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Fox Chase Cancer Center Study Confirms Regular Mammography Screening for Women 40 and Older Finds Breast Cancer at Earlier Stage and Increases Eligibility for Breast Conservation
PHILADELPHIA (Oct. 7, 2002)-A new study at Fox Chase Cancer Center shows additional evidence for the value of breast cancer screening with mammography among women 40 and older. Among 1,591 women with newly diagnosed breast cancer, those with any history of screening had earlier-stage disease; were more likely to have small tumors, under 1 centimeter; and were more often candidates for breast-conserving treatment than women with no history of mammography screening.
Fox Chase radiation oncologist Gary M. Freedman, M.D., presented the study results Monday, Oct. 7 at the 44th annual meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO), held in New Orleans Oct. 6-10. The study looked at women seen in the Fox Chase breast evaluation center, where a multidisciplinary team including a radiation oncologist, medical oncologist, breast surgeon, diagnostic radiologist and pathologist evaluates each patient.
Freedman and his colleagues compared patients in three categories: Group 1, unscreened, consisted of 192 patients with no history of screening mammography. Group 2, partially screened, contained 695 women who had averaged a screening mammogram less than once a year. Group 3, highly screened, consisted of 704 patients who on average had received screening mammograms annually or more often.
Women screened at least annually on average more often had a diagnosis of very early stage 0 breast cancer-carcinoma in situ-that was not yet invasive compared to women with less frequent or no screening. Compared to unscreened women, those with any history of mammography before diagnosis had earlier stage invasive disease as well as smaller tumor size and their physicians more often recommended the option of breast conservation instead of mastectomy if they chose.
The most significant difference was between women who had any history of screening and those who did not. However, it supported annual screening as the most likely to detect the most curable stage 0 form of breast cancer and also more likely to detect breast cancers at a smaller tumor size than less frequent screening.
"The study found a similar benefit from screening mammography in the study patients aged 40 to 49 years compared to older women, but it did not find as significant a difference in these younger women with yearly versus less frequent screening," Freedman said.
The American Cancer Society recommends annual mammography screening from women 40 and older. The National Cancer Institute and the U. S. Preventive Services Task Force of the Department of Health and Human Services recommend annual screening mammograms every one to two years for women 40 and up.
These recommendations were reassessed and reaffirmed last February in light of a controversial Oct. 20 report in the journal Lancet. Reanalyzing previous studies of screening mammography, Danish researchers questioned whether detecting breast cancer early through screening mammograms really reduces death rates. Several past studies have shown at least a 30 percent reduction in breast cancer deaths among women who had regular screening.
However, a Swedish study published August 1 in Cancer, looking at women in seven counties who received organized mammography screening, found a 44 percent reduction in breast cancer rates compared to rates in the pre-screening period.
"The Fox Chase study provides still more evidence that women can benefit from regular mammography screening," Freedman said.
Other authors of the study include radiation oncologists Penny R. Anderson, M.D., and Nicos Nicolaou, M.D.; medical oncologists Lori J. Goldstein, M.D., Michael M. Millenson M.D., Mary E. Cianfrocca, D.O., and Margaret von Mehren, M.D.; biostatistician Alexandra L. Hanlon, Ph.D.; breast surgeons Marcia Boraas, M.D., and Michael H. Torosian, M.D.; pathologists Arthur S. Patchefsky, M.D., and Harry S. Cooper, M.D.; and diagnostic radiologists Kathryn Evers, M.D., and Arthur D. Magnilner, M.D., all of Fox Chase Cancer Center.
Fox Chase Cancer Center, one of the nation's first comprehensive cancer centers designated by the National Cancer Institute in 1974, conducts basic and clinical research; programs of prevention, detection and treatment of cancer; and community outreach. For more information about Fox Chase activities, visit the Center's web site at www.fccc.edu.
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