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How Sensitive Are Screening Mammograms in Women with and without a Family History of Breast Cancer?
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What is the problem and what is known about it so far?
A mammogram is an x-ray test that looks for (screens) breast cancer at early stages, when it is most treatable. Mammography screening should begin by age 50; some experts recommend that mammograms begin at age 40. Women with a history of breast cancer in a mother, sister, or daughter are at higher risk for breast cancer than women without such a history. Many doctors advise women with a family history of breast cancer to begin mammography during their 30s and 40s, but the benefit of that practice is unknown. It is also not known whether mammograms have the same sensitivity in women with and without a family history of breast cancer. Sensitivity means how good the test is at detecting cancer when cancer is really there.
Why did the researchers do this particular study?
To find out if mammograms have the same sensitivity in women with and women without a family history of breast cancer.
Who was studied?
389,533 women who had screening mammograms between April 1985 and November 1997.
How was the study done?
Information on each study woman, including age, family history, and mammogram results, was taken from seven mammography registries in the United States. Information on breast cancer that was detected after mammography came from tumor registries. If breast cancer was diagnosed within 1 year of a normal (negative) mammogram, that mammogram was considered “false-negative”; if cancer was not diagnosed within 1 year, that negative mammogram was considered “true-negative.” If breast cancer was diagnosed within 1 year after an abnormal (positive) mammogram, that mammogram was considered “true-positive”; if cancer was not diagnosed within 1 year, that positive mammogram was considered “false-positive.” Using the numbers of true-positive and false-negative results, the researchers then calculated the sensitivity of mammograms for women with and without a family history of breast cancer.
What did the researchers find?
For women in both groups, the sensitivity of mammograms increased as women became older. However, for each decade of age, the sensitivity of mammograms was the same in women with and without a family history of breast cancer.
What were the limitations of the study?
The study used information from registries, which may not be complete. Most important, this study does not tell us whether beginning mammography at an early age improves health outcomes for women with a family history of breast cancer.
What are the implications of the study?
The sensitivity of mammography is related to a woman's age at the time of screening and is not improved or diminished in women with a family history of breast cancer.
Article and Author Information
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The summary below is from the full report titled “Performance of Screening Mammography among Women with and without a First-Degree Relative with Breast Cancer.” It is in the 5 December 2000 issue of Annals of Internal Medicine (volume 133, pages 855-863). The authors are K Kerlikowske, PA Carney, B Geller, MT Mandelson, SH Taplin, K Malvin, V Ernster, N Urban, G Cutter, R Rosenberg, and R Ballard-Barbash.
- Copyright ©2004 by the American College of Physicians
