Surveillance of women at increased risk of breast cancer using mammography and clinical breast examination: Further evidence of benefit
International Journal of Cancer, 04/25/2012
Maurice A et al. – Screening by annual mammography and CBE between age 35–50 years and 18 monthly from 50 to 60 years may diagnose breast cancer in a less advanced state in terms of size and node status compared with symptomatic cancers and, apart from BRCA1 carriers, is likely to contribute to improved long-term outcome compared with no surveillance.Methods
- We reviewed mammography and CBE effectiveness in terms of tumour size, lymph node status and survival in 7,475 women seen over a 22-year period in the Manchester Family History Clinic.
- We diagnosed 139 invasive and 26 in situ breast cancers.
- Seventy-six percent of the invasive cancers were screen detected, 65% node negative and 71% <2cm in diameter at diagnosis.
- Twenty-one tumours were BRCA1 positive and were significantly more likely to be grade 3, ER/PR negative (p < 0.0001) and have a poorer survival.
- CBE contributed to 30% of cancer diagnoses and was responsible for discovery of nine mammographically occult tumours.
- The cost per quality life year was estimated at £13,080 for tumours detected by CBE and not by mammography.