Annals of Surgical Oncology

, Volume 25, Issue 10, pp 2979–2986 | Cite as

Impact of Screening Mammography on Treatment in Women Diagnosed with Breast Cancer

  • Soojin Ahn
  • Margaux Wooster
  • Christopher Valente
  • Erin Moshier
  • Ru Meng
  • Kereeti Pisapati
  • Ronald Couri
  • Laurie Margolies
  • Hank Schmidt
  • Elisa PortEmail author
Breast Oncology



Screening mammography reduces breast cancer mortality; however, screening recommendations, ordering, and compliance remain suboptimal and controversies regarding the value of screening persist. We evaluated the influence of screening mammography on the extent of breast cancer treatment.


Patients ≥ 40 years of age diagnosed with breast cancer from September 2008 to May 2016 at a single institution were divided into two groups: those with screening 1–24 months prior to diagnosis, and those with screening at 25+ months, including patients with no prior mammography. The association between the two groups and various clinical factors were assessed using logistic regression models. Subgroup analysis was performed based on age groups.


Analysis included 1125 patients, 819 (73%) with screening at 1–24 months, and 306 (27%) with screening at 25+ months, including 65 (6%) who never had mammography. Overall, patients in the 25+ months group were more likely to receive chemotherapy [odds ratio (OR) 1.51, p = 0.0040], undergo mastectomy (OR 1.32, p = 0.0465), and require axillary dissection (AD; OR 1.66, p = 0.0045) than those in 1–24 months group. On subgroup analysis, patients aged 40–49 years with no prior mammography were more likely to have larger tumors (p = 0.0323) and positive nodes (OR 4.52, p = 0.0058), undergo mastectomy (OR 3.44, p = 0.0068), undergo AD (OR 4.64, p = 0.0002), and require chemotherapy (OR 2.52, p = 0.0287) than the 1–24 months group.


Screening mammography is associated with decreased stage at diagnosis and receipt of less-extensive treatment. This was evident in all groups, including the 40–49 years age group, where controversy exists on whether screening is even necessary.



Authors have no financial disclosures.


