Anna M Chiarelli1,2, Kristina M Blackmore1, Lucia Mirea2, Susan J Done3, Vicky Majpruz1, Ashini Weerasinghe1, Linda Rabeneck1,2,4,5, Derek Muradali1,6,7. 1. Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada. 2. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. 3. Laboratory Medicine Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada. 4. Phoenix Children's Hospital, Phoenix, AZ. 5. Department of Medicine, University of Toronto, Toronto, ON, Canada. 6. St. Michael's Hospital, Toronto, ON, Canada. 7. Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
Abstract
BACKGROUND: The Ontario Breast Screening Program recommends annual mammography to women age 50-74 years at increased risk because of family history of breast or ovarian cancer or personal history of ovarian cancer or mammographic density 75% or greater. Few studies have examined the diagnostic accuracy of recommendations based on risk factors and included screen film as well as digital mammography. METHODS: A retrospective design identified concurrent cohorts of women age 50-74 years screened annually or biennially with digital mammography only between 2011 and 2014 and followed until 2016 or breast cancer diagnosis. Diagnostic accuracy measures were compared between women screened annually because of first-degree relative of breast or ovarian cancer or personal history of ovarian cancer (n = 67 795 women), mammographic density 75% or greater (n = 51 956), or both (n = 3758) and those screened biennially (n = 526 815). The association between recommendation and sensitivity and specificity was assessed using generalized estimating equation models. All P values are two-sided. RESULTS: For annual screening because of family or personal history vs biennial, sensitivity was statistically significantly higher (81.7% vs 70.6%; OR = 1.86, 95% CI = 1.48 to 2.34), particularly for invasive cancers and postmenopausal women. Although there was no statistically significant difference in sensitivity for annual screening for mammographic density 75% or greater, specificity was statistically significantly lower (91.3%; OR = 0.87, 95% CI = 0.80 to 0.96) vs biennial (92.3%), particularly for women age 50-59 years. CONCLUSION: Compared with biennial screening, annual screening improved detection for women with a family or personal history of breast and/or ovarian cancer, supporting screening that is more frequent. The benefit for annual screening for women with higher mammographic density must be weighed against possible harms of increased false positives.
BACKGROUND: The Ontario Breast Screening Program recommends annual mammography to women age 50-74 years at increased risk because of family history of breast or ovarian cancer or personal history of ovarian cancer or mammographic density 75% or greater. Few studies have examined the diagnostic accuracy of recommendations based on risk factors and included screen film as well as digital mammography. METHODS: A retrospective design identified concurrent cohorts of women age 50-74 years screened annually or biennially with digital mammography only between 2011 and 2014 and followed until 2016 or breast cancer diagnosis. Diagnostic accuracy measures were compared between women screened annually because of first-degree relative of breast or ovarian cancer or personal history of ovarian cancer (n = 67 795 women), mammographic density 75% or greater (n = 51 956), or both (n = 3758) and those screened biennially (n = 526 815). The association between recommendation and sensitivity and specificity was assessed using generalized estimating equation models. All P values are two-sided. RESULTS: For annual screening because of family or personal history vs biennial, sensitivity was statistically significantly higher (81.7% vs 70.6%; OR = 1.86, 95% CI = 1.48 to 2.34), particularly for invasive cancers and postmenopausal women. Although there was no statistically significant difference in sensitivity for annual screening for mammographic density 75% or greater, specificity was statistically significantly lower (91.3%; OR = 0.87, 95% CI = 0.80 to 0.96) vs biennial (92.3%), particularly for women age 50-59 years. CONCLUSION: Compared with biennial screening, annual screening improved detection for women with a family or personal history of breast and/or ovarian cancer, supporting screening that is more frequent. The benefit for annual screening for women with higher mammographic density must be weighed against possible harms of increased false positives.
Authors: Rebecca A Hubbard; Karla Kerlikowske; Chris I Flowers; Bonnie C Yankaskas; Weiwei Zhu; Diana L Miglioretti Journal: Ann Intern Med Date: 2011-10-18 Impact factor: 25.391
Authors: Norman F Boyd; Helen Guo; Lisa J Martin; Limei Sun; Jennifer Stone; Eve Fishell; Roberta A Jong; Greg Hislop; Anna Chiarelli; Salomon Minkin; Martin J Yaffe Journal: N Engl J Med Date: 2007-01-18 Impact factor: 91.245
Authors: F D Gilliland; N Joste; P M Stauber; W C Hunt; R Rosenberg; G Redlich; C R Key Journal: J Natl Cancer Inst Date: 2000-05-03 Impact factor: 13.506
Authors: Etta D Pisano; Constantine Gatsonis; Edward Hendrick; Martin Yaffe; Janet K Baum; Suddhasatta Acharyya; Emily F Conant; Laurie L Fajardo; Lawrence Bassett; Carl D'Orsi; Roberta Jong; Murray Rebner Journal: N Engl J Med Date: 2005-09-16 Impact factor: 91.245
Authors: Emily White; Diana L Miglioretti; Bonnie C Yankaskas; Berta M Geller; Robert D Rosenberg; Karla Kerlikowske; Laura Saba; Pamela M Vacek; Patricia A Carney; Diana S M Buist; Nina Oestreicher; William Barlow; Rachel Ballard-Barbash; Stephen H Taplin Journal: J Natl Cancer Inst Date: 2004-12-15 Impact factor: 13.506
Authors: Karla Kerlikowske; Weiwei Zhu; Rebecca A Hubbard; Berta Geller; Kim Dittus; Dejana Braithwaite; Karen J Wernli; Diana L Miglioretti; Ellen S O'Meara Journal: JAMA Intern Med Date: 2013-05-13 Impact factor: 21.873
Authors: E S Wai; Y D'yachkova; I A Olivotto; S Tyldesley; N Phillips; L J Warren; A J Coldman Journal: Br J Cancer Date: 2005-03-14 Impact factor: 7.640
Authors: Anna M Chiarelli; Meghan J Walker; Gabriela Espino-Hernandez; Natasha Gray; Ayesha Salleh; Chamila Adhihetty; Julia Gao; Samantha Fienberg; Michelle A Rey; Linda Rabeneck Journal: CMAJ Open Date: 2021-12-21
Authors: Steven Habbous; Esha Homenauth; Andriana Barisic; Sharmilaa Kandasamy; Vicky Majpruz; Katharina Forster; Marta Yurcan; Anna M Chiarelli; Patti Groome; Claire M B Holloway; Andrea Eisen Journal: CMAJ Open Date: 2022-04-05