title: Utility of mammography for chronic kidney disease patients undergoing kidney transplant evaluation.
abstract: Transplant centers typically require screening mammography (MMG) for women ≥40 during evaluation. American Cancer Society recommends starting annual MMG at 40, while USPSTF recommends biennial MMG at 50. We sought to determine the effect of age and other breast malignancy risk factors on screening MMG in the pre-transplant renal failure population undergoing transplant evaluation.
  
  
  METHODS
  We retrospectively examined women ≥40 undergoing kidney transplant evaluation from 2006 to 2012 (n = 541).
  
  
  RESULTS
  Patients aged 40.0-49.9 and ≥50 had similar rates of breast biopsy and breast malignancy. African Americans underwent a higher rate of biopsies (OR 2.391, 95%CI 1.111-5.019, p = 0.026), with a lower rate of biopsy in those already on dialysis at presentation (OR 0.434, 95%CI 0.212-0.888, p = 0.022). Higher breast density (>50% fibroglandular tissue) increased both rate of biopsy (OR 2.876, 95%CI 1.377-6.010, p = 0.005) and malignancy (OR 5.061, 95%CI 1.012-25.315, p = 0.048).
  
  
  CONCLUSIONS
  As we found no independent differences in biopsy or malignancy between age groups, it is reasonable for transplant centers to use the same evaluation MMG screening policy for all women ≥40. However, as malignancy risk increased with higher breast density, a lower threshold for additional workup may be warranted in patients with dense breasts or an indeterminate lesion on MMG.
authors: Division of Transplant Surgery, Department of Surgery, Case Western Reserve University & University Hospitals Case Medical Center, Cleveland, OH, USA.
authors: Jordan B
authors: JB
authors: Stoecker
authors: Division of Transplant Surgery, Department of Surgery, Case Western Reserve University & University Hospitals Case Medical Center, Cleveland, OH, USA.
authors: Devan R
authors: DR
authors: Cote
authors: Division of Nephrology, Department of Internal Medicine, Case Western Reserve University & University Hospitals Case Medical Center, Cleveland, OH, USA.
authors: Joshua J
authors: JJ
authors: Augustine
authors: Division of Nephrology, Department of Internal Medicine, Case Western Reserve University & University Hospitals Case Medical Center, Cleveland, OH, USA.
authors: Nagaraju
authors: N
authors: Sarabu
authors: Division of Transplant Surgery, Department of Surgery, Case Western Reserve University & University Hospitals Case Medical Center, Cleveland, OH, USA.
authors: James A
authors: JA
authors: Schulak
authors: Division of Transplant Surgery, Department of Surgery, Case Western Reserve University & University Hospitals Case Medical Center, Cleveland, OH, USA.
authors: Edmund Q
authors: EQ
authors: Sanchez
authors: Division of Transplant Surgery, Department of Surgery, Case Western Reserve University & University Hospitals Case Medical Center, Cleveland, OH, USA.
authors: Vanessa R
authors: VR
authors: Humphreville
authors: Division of General and Oncologic Surgery, Department of Surgery, Case Western Reserve University & University Hospitals Case Medical Center, Cleveland, OH, USA.
authors: John B
authors: JB
authors: Ammori
authors: Section of Transplantation Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors: Kenneth J
authors: http://orcid.org/0000-0002-7495-3758
authors: KJ
authors: Woodside
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001943:Breast Neoplasms / Q000150:complications / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000473:pathology* / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
keywords: breast cancer; cancer screening; chronic kidney disease; end-stage renal disease; kidney transplantation; mammography