Mammographic breast density increas...

Mammographic breast density increases the risk of breast cancer four to six times and decreases the accuracy of mammography screening. Abnormalities seen upon mammography in dense breast tissue increase recall rates, form test specificity, and may jeopardize the benefit of screening in these women Breast density is affected from younger age, use of hormone therapy (HT) menstrual period phase, parity, body mass index, and familial or genetic tendencies. The impact of each of these individual factors upon the accuracy of mammographic breast screening has been studied, nevertheless the interaction of these factors has not been carefully evaluated.

Carney and associates used registry data of screening mammography forward women 40 to 89 years of age from seven disparate geographic regions in the United States to evaluate the individual and combined validitys of these factors on the accuracy of mammography screening. Premenopausal status was defined as women who were 40 to 54 years of age who had regular menstrual periods with no HT use. Perimenopausal and postmenopausal status was defined as women who were 55 years or older and women whose periods had stopped or who had had the pair ovaries removed. This latter cluster was subdivided into women who used HT and those who did not.

Screening mammograms were interpreted using the American corporation of Radiology Breast Imaging Reporting and Data combination of parts to form a whole (BI-RADS). The authors defined a positive screening examination as a BI-RADS assessment digest of 0 (incomplete), 4 (suspicious abnormality), or 5 (highly suggestive of malignancy). Radiographic breast density also was classified. Breast pathology issues included invasive or ductal carcinoma. The follow-up period was united year or the period to the nearest mammogram. An examination was classified as truthful positive when the screening was positive and a diagnosis of cancer was confirmed.

The analysis was based forward information from more than 329000 women The rate of true-positive examinations rose with increasing age. The rate of false-negative examinations rose with increasing breast density. Women who were receiving HT had a lower mammographic sensitivity rate and a slightly higher breast cancer rate than nonusers of HT Sensitivity and specificity were highest among older women who did not use HT

The authors judge that breast density and age significantly affect the accuracy of screening mammography, with the best comes being seen in women who are older than 80 years. Accuracy was lowest in younger women with compressed breasts. The use of HT alone does not significantly affect sensitivity further may cause increased breast density in a certain quantity of women, resulting in overall decreased accuracy of mammography screening. Practitioners should begin screening mammography before initiating HT and patients should be informed of the negative impact of HT in succession future mammographic studies. Mammography outcomes also should include a statement about breast density, offering women information about the accuracy of the specific examination.

Carney PA, et al. Individual and combined powers of age, breast density, and hormone replacement therapy use in succession the accuracy of screening mammography. Ann Intern M February 4 2003;138:168-75

RICHARD SADOVSKY, MD

COPYRIGHT 2003 American Academy of Family Physicians

COPYRIGHT 2003 Gale Group