Shailesh Advani1, Linn Abraham2, Diana S M Buist2, Karla Kerlikowske3, Diana L Miglioretti4, Brian L Sprague5, Louise M Henderson6, Tracy Onega7, John T Schousboe8, Joshua Demb9, Dongyu Zhang10, Louise C Walter11, Christoph I Lee12, Dejana Braithwaite13, Ellen S O'Meara14. 1. Department of Oncology, Georgetown University, Washington, DC, United States of America. 2. Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101, United States of America. 3. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States of America; Department of Medicine, University of California, San Francisco, CA, United States of America. 4. Department of Public Health Sciences, School of Medicine, University of California, Davis, CA, United States of America. 5. Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT, United States of America. 6. Department of Radiology, University of North Carolina at Chapel Hill, NC, United States of America. 7. Department of Population Health Sciences and the Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States of America. 8. Division of Research, Health Partners Institute, Bloomington, MN, United States of America. 9. Division of Gastroenterology, Department of Internal Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, United States of America. 10. Department of Epidemiology, University of Florida, Gainesville, FL, United States of America. 11. Department of Medicine, University of California, San Francisco, CA, United States of America. 12. Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States of America; Department of Health Services, University of Washington School of Public Health, Seattle, WA, United States of America. 13. Department of Epidemiology, University of Florida, Gainesville, FL, United States of America; University of Florida Health Cancer Center, Gainesville, FL, United States of America; Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States of America. Electronic address: dbraithwaite@ufl.edu. 14. Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101, United States of America. Electronic address: Ellen.S.O'Meara@kp.org.
Abstract
INTRODUCTION: Limited evidence exists on the impact of age and comorbidity on biopsy rates and findings among older women. MATERIALS AND METHODS: We used data from 170,657 women ages 66-94 enrolled in the United States Breast Cancer Surveillance Consortium (BCSC). We estimated one-year rates of biopsy by type (any, fine-needle aspiration (FNA), core or surgical) and yield of the most invasive biopsy finding (benign, ductal carcinoma in situ (DCIS) and invasive breast cancer) by age and comorbidity. Statistical significance was assessed using Wald statistics comparing coefficients estimated from logistic regression models adjusted for age, comorbidity, BCSC registry, and interaction between age and comorbidity. RESULTS: Of 524,860 screening mammograms, 9830 biopsies were performed following 7930 exams (1.5%) within one year, specifically 5589 core biopsies (1.1%), 3422 (0.7%) surgical biopsies and 819 FNAs (0.2%). Biopsy rates per 1000 screens decreased with age (66-74:15.7, 95%CI:14.8-16.8), 75-84:14.5(13.5-15.6), 85-94:13.2(11.3,15.4), ptrend < 0.001) and increased with Charlson Comorbidity Score (CCS = 0:14.4 (13.5-15.3), CCS = 1:16.6 (15.2-18.1), CCS ≥2:19.0 (16.9-21.5), ptrend < 0.001).Biopsy rates increased with CCS at ages 66-74 and 75-84 but not 85-94. Core and surgical biopsy rates increased with CCS at ages 66-74 only. For each biopsy type, the yield of invasive breast cancer increased with age irrespective of comorbidity. DISCUSSION: Women aged 66-84 with significant comorbidity in a breast cancer screening population had higher breast biopsy rates and similar rates of invasive breast cancer diagnosis than their counterparts with lower comorbidity. A considerable proportion of these diagnoses may represent overdiagnoses, given the high competing risk of death from non-breast-cancer causes among older women. Published by Elsevier Ltd.
INTRODUCTION: Limited evidence exists on the impact of age and comorbidity on biopsy rates and findings among older women. MATERIALS AND METHODS: We used data from 170,657 women ages 66-94 enrolled in the United States Breast Cancer Surveillance Consortium (BCSC). We estimated one-year rates of biopsy by type (any, fine-needle aspiration (FNA), core or surgical) and yield of the most invasive biopsy finding (benign, ductal carcinoma in situ (DCIS) and invasive breast cancer) by age and comorbidity. Statistical significance was assessed using Wald statistics comparing coefficients estimated from logistic regression models adjusted for age, comorbidity, BCSC registry, and interaction between age and comorbidity. RESULTS: Of 524,860 screening mammograms, 9830 biopsies were performed following 7930 exams (1.5%) within one year, specifically 5589 core biopsies (1.1%), 3422 (0.7%) surgical biopsies and 819 FNAs (0.2%). Biopsy rates per 1000 screens decreased with age (66-74:15.7, 95%CI:14.8-16.8), 75-84:14.5(13.5-15.6), 85-94:13.2(11.3,15.4), ptrend < 0.001) and increased with Charlson Comorbidity Score (CCS = 0:14.4 (13.5-15.3), CCS = 1:16.6 (15.2-18.1), CCS ≥2:19.0 (16.9-21.5), ptrend < 0.001).Biopsy rates increased with CCS at ages 66-74 and 75-84 but not 85-94. Core and surgical biopsy rates increased with CCS at ages 66-74 only. For each biopsy type, the yield of invasive breast cancer increased with age irrespective of comorbidity. DISCUSSION: Women aged 66-84 with significant comorbidity in a breast cancer screening population had higher breast biopsy rates and similar rates of invasive breast cancer diagnosis than their counterparts with lower comorbidity. A considerable proportion of these diagnoses may represent overdiagnoses, given the high competing risk of death from non-breast-cancer causes among older women. Published by Elsevier Ltd.
Entities:
Keywords:
Biopsy; Breast cancer; Overdiagnosis; Overtreatment
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