title: Outcomes of screening mammography by frequency, breast density, and postmenopausal hormone therapy.
abstract: OBJECTIVE
  Controversy exists about the frequency women should undergo screening mammography and whether screening interval should vary according to risk factors beyond age.
  
  
  OBJECTIVE
  To compare the benefits and harms of screening mammography frequencies according to age, breast density, and postmenopausal hormone therapy (HT) use.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  Data collected January 1994 to December 2008 from mammography facilities in community practice that participate in the Breast Cancer Surveillance Consortium (BCSC) mammography registries.
  
  
  METHODS
  Data were collected prospectively on 11,474 women with breast cancer and 922,624 without breast cancer who underwent mammography at facilities that participate in the BCSC.
  
  
  METHODS
  We used logistic regression to calculate the odds of advanced stage (IIb, III, or IV) and large tumors (>20 mm in diameter) and 10-year cumulative probability of a false-positive mammography result by screening frequency, age, breast density, and HT use. The main predictor was screening mammography interval.
  
  
  RESULTS
  Mammography biennially vs annually for women aged 50 to 74 years does not increase risk of tumors with advanced stage or large size regardless of women's breast density or HT use. Among women aged 40 to 49 years with extremely dense breasts, biennial mammography vs annual is associated with increased risk of advanced-stage cancer (odds ratio [OR], 1.89; 95% CI, 1.06-3.39) and large tumors (OR, 2.39; 95% CI, 1.37-4.18). Cumulative probability of a false-positive mammography result was high among women undergoing annual mammography with extremely dense breasts who were either aged 40 to 49 years (65.5%) or used estrogen plus progestogen (65.8%) and was lower among women aged 50 to 74 years who underwent biennial or triennial mammography with scattered fibroglandular densities (30.7% and 21.9%, respectively) or fatty breasts (17.4% and 12.1%, respectively).
  
  
  CONCLUSIONS
  Women aged 50 to 74 years, even those with high breast density or HT use, who undergo biennial screening mammography have similar risk of advanced-stage disease and lower cumulative risk of false-positive results than those who undergo annual mammography. When deciding whether to undergo mammography, women aged 40 to 49 years who have extremely dense breasts should be informed that annual mammography may minimize their risk of advanced-stage disease but the cumulative risk of false-positive results is high.
authors.affiliation: General Internal Medicine Section, San Francisco Veterans Affairs Medical Center, 4150 Clement St, Mailing Code 111A1, San Francisco, CA 94121, USA. Karla.Kerlikowske@ucsf.edu
authors.forename: Karla
authors.initials: K
authors.lastname: Kerlikowske
authors.forename: Weiwei
authors.initials: W
authors.lastname: Zhu
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Hubbard
authors.forename: Berta
authors.initials: B
authors.lastname: Geller
authors.forename: Kim
authors.initials: K
authors.lastname: Dittus
authors.forename: Dejana
authors.initials: D
authors.lastname: Braithwaite
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Wernli
authors.forename: Diana L
authors.initials: DL
authors.lastname: Miglioretti
authors.forename: Ellen S
authors.initials: ES
authors.lastname: O'Meara
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D055088:Early Detection of Cancer / Q000379:methods*; D015914:Estrogen Replacement Therapy; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D016015:Logistic Models; D008327:Mammography / Q000009:adverse effects / Q000592:standards; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D016017:Odds Ratio; D017698:Postmenopause; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors
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