Mammogram

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Although various radiographic modalities are readily available to identify lesions that are suspicious for breast cancer, mammography remains the mainstay of breast cancer screening. Role of breast sonogram is confined mainly to the diagnostic follow-up of a mammographic abnormality because it may help clarify features of a potential lesion. The role of magnetic resonance imaging (MRI) for breast cancer screening is still evolving; currently MRI screening, in combination with mammography, is reserved to the screening of high-risk patients only. ^{[1, 2, 3, 4, 5]}

In 2015, an estimated 231,840 new cases of invasive breast cancer were diagnosed, along with an estimated 60,290 additional cases of in situ breast cancer. Only lung cancer accounts for more cancer deaths among women. ^[1]

Overall breast cancer death rates decreased 36% from 1989 to 2012, because of both improvement in treatments and earlier detection. ^[1]

The lifetime risk of being diagnosed with breast cancer is 12.3%, or 1 in 8. ^[1] Due to the magnitude of the disease, its psychosocial impact, and associated morbidity and mortality, screening for early diagnosis forms a pivotal part of the struggle against this cancer.

According to the National Health Interview Survey, 69% of women 45 years and older have had a mammogram within the past 2 years. Since 1987, the prevalence of women 40 years and older who have had a mammogram has increased from 29% to 70%. ^[1]

According to the U.S. Preventive Services Task Force, the number of breast cancer deaths averted by screening and early treatment increases with age: over a 10-year period, screening 10,000 women aged 60-69 years will result in 21 fewer deaths from breast cancer; 8 fewer deaths in 10,000 women 50-59 years; and 3 fewer deaths in 10,000 women 40-49 years. ^[2]

In studies, mammography has clearly been shown to increase the detection of breast cancer at an earlier stage. ^[6] Based upon consistent data from multiple randomized trials, a strong consensus has been developed in favor of routine screening mammography for all women aged 50-69. Consensus, however, is not as strong in favor of routine screening among women aged 40-49 or women over the age of 70, and in terms of how frequently these patient populations should be screened.

Based upon pooled data form 8 trials, the United States Preventive Services Task Force (USPSTF) has given an estimate that 1904 women aged 39-49 (credible interval, CrI 929 to 6378 women) would need to be screened to prevent one death from breast cancer after at least 11 years of observation, compared to 1339 women in their 50s (CrI 322-7455) and 377 women in their 60s (CrI 230-1050). ^[7] Moreover, false-positive readings are more common in younger women, both because the tests are less specific and because breast cancer occurs less commonly in that population. ^{[8, 9]}

Recommendations for mammography by the ACS include the following ^{[1, 3, 4]} :

Recommendations for mammography by the USPSTF include the following ^{[2, 5]} :

American Cancer Society. Breast Cancer Facts and Figures 2015-2016. American Cancer Society, Inc. Atlanta. Available at https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2015-2016.pdf. 2015; Accessed: January 30, 2016.

[Guideline] U.S. Preventive Services Task Force. Final Recommendationn Statement. Breast Cancer: Screening. U.S. Preventive Services Task Forc. Available at https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/breast-cancer-screening1. January 2016; Accessed: January 30, 2017.

Oeffinger KC, Fontham ET, Etzioni R, et al. Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society. JAMA. 2015 Oct 20. 314 (15):1599-614. [Medline].

Smith RA, Andrews K, Brooks D, DeSantis CE, Fedewa SA, Lortet-Tieulent J, et al. Cancer screening in the United States, 2016: A review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin. 2016 Mar-Apr. 66 (2):96-114. [Medline].

Siu AL, U.S. Preventive Services Task Force. Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2016 Feb 16. 164 (4):279-96. [Medline].

Weaver DL, Rosenberg RD, Barlow WE, Ichikawa L, Carney PA, Kerlikowske K. Pathologic findings from the Breast Cancer Surveillance Consortium: population-based outcomes in women undergoing biopsy after screening mammography. Cancer. 2006 Feb 15. 106(4):732-42. [Medline].

Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L. Screening for breast cancer: an update for the U.S. Preventive Services Task Force. Ann Intern Med. 2009 Nov 17. 151(10):727-37, W237-42. [Medline].

