Neglecting to screen women between 40 and 49 years old with mammography: what is the impact on treatment morbidity and potential risk reduction?

OBJECTIVE: The purpose of this study is to determine whether there were significant differences with respect to treatment recommendations, stage at diagnosis, and identification of high-risk lesions for women 40-49 years old undergoing screening mammography (screened) compared to women with a symptom needing a diagnostic evaluation (nonscreened). MATERIALS AND METHODS: We reviewed the pathology results of all imaging-guided biopsies performed at the three breast center locations of University Hospitals Case Medical Center from January 1, 2008, to December 31, 2011. In patients diagnosed with a high-risk lesion or breast cancer, the reason for presentation, pathology, tumor size, stage, receptor characteristics, and treatment were recorded. The chi-square test was used for statistical analysis. RESULTS: Of 230 primary breast cancers, 149 were in the screened group and 81 were considered nonscreened. Nonscreened patients were more likely to undergo chemotherapy (p = 0.042). Eighty-one percent of the high-risk lesions were diagnosed in the screened patients. Screened patients with cancer were significantly more likely to receive a diagnosis at earlier stages (p = 0.001), to have negative axillary lymph nodes (p = 0.005), and to have smaller tumors (p < 0.001). CONCLUSION: In addition to the benefits of receiving a diagnosis at earlier stages, with smaller tumors and node negativity, patients with breast cancer undergoing screening mammography aged 40-49 years are less likely to require chemotherapy and its associated morbidities. The majority of high-risk lesions were diagnosed in the screened group, which may lead to the benefit of chemoprevention, lowering their risk of subsequent breast cancer, or screening with MRI, which may diagnose future mammographically occult malignancies.

Neglecting to screen women between the ages of 40 and 49 years with mammography: what is the impact on breast cancer diagnosis?

OBJECTIVE: The purpose of this study was to compare breast cancer stage at diagnosis in two groups of women between 40 and 49 years old: women undergoing screening mammography and women with a symptom needing diagnostic workup. This comparison is indicative of the impact of forgoing screening in this age group, as recommended by the United States Preventive Services Task Force. MATERIALS AND METHODS: A retrospective chart review was used to collect the results of imaging-guided core needle biopsies performed in women between the ages of 40 and 49 years from January 1, 2008, to December 31, 2009. In patients diagnosed with breast cancer or a high-risk lesion, the reason for presentation, pathology, tumor size, stage, and receptor characteristics were recorded. The chi-square test was used for statistical analysis. RESULTS: Of 108 primary breast cancers, 71 were detected in the screened group and 37 in the unscreened group. The screened group was significantly more likely to be diagnosed with ductal carcinoma in situ than the unscreened group (22 vs 1, chi-square = 11.6, p = 0.001). Furthermore, screened patients with invasive carcinoma were significantly more likely to be diagnosed at earlier stages (chi-square = 5.02, p = 0.025). The size of invasive breast cancer in the screened group was significantly smaller as well (chi-square = 9.3, p = 0.002). Of the high-risk lesions, atypical ductal hyperplasia (n = 29) and lobular carcinoma in situ (n = 8) were most frequently seen. CONCLUSION: Breast cancer patients undergoing screening mammography were diagnosed at earlier stages with smaller tumors. Screening also allows detection of high-risk lesions, which may prompt chemoprevention and lower subsequent breast cancer risk. We continue to support screening mammography in women between the ages of 40 and 49 years.

Feasibility of a team based prognosis and treatment goal discussion (T-PAT) with women diagnosed with advanced breast cancer.

OBJECTIVE: To assess the feasibility of a team-based prognosis and treatment goal discussion for women living with advanced breast cancer. METHODS: Female patients diagnosed with advanced breast cancer (n = 25) participated in a mixed methods study that evaluated the feasibility and effects of a planned and structured prognosis discussion. Audio analysis of the intervention appointments was conducted to assess intervention feasibility. Patient self-reports of prognosis related beliefs and treatment preferences were compared across intervention and usual care groups. RESULTS: Most patients found the T-PAT appointment challenging but worthwhile. Intervention uptake by clinicians was good, but some fidelity disruptions were noted. T-PAT participants were more likely to hold realistic beliefs about disease curability after the appointment. CONCLUSION: Productive prognosis discussions can be delivered effectively by a practice-based clinical team within a semi-structured patient education appointment. It was perceived by patients with advanced breast cancer as both valuable and acceptable. T-PAT clinicians found the intervention easy to deliver. PRACTICE IMPLICATIONS: Regular implementation of T-PAT may help clinicians' build prognosis discussion communication skills. T-PAT documentation provides valuable information that can be used to tailor ongoing care.

Development of a survivorship program.

The number of cancer survivors has steadily climbed to more than 10 million since the 1980s secondary to advances in detection and treatment modalities. This reality, combined with an aging population, has drawn the attention of the medical community to meet the needs of this population. Therefore, cancer care providers are being called to develop survivorship programs for patients with curable disease. Some of the prominent organizations supporting this movement for focused survivorship care include the Institute of Medicine, the National Comprehensive Cancer Network, the American Society of Clinical Oncology, LiveStrong™, and the Oncology Nursing Society. This article provides the necessary steps for the development and implementation of an institution-specific survivorship program to fulfill the new standards for survivorship care.

Breast cancer: overview & updates.

Breast cancer is a complex disease and treatment recommendations are continually changing. It is the leading cancer in women and the second leading cause of cancer mortality. This overview of breast cancer will discuss pathologic features, local and systemic treatment considerations, endocrine therapy, metastatic treatment regimens, and follow-up for optimal breast health. Recent approvals that advance the treatment of metastatic breast cancer are also addressed.