Aim: To review all previous mammograms of breast cancer cases diagnosed during a randomized trial comparing 3 yearly to annual mammographic screening with a view to identifying and quantifying cases that might potentially have been diagnosed earlier.
Methods: Mammograms of 602 breast cancer cases (399 screen-detected and 203 interval cases) were reviewed in chronological order and suspicious radiological features noted for each mammogram, up to and including the diagnostic mammogram.
Results: Of the 602 cases, 79 (13%) had features at diagnosis that were visible on previous mammograms, suggesting a sensitivity of interpretation of 87%. A similar proportion of screen-detected (14%) and interval cancers (11%) had signs at diagnosis that were visible on previous mammograms. The potential for improvement was particularly noted for asymmetric density (sensitivity = 77%, average time visible before diagnosis 14 months) and parenchymal deformity/stellate lesion (sensitivity = 81%, average time visible before diagnosis 12 months).
Conclusion: The highest sensitivity was observed for comedo-type microcalcifications (sensitivity = 97%, average time visible before diagnosis 5 months). By improvements in sensitivity to asymmetric density and parenchymal deformity/stellate lesion, 4% of tumours could have their time of diagnosis advanced substantially.
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Article Synopsis
- Breast density is a significant predictor of breast cancer risk, particularly examining categories C (heterogeneously dense) and D (extremely dense), which have been less studied.
- The study analyzed data from 107 women with breast density in categories C and D, finding a 32% breast cancer incidence, predominantly infiltrating ductal carcinoma, and established a strong link between higher BI-RADS categories and malignancy risk.
- The findings highlight the need for improved screening methods for women with extremely dense breasts, as they carry a higher risk of cancer, emphasizing the importance of targeted healthcare resources for these patients.
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