According to a recent article in the British Medical Journal, patients who are thin, those who use hormone replacement therapy, and those who have had breast surgery, have a lower detection rate of breast cancer with screening mammography than other women. However, the detection rate in these women is only slightly lower than in their counterparts and mammography still remains important for early detection of breast cancer.

Breast cancer is diagnosed in approximately 250,000 women annually in the United States. Fortunately, if breast cancer is diagnosed early, prior to its spread, cure rates with standard treatment approaches are high. However, once breast cancer has spread, particularly if it has spread to distant sites in the body, cure rates plummet dramatically. Therefore, the early detection and treatment of breast cancer is imperative in order to provide optimal long-term results from treatment. Screening for breast cancer with mammography should be a standard practice for women who are 40 years of age or older, or women who have a strong family history of breast cancer. Although screening mammography has demonstrated an association with improved survival in women, researchers continue to evaluate different screening methods and also different subgroups of patients who may benefit from screening with combined modalities.

Researchers from England recently conducted a clinical study including over 120,000 women aged 50 to 64. All patients had undergone screening mammography and were assessed on variables including use of hormone therapy, lifestyle, age, menopausal status, screening center, sociodemographic factors, overall health, and reproductive history. Overall, patients who had used, or were still using hormone therapy, those who were thin and those who had previous breast surgery had a decreased sensitivity with mammography compared to women who had never used hormone therapy, those who were less thin, and those who had never had breast surgery. Sensitivity (the ability for mammography to detect breast cancer) was 83% for patients who were using hormone therapy, compared to 92% for those who had never used hormone therapy; 85.7% for patients whose body mass index (measure of weight and body fat) was less than 25, compared to nearly 90% for those who body mass index was higher than 25; and 83.5% for patients who had undergone past breast surgery, compared to 89.4% for those who had never undergone breast surgery.

The researchers concluded that women who have ever used hormone therapy, who are thin and who have had prior breast surgery have higher breast density, and therefore a reduced sensitivity for the detection of breast cancer by mammography. However, the rates of early detection are still high among these women and screening mammography clearly remains an important tool for the early detection, treatment, and ultimately survival for all women. Women who are 40 years of age or older, or who are at a high risk of developing breast cancer should speak with their physician about undergoing regular screening mammography.

Reference: Banks E, Reeves G, Beral V, et al. Influence of personal characteristics of individual women on sensitivity and specificity of mammography in the Million Women Study: cohort study. British Medical Journal

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