Regular Mammography Use Is Associated with Elimination of Age-Related Disparities in Size and Stage of Breast Cancer at Diagnosis

19 November 2002 | Volume 137 Issue 10 | Pages 783-790

Background: There is little consensus about recommending mammography for women 75 years of age and older. These women have mammography less frequently and are more likely to receive a diagnosis of advanced breast cancer.

Objective: To examine the relationship between use of screening mammography and size and stage of cancer at diagnosis in older women.

Design: Retrospective cohort study.

Setting: Tumor registries in the Surveillance, Epidemiology, and End Results (SEER) program.

Patients: 12 038 women who were Medicare beneficiaries, were at least 69 years of age, resided in a SEER area, and received a new diagnosis of breast cancer in 1995 through 1996.

Measurements: Screening mammograms obtained in the 2 years before breast cancer diagnosis (none, one, or at least two) and stage and size of tumor at diagnosis.

Results: Older women ( 75 years of age) had larger tumors at diagnosis and were less likely to have undergone screening mammography than younger women (69 to 74 years of age). The association between increased mammography use and smaller tumor size and stage was significantly greater in older women than in younger women (P = 0.010 for stage; P = 0.001 for size). The percentage of regular mammography users who received a diagnosis of high-stage disease (28% vs. 26%; P > 0.2) and the mean size of the tumors (15.0 mm vs. 15.1 mm; P > 0.2) did not significantly differ between younger and older women, respectively. These findings remained constant after controlling for factors that might contribute to biases.

Conclusion: Mammography in older women is associated with elimination of age-related disparities in size and stage of breast cancer at diagnosis.

Editors' Notes Context Women older than 75 years of age use mammography less frequently than younger women and more frequently have advanced-stage breast cancer at diagnosis. The effectiveness of screening mammography after age 75 years is unknown. Contribution These researchers used data from the Surveillance, Epidemiology, and End Results program to explore the relationship between previous mammography in older women and size and stage of breast cancer at diagnosis. Older and younger women who used mammography had tumors that were of similar size and stage at diagnosis. Implications Mammography use after age 75 years leads to earlier detection of tumors. This study does not tell us whether screening women after age 75 years improves breast cancer mortality rates. –The Editors

 

Author and Article Information

From the University of Texas Medical Branch, Galveston, Texas.

Disclaimer: This study used the linked SEER–Medicare Database. The interpretation and reporting of data from this database are the sole responsibility of the authors.

Acknowledgments: The authors thank Dr. Dong Zhang of the Office of Biostatistics, University of Texas Medical Branch, for his contribution in organizing the database and Dr. Daniel H. Freeman Jr., also of the Office of Biostatistics, for expert statistical advice. The authors acknowledge the efforts of the Applied Research Program, National Cancer Institute; the Office of Information Services and the Office of Strategic Planning, Center for Medicare & Medicaid Services; Information Management Services, Inc.; and the Surveillance, Epidemiology, and End Results program tumor registries in the creation of the SEER–Medicare database.

Grant Support: By the National Cancer Institute (CA72076) and the Department of the U.S. Army (BC990990).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Jean L. Freeman, PhD, Sealy Center on Aging, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0460.

Current Author Addresses: Dr. Randolph: National Cancer Institute, Cancer Prevention Fellowship Program, 6130 Executive Boulevard, Suite 3109, Bethesda, MD 20892-7361.

Drs. Goodwin and Freeman and Mr. Mahnken: Sealy Center on Aging, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0460.

Author Contributions: Conception and design: W.M. Randolph, J.S. Goodwin, J.L. Freeman.

Analysis and interpretation of the data: W.M. Randolph, J.S. Goodwin, J.D. Mahnken, J.L. Freeman.

Drafting of the article: W.M. Randolph, J.S. Goodwin, J.L. Freeman.

Critical revision of the article for important intellectual content: W.M. Randolph, J.S. Goodwin, J.D. Mahnken, J.L. Freeman.

Final approval of the article: J.S. Goodwin, J.D. Mahnken, J.L. Freeman.

Statistical expertise: J.D. Mahnken.

Obtaining of funding: W.M. Randolph, J.L. Freeman.

Administrative, technical, or logistic support: J.L. Freeman.