title: Discovery of breast cancers within 1 year of a normal screening mammogram: how are they found?
abstract: OBJECTIVE
  We sought to determine how breast cancers that occur within 1 year after a normal mammogram are discovered.
  
  
  METHODS
  Using population-based mammography registry data from 2000-2002, we identified 143 women with interval breast cancers and 481 women with screen-detected breast cancers. We surveyed women's primary care clinicians to assess how the interval breast cancers were found and factors associated with their discovery.
  
  
  RESULTS
  Women with interval cancers were twice as likely to have a personal history of breast cancer (30.1%) as women with screen-detected cancers (13.6%). Among women with interval cancers, one half of the invasive tumors (49.5%) were discovered when women initiated a health care visit because of a breast concern, and 16.8% were discovered when a clinician found an area of concern while conducting a routine clinical breast examination. Having a lump and both a personal and a family history of breast cancer was the most common reason why women initiated a health care visit (44%) (P <.01).
  
  
  CONCLUSIONS
  Women with interval cancers are most likely to initiate a visit to a primary care clinician when they have 2 or more breast concerns. These concerns are most likely to include having a lump and a personal and/or family history of breast cancer. Women at highest risk for breast cancer may need closer surveillance by their primary care clinicians and may benefit from a strong educational message to come for a visit as soon as they find a lump.
authors.affiliation: Department of Community & Family Medicine, Dartmouth Medical School, Lebanon, NH, USA. carneyp@ohsu.edu
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Carney
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Steiner
authors.forename: Martha E
authors.initials: ME
authors.lastname: Goodrich
authors.forename: Allen J
authors.initials: AJ
authors.lastname: Dietrich
authors.forename: Claudia J
authors.initials: CJ
authors.lastname: Kasales
authors.forename: Julia E
authors.initials: JE
authors.lastname: Weiss
authors.forename: Todd
authors.initials: T
authors.lastname: MacKenzie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008875:Middle Aged; D009819:Office Visits; D011320:Primary Health Care; D012959:Socioeconomic Factors; D013997:Time Factors; D016217:Ultrasonography, Mammary