STUDY: Mammography Lowers Needs For Aggressive Treatment

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A new analysis on breast cancer screening was presented last week at the annual meeting of the American Society of Breast Surgeons. The study sought to determine how mammography affects outcomes other than survival.

The report was presented by Dr. Elisa Port, who has been chief of breast surgery service at the Mount Sinai Hospital in New York, NY, since 2010. Port explained how the investigators examined the capacity of mammography screening to reduce treatment in women who are diagnosed with breast cancer.

“This study shows that women who don’t get screened have later-stage disease and require more aggressive treatment,” Port said in an interview with Forbes.

Researchers discovered that women with breast cancer who had not been screened in the 2 years prior to their diagnosis had larger tumors and more lymph node involvement. Following diagnosis, breast cancer patients who had not been screened were more likely to undergo mastectomy, to have dissection of lymph nodes in the armpit during surgery and to receive chemotherapy.

“Controversy persists,” Port said at a press meeting in Orlando. “In 2018, mammography is underutilized. The guidelines keep changing for women ages 40 to 49. And they vary. So, what’s a woman to do? What’s a clinician to do?”

Port noted that only 60–70 percent of U.S. women who qualify for mammography, based on recent guidelines, actually seek screening.

Forbes reported: The retrospective analysis includes 1125 consecutive breast cancer cases diagnosed at a single institution in a recent 8-year interval (Sept. 2008 and May 2016). Of those patients, 73% had screening within 24 months before diagnosis; 306 women (27%) had not been screened in the 2 years prior; 6% had never had mammogram. Approximately 1 in 4 (290, 25.8%) of the cases were found in women ages 40 – 49; the investigators focused on this age bracket in a subgroup analysis.

Women in their forties without prior screening had significantly larger tumors (2.3 vs. 1.3 cm, mean) and were much more likely to have positive lymph nodes (hazard ratio 4.52, confidence interval range 1.64 – 12.42; p=0.0035). Without prior mammography, women in their forties were also more likely to undergo mastectomy, have lymph node dissection, and to receive chemotherapy. In this study, only 29 women among those in their forties had never had a mammogram.

“We thought it particularly important to focus on this age group because it’s for women in their forties for which the guidelines have been pulled back and are most confusing,” Port said. “Cancers tend to be more aggressive in those younger patients.”

Port insisted, “There’s not just a survival advantage to screening. There’s potential for less treatment.” Port noted that women need to know this. “Besides discussing the lower likelihood of surviving, we need to be talking about the risks of needing more treatment when we discuss whether or not to do mammograms.”

Port said that the guidelines regarding mammography screening vary, “and it’s confusing. A lot of the guidelines are about weighing costs and harms. But the current approach may be penny wise, pound foolish. I worry that the costs will blow up later, with more money spent and more toxicity. More women will be needing more chemotherapy and more extensive surgery. Without mammography, the personal harms go up, of having larger tumors, greater risk, and more treatment.”

Port noted, “Screening is an opportunity. Screening is the only way we have to intervene to get the tumor before it needs more extensive treatment.”

Regarding false alarms in screening, Port said, “I think the false positive story has been largely overestimated. Most false positives are really just a call back for additional imaging.”

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