title: Accuracy of screening mammography in women with a history of lobular carcinoma in situ or atypical hyperplasia of the breast.
abstract: Women with lobular carcinoma in situ (LCIS), atypical lobular hyperplasia (ALH), atypical ductal hyperplasia (ADH), or atypical hyperplasia (AH) are at increased breast cancer (BC) risk. We investigated the accuracy and outcomes of mammography screening in women with histology-proven LCIS, ALH, ADH, or AH history who had screening through Breast Cancer Surveillance Consortium-affiliated mammography facilities. Screens from two cohorts, defined by LCIS/ALH or ADH/AH history, were compared to two cohorts without such history mammogram-matched for age-group, breast density, family history, screen-year, and mammography registry. Overall 359 BCs (277 invasive BC) occurred within 1 year from screening among 52,380 screens. In the LCIS/ALH cohort [versus comparator screens] cancer incidence rates, cancer detection rates (CDR), and interval cancer rates (ICR) were significantly higher (all P < 0.001); although ICR was 4.4/1,000 screens [versus 0.9/1,000; P < 0.001] the proportion that were interval cancers did not differ between compared cohorts (P = 0.43); screening sensitivity was 76.1 % [versus 82.3 %; P = 0.43], however, specificity was significantly lower at 85.1 % [versus 90.7 %; P < 0.0001]. In the ADH/AH cohort [versus comparator] cancer rates and CDR were significantly higher (P < 0.001); although ICR was 2.6/1,000 screens [versus 0.9/1,000; P = 0.002] the proportion that were interval cancers did not differ between cohorts (P = 0.74); screening sensitivity was 81.0 % [versus 82.6 %; P = 0.74] and specificity was lower at 86.2 % [versus 90.2 %; P < 0.0001]. Mammography screening sensitivity in LCIS/ALH and ADH/AH cohorts did not significantly differ from that of matched screens, however, specificity was lower, and ICRs were higher (reflecting underlying cancer rates). Adjunct screening may be of value in these women if it reduces ICR without substantially reducing specificity.
authors.affiliation: Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, 2006, 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: Tracy
authors.initials: T
authors.lastname: Onega
authors.forename: Laura C
authors.initials: LC
authors.lastname: Collins
authors.forename: Brian L
authors.initials: BL
authors.lastname: Sprague
authors.forename: Deirdre A
authors.initials: DA
authors.lastname: Hill
authors.forename: Diana L
authors.initials: DL
authors.lastname: Miglioretti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D018275:Carcinoma, Lobular / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D003951:Diagnostic Errors; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000175:diagnosis* / Q000473:pathology; D008327:Mammography; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis / Q000473:pathology; D055815:Young Adult