Kerlikowske K, Grady D, Barclay J, Sickles EA, Eaton A, Ernster V. Positive predictive value of screening mammography by age and family history of breast cancer. JAMA. 1993 Nov 24. 270(20):2444-50. [Medline].

Lidbrink E, Elfving J, Frisell J, Jonsson E. Neglected aspects of false positive findings of mammography in breast cancer screening: analysis of false positive cases from the Stockholm trial. BMJ. 1996 Feb 3. 312(7026):273-6. [Medline].

Kerlikowske K, Ichikawa L, Miglioretti DL, Buist DS, Vacek PM, Smith-Bindman R. Longitudinal measurement of clinical mammographic breast density to improve estimation of breast cancer risk. J Natl Cancer Inst. 2007 Mar 7. 99(5):386-95. [Medline].

Pisano ED, Hendrick RE, Yaffe MJ, Baum JK, Acharyya S, Cormack JB. Diagnostic accuracy of digital versus film mammography: exploratory analysis of selected population subgroups in DMIST. Radiology. 2008 Feb. 246(2):376-83. [Medline]. [Full Text].

Pisano ED, Gatsonis C, Hendrick E, Yaffe M, Baum JK, Acharyya S. Diagnostic performance of digital versus film mammography for breast-cancer screening. N Engl J Med. 2005 Oct 27. 353(17):1773-83. [Medline].

Hofvind S, Geller BM, Rosenberg RD, Skaane P. Screening-detected breast cancers: discordant independent double reading in a population-based screening program. Radiology. 2009 Dec. 253(3):652-60. [Medline].

Taylor P, Potts HW. Computer aids and human second reading as interventions in screening mammography: two systematic reviews to compare effects on cancer detection and recall rate. Eur J Cancer. 2008 Apr. 44(6):798-807. [Medline].

McDonald ES, Oustimov A, Weinstein SP, Synnestvedt MB, Schnall M, Conant EF. Effectiveness of Digital Breast Tomosynthesis Compared With Digital Mammography: Outcomes Analysis From 3 Years of Breast Cancer Screening. JAMA Oncol. 2016 Feb 18. [Medline].

Morel JC, Iqbal A, Wasan RK, Peacock C, Evans DR, Rahim R, et al. The accuracy of digital breast tomosynthesis compared with coned compression magnification mammography in the assessment of abnormalities found on mammography. Clin Radiol. 2014 Nov. 69(11):1112-6. [Medline].

Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011 Mar-Apr. 61(2):69-90. [Medline].

National Cancer Institute. SEER Cancer Statistics Review, 1975-2000. [Full Text].

Kohler BA, Ward E, McCarthy BJ, Schymura MJ, Ries LA, Eheman C. Annual report to the nation on the status of cancer, 1975-2007, featuring tumors of the brain and other nervous system. J Natl Cancer Inst. 2011 May 4. 103(9):714-36. [Medline].

Berry DA, Cronin KA, Plevritis SK, Fryback DG, Clarke L, Zelen M. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med. 2005 Oct 27. 353(17):1784-92. [Medline].

Muhammad Neaman Siddique, MBBS Resident Physician, Department of Medicine, Staten Island University Hospital

Muhammad Neaman Siddique, MBBS is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Najum Us Saher, MBBS 

Disclosure: Nothing to disclose.

Nimrah Siddique King Edward Medical College, Pakistan

Disclosure: Nothing to disclose.

Naila Saleem, MBBS 

Disclosure: Nothing to disclose.

Seema N Varma, MD Attending Physician, Division of Hematology and Oncology, Department of Medicine, Sanford R Nalitt Institute for Cancer and Blood Related Diseases, North Shore-Long Island Jewish Health System/Staten Island University Hospital; Hospice Medical Director, University Hospice, Staten Island University Hospital

Seema N Varma, MD is a member of the following medical societies: American College of Physicians, American Society of Hematology, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eugene C Lin, MD Attending Radiologist, Teaching Coordinator for Cardiac Imaging, Radiology Residency Program, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine

Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, Society of Nuclear Medicine and Molecular Imaging

Disclosure: Nothing to disclose.

Mammogram

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