Abstract
Background
Screening mammography can detect early breast cancers and reduce subsequent cancer mortality. However, there is a lack of consensus as to when to discontinue screening. The absence of clear-cut guidelines on when not to screen means that many patients with advanced malignancies continue screening despite unclear benefit.
Methods
We performed a retrospective cohort study of female patients diagnosed with a non-breast malignancy to explore the incidence and effects of screening mammography. Female patients diagnosed with a non-breast malignancy stage II or higher between 2007 and 2012 were identified through the Vermont Cancer Registry and cross-referenced with mammography screening logs from January 1, 2007 to September 30, 2014. Additional data were collected through chart review, in May 2016.
Results
Twenty-six percent of women (398/1501) with a stage II or greater cancer (other than breast) diagnosed between 2007 and 2012 had a screening mammogram within the first 5 years of their diagnosis. Of these 398 women, 193 (48.5%) were alive without cancer, 132 (33.2%) had died, and 73 (18.3%) were alive with cancer at the time of chart review. Of those who died, 84 (63.6%) had a stage III or IV cancer. Eighteen (4.5%) had a breast biopsy following a screening mammogram suspicious for cancer, resulting in 13 (3.3%) benign diagnoses and 5 (1.3%) breast cancer diagnoses. No patient died of breast cancer.
Conclusions
Except for highly curable cancers, female patients diagnosed with an advanced non-breast malignancy experienced mortality that outweighs a breast cancer mortality benefit from screening mammography as estimated from prior studies.
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Acknowledgements
We would like to thank Lisa Thompson, Cancer Registry, Vermont Dept. of Health Information Management and Mark Bowman, Vermont Breast Cancer Surveillance System for their support. The collection of screening mammography records by the Vermont Breast Cancer Surveillance System was supported by Grant Nos. U54 CA163303 and P01 CA154292 from the National Cancer Institute.
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There was no funding for this study.
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Dr. Sally Herschorn owns stock in Hologic, Inc. All other authors declare that they have no conflict of interest.
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The study received a waiver of consent form. All procedures performed in this study involved registry data from human participants and were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Leopold, R.B., Thomas, A.W., Concannon, K.F. et al. Breast cancer screening in patients with cancers other than breast. Breast Cancer Res Treat 163, 343–348 (2017). https://doi.org/10.1007/s10549-017-4179-7
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DOI: https://doi.org/10.1007/s10549-017-4179-7