title: Determining the impact of US mammography screening guidelines on patient survival in a predominantly African American population treated in a public hospital during 2008.
abstract: BACKGROUND
  In November 2009, the US Preventive Service Task Force (USPSTF) published updated breast cancer screening guidelines. This marked a change from the 2002 recommendations and a significant divergence from the American Cancer Society (ACS) guidelines. In the current study, the potential effect of using the revised 2009 USPSTF guidelines on patient disease stage and survival were evaluated and compared with those actually observed and to predicted under ACS recommendations.
  
  
  METHODS
  A retrospective chart review was performed for 84 patients who were diagnosed with stage I through III breast cancer at Grady Memorial Hospital during 2008. Previously published tumor volume doubling times were used to model an equation that would estimate tumor sizes. For each patient, a disease stage at diagnosis was predicted, and outcomes were modeled as though the patient had been screened according to the recommended versions of the ACS and USPSTF guidelines. Patient survival rates were then estimated based on prognostic data according to disease stage.
  
  
  RESULTS
  The average age of patients in the study was 55 years, and 85% were African American. The USPSTF guidelines predicted later stages at diagnosis (14% stage I, 73% stage II), whereas the ACS guidelines predicted earlier stages (47% stage I, 53% stage II).
  
  
  CONCLUSIONS
  A large stage migration was predicted, indicating significantly earlier diagnosis, when the ACS-recommended screening guidelines were followed. The authors concluded that practitioners should understand how race and/or socioeconomic factors increase the risk of breast cancer and should be encouraged to prioritize discussions regarding the benefits and risks of annual mammographic screening, especially among women who have a potentially greater risk of developing breast cancer at a younger age.
authors.affiliation: Georgia Cancer Center for Excellence, Grady Memorial Hospital, Atlanta, GA, USA.
authors.forename: Imnett
authors.initials: I
authors.lastname: Habtes
authors.forename: Danielle
authors.initials: D
authors.lastname: Friedman
authors.forename: Cheryl
authors.initials: C
authors.lastname: Raskind-Hood
authors.forename: Kathleen
authors.initials: K
authors.lastname: Adams
authors.forename: Edmund R
authors.initials: ER
authors.lastname: Becker
authors.forename: Carl
authors.initials: C
authors.lastname: D'Orsi
authors.forename: George
authors.initials: G
authors.lastname: Birdsong
authors.forename: Kathleen
authors.initials: K
authors.lastname: Gundry
authors.forename: Ruth
authors.initials: R
authors.lastname: O'Regan
authors.forename: Sheryl G A
authors.initials: SG
authors.lastname: Gabram
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000208:ethnology / Q000401:mortality*; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000208:ethnology / Q000401:mortality*; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods* / Q000592:standards; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D011153:Population; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D015996:Survival Rate; D016217:Ultrasonography, Mammary / Q000379:methods* / Q000592:standards; D014481:United States / Q000453:epidemiology