title: Neglecting to screen women between the ages of 40 and 49 years with mammography: what is the impact on breast cancer diagnosis?
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: Mallory E
authors.initials: ME
authors.lastname: Kremer
authors.forename: Catherine
authors.initials: C
authors.lastname: Downs-Holmes
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Novak
authors.forename: Janice A
authors.initials: JA
authors.lastname: Lyons
authors.forename: Paula
authors.initials: P
authors.lastname: Silverman
authors.forename: Ramya M
authors.initials: RM
authors.lastname: Pham
authors.forename: Donna M
authors.initials: DM
authors.lastname: Plecha
mesh_terms: D000328:Adult; D000367:Age Factors; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D016009:Chi-Square Distribution; D003657:Decision Making; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology