title: Mammographic Screening Downstages Breast Carcinomas at Time of Diagnosis: A Community-Based Experience.
abstract: To determine the effectiveness of screening mammography in a community medical setting, data from a population-based, retrospective study was analyzed. Medical records of 827 patients with newly diagnosed breast cancer in California between October 1994 and March 1996 were reviewed. The primary care physician's record was abstracted for clinical history, including recommendation of screening mammography. The facility records where final diagnosis was made were abstracted for stage and treatment data. Among the patients who did not have previous screening mammography, 65.7% were diagnosed with "advanced" breast cancer (stages II, III, IV), while only 39.9% who had previous screening mammography were diagnosed with advanced breast cancer (p < 0.001). This study has reaffirmed that screening mammography of adult females generates downstaging at the time of diagnosis of breast cancer. Despite possession of a health insurance program and receiving educational materials, only 65% of patients over 50 years of age had screening mammography. As opposed to the once-a-year mailing of general reminders to all women 40 years old and older, developing a longitudinal electronic medical record in the managed care setting will support a more coordinated and individualized intervention based on age, date of last mammogram, and relative risk, among other factors. Continuing education efforts must also be directed to referring physicians, who may not yet recognize the value of screening mammography.
authors.affiliation: Departments of Radiation Oncology and Radiological Sciences, University of California at Los Angeles, School of Medicine, Los Angeles, California; Health Benchmarks, Inc., Woodland Hills, California, and Department of Community Medicine, Mount Sinai School of Medicine, New York, New York.
authors.forename: Robert G.
authors.initials: RG
authors.lastname: Parker
authors.forename: Kwan-Moon
authors.initials: KM
authors.lastname: Leung
authors.forename: Karen S.
authors.initials: KS
authors.lastname: Rees
authors.forename: Lawrence W.
authors.initials: LW
authors.lastname: Bassett
authors.forename: Antonio P.
authors.initials: AP
authors.lastname: Legorreta