  1. 1.
    Shapiro S. Periodic screening for breast cancer: the HIP randomized controlled trial. JNCI Monogr. 1997;22:27–30.CrossRefGoogle Scholar
  2. 2.
    Tabár L, Fagerberg CJG, Gad A, et al. Reduction in mortality from breast cancer after mass screening with mammography. The Lancet. 1985;325(8433):829–32.CrossRefGoogle Scholar
  3. 3.
    Tabár L, Vitak B, Chen TH-H, et al. Swedish two-county trial: impact of mammographic screening on breast cancer mortality during 3 decades. Radiology. 2011;260:658–63.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Alexander FE, Anderson TJ, Brown HK, et al. 14 years of follow-up from the Edinburgh randomised trial of breast-cancer screening. The Lancet. 1999;353:1903–8.CrossRefGoogle Scholar
  5. 5.
    Miller AB, Baines CJ, To T, Wall C. Canadian National Breast Screening Study: 1-breast cancer detection and death rates among women aged 40–49 years. Can Med Assoc J. 1992;147:1459–76.Google Scholar
  6. 6.
    Andersson I, Aspegren K, Janzon L, et al. Mammographic screening and mortality from breast cancer: the Malmo mammographic screening trial. BMJ. 1988;297:943.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Frisell J, Lidbrink E, Hellstrom L, Rutqvist LE. Follow-up after 11 years: update of mortality results in the Stockholm mammographic screening trial Breast Cancer. Res Treat. 1997;45:263–70.CrossRefGoogle Scholar
  8. 8.
    Bjurstam N, Bjorneld L, Duffy SW, et al. The Gothenburg breast screening trial: first results on mortality, incidence, and mode of detection for women ages 39–49 years at randomization. Cancer. 1997;80:2091–9.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Centers for Disease Control and Prevention, National Center for Health Statistics. Health, United States, 2016: with chartbook on long-term trends in health. 2017. Accessed 17 Mar 2018.
  10. 10.
    National Comprehensive Cancer Network (NCCN) Guidelines. NCCN clinical practice guidelines in oncology. Breast cancer screening and diagnosis. 2017. Accessed 17 Mar 2018.
  11. 11.
    Monticciolo DL, Newell MS, Hendrick RE, et al. Breast cancer screening for average-risk women: recommendations from the ACR commission on breast imaging. J Am Coll Radiol. 2017;14(9):1137–43.CrossRefGoogle Scholar
  12. 12.
    United States Preventive Services Task Force. Breast cancer: screening recommendations. 2016. Accessed 17 Mar 2018.
  13. 13.
    Oeffinger KC, Fontham ETH, Etzioni R, et al. Breast cancer screening for women at average risk 2015 guideline update from the American Cancer Society. JAMA. 2015;314(15):1599–614.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Miller AB, Wall C, Baines CJ, et al. Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial. BMJ. 2014;348:g366.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
  16. 16.
  17. 17.
    Berry DA, Cronin KA, Plevritis SK, et al. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med. 2005;353:1784–92.CrossRefGoogle Scholar
  18. 18.
    Saadatmand S, Bretveld R, Siesling S, et al. Influence of tumour stage at breast cancer detection on survival in modern times: population based study in 173,797 patients. BMJ. 2015;351:h4901.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Brown LM, Chen BE, Pfeiffer RM, et al. Risk of second non-hematological malignancies among 376,826 breast cancer survivors. Breast Cancer Res and Treat. 2007;106(3):439–51.CrossRefGoogle Scholar
  20. 20.
    Ng AK, Travis LB. Subsequent malignant neoplasms in cancer survivors. Cancer J. 2008;14(6):429–34.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Collichio F, Pandya K. Amenorrhea following chemotherapy for breast cancer: effect on disease-free survival. Oncology. 1994;8(12):45–52.PubMedGoogle Scholar
  22. 22.
    Kayl AE, Meyers CA. Side-effects of chemotherapy and quality of life in ovarian and breast cancer patients. Curr Opin Obstet Gynecol. 2006;18(1):24–8.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Correa DD, Ahles TA. Cognitive adverse effects of chemotherapy in breast cancer patients. Curr Opin Support Palliat Care. 2007;1(1):57–62.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Kummerow KL, Du L, Penson DF, et al. Nationwide trends in mastectomy for early-stage breast cancer. JAMA Surg. 2015;150(1):9–16.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Garcia-Etienne CA, Tomatis M, Joerg Heil, et al. Mastectomy trends for early-stage breast cancer: a report from the EUSOMA multi-institutional European database. Eur J Cancer. 2012;48(13):1947–56.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    McLaughlin SA, Wright MJ, Morris KT, et al. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol. 2008;26(32):5213–9.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    DiSipio T, Rye S, Newman B, et al. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 2013;14(6):500–15.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Harris JR, Murphy PH, McNeese M, Mendelhall NP, Morrow M, Robert NJ. Consensus statement on postmastectomy radiation therapy. Int J Radiat Oncol Biol Phys. 1999;44:989–90.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Recht A, Edge SB, Solin LJ, et al. Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol. 2001;19:1539–69.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    National Comprehensive Cancer Network (NCCN) guidelines. NCCN clinical practice guidelines in oncology. Invasive breast cancer. Accessed 20 Apr 2018.
  31. 31.
    Truong PT, Olivotto IA, Whelan TJ, et al. Clinical practice guidelines for the care and treatment of breast cancer: 16. Locoregional post-mastectomy radiotherapy. CMAJ. 2004;170:1263–73.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Recht A, Comen EA, Fine RE, et al. Postmastectomy radiotherapy: an American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology focused guideline update. Ann Surg Oncol. 2017;24(1):38–51.CrossRefGoogle Scholar
  33. 33.
    Hinrichs CS, Watroba NL, Rezaishiraz H, et al. Lymphedema secondary to postmastectomy radiation: incidence and risk factors. Ann Surg Oncol. 2004;11(6):573–80.CrossRefGoogle Scholar
  34. 34.
    Sparano JA, Gray JR, Makower DF, et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N Engl J Med. 2018. Scholar
  35. 35.
    Nelson HD, Fu R, Cantor A, et al. Effectiveness of breast cancer screening: systematic review and meta-analysis to update the 2009 U.S. Preventive Services Task Force recommendation. Ann Int Med. 2016;164(4):244–55.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Soojin Ahn
    • 1
  • Margaux Wooster
    • 1
  • Christopher Valente
    • 1
  • Erin Moshier
    • 1
  • Ru Meng
    • 1
  • Kereeti Pisapati
    • 1
  • Ronald Couri
    • 1
  • Laurie Margolies
    • 1
  • Hank Schmidt
    • 1
  • Elisa Port
    • 1
    Email author
  1. 1.Icahn School of Medicine at Mount SinaiNew YorkUSA

Personalised recommendations