title: Accuracy and outcomes of screening mammography in women with a personal history of early-stage breast cancer.
abstract: BACKGROUND
  Women with a personal history of breast cancer (PHBC) are at risk of developing another breast cancer and are recommended for screening mammography. Few high-quality data exist on screening performance in PHBC women.
  
  
  OBJECTIVE
  To examine the accuracy and outcomes of mammography screening in PHBC women relative to screening of similar women without PHBC.
  
  
  METHODS
  Cohort of PHBC women, mammogram matched to non-PHBC women, screened through facilities (1996-2007) affiliated with the Breast Cancer Surveillance Consortium.
  
  
  METHODS
  There were 58,870 screening mammograms in 19,078 women with a history of early-stage (in situ or stage I-II invasive) breast cancer and 58,870 matched (breast density, age group, mammography year, and registry) screening mammograms in 55,315 non-PHBC women.
  
  
  METHODS
  Mammography accuracy based on final assessment, cancer detection rate, interval cancer rate, and stage at diagnosis.
  
  
  RESULTS
  Within 1 year after screening, 655 cancers were observed in PHBC women (499 invasive, 156 in situ) and 342 cancers (285 invasive, 57 in situ) in non-PHBC women. Screening accuracy and outcomes in PHBC relative to non-PHBC women were cancer rates of 10.5 per 1000 screens (95% CI, 9.7-11.3) vs 5.8 per 1000 screens (95% CI, 5.2-6.4), cancer detection rate of 6.8 per 1000 screens (95% CI, 6.2-7.5) vs 4.4 per 1000 screens (95% CI, 3.9-5.0), interval cancer rate of 3.6 per 1000 screens (95% CI, 3.2-4.1) vs 1.4 per 1000 screens (95% CI, 1.1-1.7), sensitivity 65.4% (95% CI, 61.5%-69.0%) vs 76.5% (95% CI, 71.7%-80.7%), specificity 98.3% (95% CI, 98.2%-98.4%) vs 99.0% (95% CI, 98.9%-99.1%), abnormal mammogram results in 2.3% (95% CI, 2.2%-2.5%) vs 1.4% (95% CI, 1.3%-1.5%) (all comparisons P < .001). Screening sensitivity in PHBC women was higher for detection of in situ cancer (78.7%; 95% CI, 71.4%-84.5%) than invasive cancer (61.1%; 95% CI, 56.6%-65.4%), P < .001; lower in the initial 5 years (60.2%; 95% CI, 54.7%-65.5%) than after 5 years from first cancer (70.8%; 95% CI, 65.4%-75.6%), P = .006; and was similar for detection of ipsilateral cancer (66.3%; 95% CI, 60.3%-71.8%) and contralateral cancer (66.1%; 95% CI, 60.9%-70.9%), P = .96. Screen-detected and interval cancers in women with and without PHBC were predominantly early stage.
  
  
  CONCLUSIONS
  Mammography screening in PHBC women detects early-stage second breast cancers but has lower sensitivity and higher interval cancer rate, despite more evaluation and higher underlying cancer rate, relative to that in non-PHBC women.
authors.affiliation: Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia. nehmath@med.usyd.edu.au
authors.forename: Nehmat
authors.initials: N
authors.lastname: Houssami
authors.forename: Linn A
authors.initials: LA
authors.lastname: Abraham
authors.forename: Diana L
authors.initials: DL
authors.lastname: Miglioretti
authors.forename: Edward A
authors.initials: EA
authors.lastname: Sickles
authors.forename: Karla
authors.initials: K
authors.lastname: Kerlikowske
authors.forename: Diana S M
authors.initials: DS
authors.lastname: Buist
authors.forename: Berta M
authors.initials: BM
authors.lastname: Geller
authors.forename: Hyman B
authors.initials: HB
authors.lastname: Muss
authors.forename: Les
authors.initials: L
authors.lastname: Irwig
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008327:Mammography / Q000592:standards*; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000000981:diagnostic imaging*; D017063:Outcome Assessment, Health Care; D012680:Sensitivity and Specificity