Breast Cancer Study Supports Role of Mammography, Self-Exams

Jamie Caughran, MD

The importance of mammography and self examination as methods of detecting breast cancer were affirmed in a study that will be presented this week at the 2011 Breast Cancer Symposium of the American Society of Clinical Oncology (ASCO) in San Francisco, California.

The findings, discussed during a presscast Tuesday, contrast sharply with the controversial 2009 recommendations of the US Preventive Services Task Force (USPSTF).

Jamie Caughran, MD, medical director of the Comprehensive Breast Center at the Lacks Cancer Center in Grand Rapids, Michigan, and colleagues launched the study to evaluate therapies given patients in light of those recommendations.

The USPSTF recommended that routine screening mammograms should only be conducted every 2 years for women over 50 years old and that women aged 40 to 49 should make individual decisions on mammograms after weighing the potential risks and benefits. The task force recommended against the teaching of breast self-examination techniques.

Caughran and colleagues analyzed detection and treatment patterns involving 5628 patients diagnosed with stage 0 to III breast cancer at 14 institutions in Michigan from 2006 to 2009. The average age of women included in the analysis was 59.4 years.

Overall, the cancers were detected through mammography in 65.5% of patients, through palpable presentation in 29.8%, and through other methods in 4.7%. Of those in the palpation group, masses were discovered in 90.2% through patient self-examination and in 9.8% though clinical examination.

Investigators found that 81% of the women whose tumors were detected through mammography were over 50.

Patients with palpable presentations tended to be younger than those diagnosed with mammography (55.8 years vs 61.2 years), but presented with more advanced cancers. As a result, more patients in the palpation group underwent mastectomies than those detected by mammography (45.8% vs 27.1%). Women in the palpation group were also more likely to undergo chemotherapy (22.7% vs 15.7%).

Caughran said the study demonstrates that women whose tumors are discovered through mammography present at earlier stages and are more likely to undergo breast conservation therapy. Meanwhile, she noted that women with breast cancer “continue to present with palpable masses.”

“It continues to reinforce what we believe is inherently true,” she said.

Caughran said she supports annual screenings starting at age 40, which is the recommendation of the American Cancer Society and the American College of Obstetricians and Gynecologists.

All symposium abstracts are posted at http://breastcasymposium.org.

Smith DR, Caughran J, Kreinbrink JL, et al. Clinical presentation of breast cancer: age, stage, and treatment modalities in a contemporary cohort of Michigan women. In: Proceedings from the 2011 Breast Cancer Symposium of the American Society of Clinical Oncology; September 8-10, 2011; San Francisco, CA. Abstract 1.