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Most Breast Cancer Deaths Occur in Unscreened Women

Rosenberg, Karen

AJN The American Journal of Nursing: December 2013 - Volume 113 - Issue 12 - p 16
doi: 10.1097/01.NAJ.0000438856.12627.62
In the News

Support for the view that regular screening before age 50 could reduce mortality.

Mixed results from recent studies have raised questions about the value of mammographic screening in reducing breast cancer deaths. A new study, however, suggests that most deaths from breast cancer occur in women who aren't regularly screened and provides support for more-frequent screening in women younger than 50 but less-frequent screening in those older than 69.

Researchers in Boston reviewed the medical records and screening histories of women who died after a diagnosis of breast cancer. The presenting breast cancer was classified as either nonpalpable and asymptomatic (detected through screening mammography) or palpable or symptomatic (or both). Breast cancer deaths were confirmed by the presence of distant metastases.

Of 7,301 women diagnosed with potentially curable invasive breast cancer between 1990 and 1999 and followed through 2007, 2,141 patients died, including 609 proven to have died of breast cancer. Half of all breast cancer deaths occurred in women younger than 50 years.

Of the 609 confirmed breast cancer deaths, 29% occurred in women who had been screened; 19% were detected on a screening mammogram and 10% were detected in the interval between screenings. The other 71% of confirmed breast cancer deaths occurred in “unscreened” women, those who'd not had a mammogram for more than two years (6%) or had never been screened (65%).

The median age at diagnosis among women who died of breast cancer was 49 years, compared with 72 years among those who died of other causes. In all age groups, most women who died of breast cancer were unscreened at the time of diagnosis.

The researchers note that nearly a third of all breast cancer deaths occurred in women diagnosed when they were 40 to 49 years old, a decade in which the value of mammography screening has been controversial. They point out that detecting and treating breast cancer in younger women would not only prevent death but also increase disease-free life years. They recommend that more emphasis be placed on screening women younger than 50—and less on screening those older than 69.

Sharon Gentry, breast nurse navigator at the Derrick L. Davis Cancer Center in Winston-Salem, North Carolina, says that the findings not only support the American Cancer Society's recommendation of annual screening for women between 40 and 50 years of age, but also reflect clinical experience. She adds that the value of a mother to her children or that of a caregiver to aging parents can't be calculated in dollars, nor can the cost to a young family of the death of a woman who could—or should—have been screened in a more timely manner.—Karen Rosenberg

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Webb ML, et al. Cancer 2013 Sep 9. [Epub ahead of print.]
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