially to screening. Various randomised controlled trials demonstrated a statistically significant breast cancer mortality reduction due to mammography screening in this age group. 2-4 Furthermore, Otto et al. 5,6 showed that the Dutch population-based screening programme is effective in reducing breast cancer mortality. The evidence for the benefit of mammography screening for younger women is less conclusive, 7-9 however, an effect for this age group is supported by several studies. Although the UK Age Trial showed a non-significant 17% reduction in breast cancer mortality, 9 a statistically significant breast cancer mortality reduction of 15% to 18% associated with screening for women aged 39 to 49 or 40 to 49 at entry was demonstrated by several meta-analyses of randomised controlled trials. [10][11][12][13] In addition, a recent Swedish observational study that compared breast cancer mortality rates between women aged 40 and 49 who were invited to screening and women who were not invited to screening demonstrated a 26% statistically significant br...

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“…15,16 Test sensitivity of mammography and positive predictive value (PPV) of a screening mammogram are therefore likely to be lower for younger women. Recent Dutch data on What's new?…”

Section: Model Parameters and Assumptionsmentioning

confidence: 99%

Section: Screening Strategiesmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Cost‐effectiveness of digital mammography screening before the age of 50 in The Netherlands

Sankatsing

Heijnsdijk

Luijt

et al. 2015

Intl Journal of Cancer

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“…Whether screening should be offered to women younger than age 50 years, particularly to those thought to be at a higher than average risk of the disease because of a family history of breast cancer, is a question that is frequently raised. However, mammographic screening before age 50 years is less effective than at older ages possibly because premenopausal women have denser breasts and because the tumours grow more rapidly (Buist et al, 2004). Preliminary results from the UK Age Trial suggest that the reduction in breast cancer mortality associated with offering annual mammographic screening from age 40 to 47/48 years may be 10% (Moss et al, 2005), which is considerably lower than the 25% reduction achieved in randomised trials offering regular screening to women aged 50 -69 years (IARC, 2002).…”

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confidence: 99%

Mammographic screening before age 50 years in the UK: comparison of the radiation risks with the mortality benefits

González

Reeves

2005

Br J Cancer

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Mammographic screening before age 50 years is less effective than at older ages and the associated radiation risks are higher. We estimated how many breast cancer deaths could be caused and how many could be prevented by a decade of annual two-view mammographic screening starting at ages 20, 30 and 40 years, respectively, in the UK; for all women, and for women with first-degree relatives affected with breast cancer. We extrapolated from a radiation risk model to estimate the number of radiation-induced breast cancer deaths, and used results from randomised trials, which suggest a reduction in breast cancer mortality of 10 -20% in women invited to screening before age 50 years, to estimate the number of deaths that could be prevented. The net change in breast cancer deaths was defined as the number of radiation-induced deaths minus the number of prevented deaths. For all women, assuming a reduction in mortality from screening of 20%, a decade of annual screening was estimated to induce more deaths than it prevents if started at age 20 years and at age 30 years (net increase ¼ 0.86 and 0.37 breast cancer deaths, respectively, per 1000 women screened). The corresponding estimate for screening starting at age 40 years was a net decrease of 0.46 deaths/1000 women screened and a zero net change assuming a 10% mortality reduction. Results for women with first-degree relatives with breast cancer were generally in the same direction but, because their background incidence rates are higher, the net increases or decreases were greater. In conclusion, our estimates suggest that a decade of annual two-view mammographic screening before age 40 years would result in a net increase in breast cancer deaths, and that starting at age 40 years could result in a material net decrease only if breast cancer mortality is reduced by about 20% or more in women screened. Although these calculations were based on a number of uncertain parameters, in general, the conclusions were not altered when these parameters were varied within a feasible range. The National Health Service Breast Screening Programme currently invites women in the UK aged 50 -70 years for mammographic screening once every 3 years. Whether screening should be offered to women younger than age 50 years, particularly to those thought to be at a higher than average risk of the disease because of a family history of breast cancer, is a question that is frequently raised. However, mammographic screening before age 50 years is less effective than at older ages possibly because premenopausal women have denser breasts and because the tumours grow more rapidly (Buist et al, 2004). Preliminary results from the UK Age Trial suggest that the reduction in breast cancer mortality associated with offering annual mammographic screening from age 40 to 47/48 years may be 10% (Moss et al, 2005), which is considerably lower than the 25% reduction achieved in randomised trials offering regular screening to women aged 50 -69 years (IARC, 2002).Exposure to mammographic X-rays confers a risk of...

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“…This means the sensitivity of mammography for detecting breast cancer can be significantly reduced in the case of dense breasts [5]. Retrospective studies have shown that in current breast cancer screening 10% to 25% of tumors are missed by radiologists [6,7] and some of these false negative results can be explained by higher breast density.…”

Section: Introductionmentioning

confidence: 99%

Semi-automated and fully automated mammographic density measurement and breast cancer risk prediction

Llobet

Pollán

Antón

et al. 2014

Computer Methods and Programs in Biomedicine

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Semi-automated and fully-automated mammographic density measurement and breast cancer risk prediction better tissue classification and density measurement on a continuous scale. The fully-automated method presented combines a classification scheme based on local features and thresholding operations that improve the performance of the classifier. A dataset of 655 mammograms was used to test the concordance of both approaches in measuring MD. Three expert radiologists measured MD in each of the mammograms using the semi-automated tool (DM-Scan). It was then measured by the fully-automated system and the correlation between both methods was computed. The relation between MD and breast cancer was then analyzed using a case-control dataset consisting of 230 mammograms.The Intraclass Correlation Coefficient (ICC) was used to compute reliability among raters and between techniques. The results obtained showed an average ICC=0.922 among raters when using the semi-automated tool, whilst the average correlation between the semi-automated and automated measures was ICC=0.838. In the case-control study, the results obtained showed Odds Ratios (OR) of 1.38 and 1.50 per 10% increase in MD when using the semi-automated and fully-automated approaches respectively. It can therefore be concluded that the automated and semi-automated MD assessment present a good correlation.Both methods also found an association between MD and breast cancer risk, which warrants the proposed tools for breast cancer risk prediction and clinical decision making. A full version of the DM-Scan is freely available.

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Factors Contributing to Mammography Failure in Women Aged 40-49 Years

Cited by 280 publications

References 33 publications

Cost‐effectiveness of digital mammography screening before the age of 50 in The Netherlands

Cost‐effectiveness of digital mammography screening before the age of 50 in The Netherlands

Mammographic screening before age 50 years in the UK: comparison of the radiation risks with the mortality benefits

Semi-automated and fully automated mammographic density measurement and breast cancer risk prediction

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