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Breast Cancer Diagnosis May Be Influenced by Mammography Screening Intervals

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In a study of screening mammography-detected breast cancers, patients who had more common screening mammography had a considerably lower rate of lymph node positivity, or cancer cells in the lymph nodes, as opposed to women who went through longer periods between screening mammography exams.

Results of the study were presented at the annual meeting of the Radiological Society of North America (RSNA).

In its earliest stages, breast cancer is restricted to the breast and can be treated by surgical excision of the cancer cells. As the disease progresses, breast cancer cells may metastasize and spread to the lymph nodes and then to other parts of the body.

"On its pathway to other places in the body, the first place breast cancer typically drains into before metastasizing is the lymph nodes. When breast cancer has spread into the lymph nodes, the patient is often treated both locally and systemically, with either hormone therapy, chemotherapy, trastuzumab or some combination of these therapies, said assistant professor of radiology at Northwestern University/Feinberg School of Medicine in Chicago, Ill, Lilian Wang, M.D.mammography EXAm

Historically, healthcare organizations, such as RSNA and the American Cancer Society (ACS), have recommended annual screening with mammography for women starting at the age of 40. Yet, in 2009, the United States Preventive Services Task Force (USPSTF) announced a contentious new recommendation for biennial screening for women between the ages of 50 and 74.

"Our study looks at what would happen if the revised guidelines issued by USPSTF were followed by women, said Wang.

The retrospective study, carried out at Northwestern Memorial Hospital, included 332 women with breast cancer detected by screening mammography between 2007 and 2010. The women were separated into one of three groups, predicated on the length of time between their screening mammography exams: less than 1.5 years, 1.5 to three years and more than three years. There were 207, 73, and 52 patients in each category, respectively.

Controlling for age, breast density, high-risk status and a family history of breast cancer, the researchers assessed that women in the less than 1.5-year interval group had the lowest lymph node positivity rate at 8.7 percent. The rate of lymph node involvement was notablly higher in the 1.5- to three-year and over three-year interval groups at 20.5 percent and 15.4 percent, respectively.

"Our study shows that screening mammography performed at an interval of less than 1.5 years reduces the rate of lymph node positivity, thereby improving patient prognosis. We should be following the guidelines of the American Cancer Society and other organizations, recommending that women undergo annual screening mammography beginning at age 40, Wang concluded.

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