title: Lower sensitivity of screening mammography after previous benign breast surgery.
abstract: Few data are available on the effect of previous benign breast surgery on screening mammography accuracy. We determined whether sensitivity of screening mammography and tumor characteristics are different for women with and without previous benign breast surgery. We included a consecutive series of 317,398 screening mammograms of women screened between 1997 and 2008. During 2-year follow-up, clinical data, breast imaging, biopsy and surgery reports were collected from women with screen-detected or interval breast cancers. Screening sensitivity, tumor biology and tumor stages were compared between 168 women with breast cancer and prior ipsilateral benign breast surgery and 2,039 women with breast cancer but without previous ipsilateral, benign breast surgery. The sensitivity of screening mammography was significantly lower for women with prior surgery [64.3% (108/168) versus 73.4% (1,496/2,039), p = 0.01]. The concomitant increased interval cancer risk remained significant after logistic regression adjustment for age and breast density (OR = 1.5, 95% CI: 1.1-2.1). Comparing screen-detected cancers in women with and without prior breast surgery, no significant differences in estrogen receptor status (p = 0.56), mitotic activity (p = 0.17), proportions of large (T2+) tumors (p = 0.6) or lymph node positive tumors (p = 0.4) were found. Also for interval cancers, no differences were found in estrogen receptor status (p = 0.41), mitotic activity (p = 0.39), proportions of large tumors (p = 0.9) and lymph node positive tumors (p = 0.5) between women with and without prior breast surgery. We conclude that sensitivity of screening mammography is significantly lower in women with previous benign breast surgery than without, but tumor characteristics are comparable both for screen detected cancers and interval cancers.
authors.affiliation: Department of Radiology, Catharina Hospital, 5602 ZA, Eindhoven, The Netherlands. vivianvbreestsm@hotmail.com
authors.forename: Vivian
authors.initials: V
authors.lastname: van Breest Smallenburg
authors.forename: Lucien E M
authors.initials: LE
authors.lastname: Duijm
authors.forename: Adri C
authors.initials: AC
authors.lastname: Voogd
authors.forename: Johanna H
authors.initials: JH
authors.lastname: Groenewoud
authors.forename: Frits H
authors.initials: FH
authors.lastname: Jansen
authors.forename: Mike
authors.initials: M
authors.lastname: van Beek
authors.forename: Marieke W J
authors.initials: MW
authors.lastname: Louwman
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000517:prevention & control / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000517:prevention & control / Q000601:surgery; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000517:prevention & control / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008327:Mammography; D008403:Mass Screening; D008408:Mastectomy; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity