mammography

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Indications

Benefit/risk

  • of no benefit for prevention of breast cancer mortality[31]
  • number need to harm
    • 2 within 10 years for false positive[31]
    • 5 within 10 years for unnecessary surgery[31]
  • U.S. women are more likely to be aware of screening's benefits than its harms[40]
  • AI-supported mammography screening results in a similar rate of cancer detection reading by 2 radiologist, with a substantially lower radiologist workload[45]

Adverse effects

Procedure

Notes

* overdiagnosed breast cancer refers to breast cancer detected by screening that would not have caused clinical disease if screening had not occurred[46]

* false positives

  • false positive may delay subsequent mammograms[39]
  • false-positives with 20-year cumulative incidence of breast cancer of 11.3%, vs 7.3% for controls (RR=1.6)[47]
    • association strongest in women 60-76 years, women with lower breast density, & cases of biopsy with diagnosis of benign nature
    • association strongest for ipsilateral cancers[47]

Recommendations*:

* most recent randomized trial of screening mammography occurred > 50 years ago

* of 1000 women 50 years of age screened yearly for 10 years, 0.3-3.2 fewer breast cancer deaths, 490-670 false-positives & 3-14 overdiagnoses usually leading to unnecessary treatment[23]

Sensitivity: 87%, Specificity 97%[4]

Sensitivity: 36%*, positive predictive value: 89%[5]

False positives:

  • annual screening 10 year window: 61% of women
  • biennial screening 10 year window: 42% of women[14]

In this same study (BRCA+ women), sensitivity of MRI = 77%[5]

Mammographic breast density:[3]

  • risk factor for breast cancer
  • genetically determined
  • 4 categories of mammographic density[7]
    • almost entirely fat (< 25%)
    • scattered fibroglandular densities (25-50%)
    • heterogenously dense (51-75%)
    • extremely dense (>75%)
  • some states may require informing women whether they have dense breast tissue
    • and if so, that dense tissue may hide tumors on mammograms & increase one's risk for breast cancer[17]
  • FDA proposes that information on breast density must be included in the mammography summary letter sent to patients[42]
  • radiologists often disagree when assessing breast density on mammograms[38]

3 parameters adversely affecting mammographic screening all affect breast density:[4]

supplemental ultrasonography to screen women with dense breasts of little benefit[29]

breast density alone shouldn't guide decisions about supplemental screening[32]

incorporating breast cancer risk assessment into mammogram reporting could help determine which women would benefit from supplemental screening[32][33]

5-year risk for advanced breast cancer more useful than breast density[43]

Digital mammography vs film mammography:

3D mammography (tomosynthesis) imaging FDA-approved Feb 2011

American College of Radiology Breast Imaging Reporting & Data System (BI-RADS) Assessment Categories:

  • 0: incomplete assessment; need additional imaging evaluation, prior mammograms for comparison, or both
  • 1: negative; normal mammographic study
  • 2: benign findings
  • 3: probably benign findings; initial short-interval follow-up suggested
  • 4: suspicious abnormality; biopsy should be considered
  • 5: highly suggestive of malignancy; appropriate action should be taken
  • 6: known-biopsy-proven malignancy; appropriate action should be taken

FDA proposes known 'biopsy proven malignancy' available for mammography reports so the it is clear that cancers being mammographically assessed for treatment are already known & identified[42]

FDA can contact patients & providers directly when a facility does not meet reporting requirements[42]

More general terms

More specific terms

Additional terms

References

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    Mandelblatt JS et al. for the Breast Cancer Working Group of the Cancer Intervention and Surveillance Modeling Network (CISNET). Effects of mammography screening under different screening schedules: Model estimates of potential benefits and harms. Ann Intern Med 2009 Nov 17; 151:738. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19920274
    Kerlikowske K. Evidence-based breast cancer prevention: The importance of individual risk. Ann Intern Med 2009 Nov 17; 151:750.
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  48. Breast Cancer Surveillance Consortium Risk Calculator https://tools.bcsc-scc.org/BC5yearRisk/calculator.htm

Patient information

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