Performance of Screening Mammography among Women with and without a First-Degree Relative with Breast Cancer

Performance of Screening Mammography among Women with and without a First-Degree Relative with Breast Cancer

From University of California, San Francisco, California; Dartmouth Medical School, Lebanon, New Hampshire; University of Vermont College of Medicine, Burlington, Vermont; Center for Health Studies, Group Health Cooperative of Puget Sound, and Fred Hutchinson Cancer Research Center, Seattle, Washington; AMC Cancer Research Center, Denver, Colorado; University of New Mexico Medical Center, New Mexico Tumor Registry, Albuquerque, New Mexico; and National Cancer Institute, Bethesda, Maryland.

Abstract

Background: Although it is recommended that women with a family history of breast cancer begin screening mammography at a younger age than average-risk women, few studies have evaluated the performance of mammography in this group.

Objective: To compare the performance of screening mammography in women with a first-degree family history of breast cancer and women of similar age without such history.

Design: Cross-sectional.

Setting: Mammography registries in California (n = 1), New Hampshire (n = 1), New Mexico (n = 1), Vermont [n = 1], Washington State n = 2), and Colorado (n = 1).

Participants: 389 533 women 30 to 69 years of age who were referred for screening mammography from April 1985 to November 1997.

Measurements: Risk factors for breast cancer; results of first screening examination captured for a woman by a registry; and any invasive cancer or ductal carcinoma in situ identified by linkage to a pathology database, the Surveillance, Epidemiology, and End Results program, or a state tumor registry.

Results: The number of cancer cases per 1000 examinations increased with age and was higher in women with a family history of breast cancer than in those without (3.2 vs. 1.6 for ages 30 to 39 years, 4.7 vs. 2.7 for ages 40 to 49 years, 6.6 vs. 4.6 for ages 50 to 59 years, and 9.3 vs. 6.9 for ages 60 to 69 years). The sensitivity of mammography increased significantly with age (P = 0.001 [chi-square test for trend]) in women with a family history and in those without (63.2% [95% CI, 41.5% to 84.8%] vs. 69.5% [CI, 57.7% to 81.2%] for ages 30 to 39 years, 70.2% [CI, 61.0% to 79.5%] vs. 77.5% [CI, 73.3% to 81.8%] for ages 40 to 49 years, 81.3% [CI, 73.3% to 89.3%] vs. 80.2% [CI, 76.5% to 83.9%] for ages 50 to 59 years, and 83.8% [CI, 76.8% to 90.9%] vs. 87.7% [CI, 84.8% to 90.7%] for ages 60 to 69 years). Sensitivity was similar for each decade of age regardless of family history. The positive predictive value of mammography was higher in women with a family history than in those without (3.7% vs. 2.9%; P = 0.001).

Conclusions: Cancer detection rates in women who had a first-degree relative with a history of breast cancer were similar to those in women a decade older without such a history. The sensitivity of screening mammography was influenced primarily by age.

Article and Author Information

Grant Support: By a Breast Cancer Surveillance Consortium cooperative agreement funded by the National Cancer Institute (1 U01 CA 63740), by the Department of Health and Human Services (K07CA71869), by the National Cancer Institute (CA63146), and by the Department of Defense (DAMD17-96-1-6288).
Requests for Single Reprints: Karla Kerlikowske, MD, General Internal Medicine Section, 111A1, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121; e-mail, kerliko{at}itsa.ucsf.edu.
Current Author Addresses: Dr. Kerlikowske: General Internal Medicine Section, 111A1, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121.
Dr. Carney: Department of Community and Family Medicine, Dartmouth Medical School, 1 Medical Center Drive, HB 7925, Lebanon, NH 03756.
Dr. Geller: Health Promotion Research, University of Vermont, 1 South Prospect Street, Burlington, VT 05401-3444.
Drs. Mandelson and Taplin: Center for Health Studies, Group Health Cooperative, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101.
Ms. Malvin: University of California, San Francisco, 74 New Montgomery Street, #600, San Francisco, CA 94105.
Dr. Ernster: University of California, San Francisco, 500 Parnassus Avenue, Box 0560, MU 420W, San Francisco, CA 94143.
Dr. Urban: Cancer Prevention Research Program, 1100 Fairview Avenue North, MP900, Box 19024, Seattle, WA 98109-1024.
Dr. Cutter: AMC Cancer Research Center, Center for Research Methods and Biometrics, 1600 Pierce Street, Lakewood, CO 80214.
Dr. Rosenberg: Department of Radiology, University of New Mexico Health Sciences Center, 915 Camino de Salod NE, Albuquerque, NM 87131-5336.
Dr. Ballard-Barbash: Applied Research Program, National Cancer Institute, EPN 4005, 6130 Executive Boulevard, MSC 7344, Bethesda, MD 20892-7344.
Author Contributions: Conception and design: K. Kerlikowske, M.T. Mandelson, S.H. Taplin, N. Urban, R. Ballard-Barbash.
Analysis and interpretation of the data: K. Kerlikowske, B. Geller, M.T. Mandelson, S.H. Taplin, K. Malvin, V. Ernster, N. Urban, G. Cutter, R. Ballard-Barbash.
Drafting of the article: K. Kerlikowske, P.A. Carney, S.H. Taplin.
Critical revision of the article for important intellectual content: K. Kerlikowske, P.A. Carney, B. Geller, M.T. Mandelson, S.H. Taplin, V. Ernster, N. Urban, R. Rosenberg, R. Ballard-Barbash.
Final approval of the article: K. Kerlikowske, P.A. Carney, B. Geller, M.T. Mandelson, S.H. Taplin, V. Ernster, N. Urban, G. Cutter, R. Rosenberg, R. Ballard-Barbash.
Provision of study materials or patients: K. Kerlikowske, P.A. Carney, B. Geller, M.T. Mandelson, S.H. Taplin, N. Urban, R. Rosenberg.
Statistical expertise: K. Malvin, G. Cutter.
Obtaining of funding: K. Kerlikowske, P.A. Carney, V. Ernster.
Administrative, technical, or logistic support: P.A. Carney.
Collection and assembly of data: K. Kerlikowske, P.A. Carney, B. Geller, G. Cutter, R. Rosenberg.