Annual Vs Biennial Screening Mammography Use Could Depend On Menopausal Status

Premenopausal women derive more benefit from annual versus biennial screening mammography than their postmenopausal counterparts

medwireNews: A study of over 15,000 US women diagnosed with breast cancer by screening mammography has revealed insights into the relationship between the timing of mammograms, menopausal status and patient prognosis.

 

Diana Miglioretti, from the University of California–Davis School of Medicine, and team found that in a group of 2027 premenopausal women diagnosed at screening mammography, those who underwent biennial screening were more likely to have poor prognostic characteristics than those who received annual check-ups.

The relative risk (RR) of stage IIB or more advanced disease was 1.28 for the biennial versus annual patient groups, with a RR of 1.21 for tumours larger than 15 mm in diameter and a RR of 1.11 for these two characteristics or disease spread to the lymph nodes.

By contrast, there was no significant difference in the prognostic features found among the 9823 postmenopausal women who underwent biennial or annual screening mammography, the authors report in JAMA Oncology.

This was true regardless of whether patients used postmenopausal hormone therapy, the type of hormone therapy used and when patient risk was assessed in 10-year age groups, the researchers report.

“Our findings suggest that menopausal status may be more important than age when considering breast cancer screening intervals, which is biologically plausible”, Diana Miglioretti et al write, citing the impact of oestrogen on tumour growth and increasing breast density with menopause.

Wendy Chen, from Brigham and Women’s Hospital in Boston, Massachusetts, USA, writes in an accompanying editorial that the study “clearly demonstrated that with less frequent mammography, the tumours will be bigger and have a slightly more advanced stage”.

“However”, she suggests, “with our better understanding of tumor biology and improvements in targeted therapy, the best way to optimize the risk and/or benefit of screening may not be to maximize the chances of finding a smaller tumor.”

Instead, the editor recommends that screening research should now focus on detection of breast cancers that are curable after screening but not when found in the clinic – disease that is “likely best defined by tumor biological characteristics rather than tumor size and nodal status”, she says.

References

Miglioretti DL, Zhu W, Kerlikowske K, et al. Breast tumor prognostic characteristics and biennial vs annual mammography, age, and menopausal status. JAMA Oncol 2015; Advance online publication 20 October.doi:10.1001/jamaoncol.2015.3084

Chen WY. Measuring the effectiveness of mammography. JAMA Oncol 2015; Advance online publication 20 October.doi:10.1001/jamaoncol.2015.3286

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