Lower sensitivity of screening mammography after previous benign breast surgery

Abstract

Few data are available on the effect of previous benign breast surgery on screening mammography accuracy. We determined whether sensitivity of screening mammography and tumor characteristics are different for women with and without previous benign breast surgery. We included a consecutive series of 317,398 screening mammograms of women screened between 1997 and 2008. During 2-year follow-up, clinical data, breast imaging, biopsy and surgery reports were collected from women with screen-detected or interval breast cancers. Screening sensitivity, tumor biology and tumor stages were compared between 168 women with breast cancer and prior ipsilateral benign breast surgery and 2,039 women with breast cancer but without previous ipsilateral, benign breast surgery. The sensitivity of screening mammography was significantly lower for women with prior surgery [64.3% (108/168) versus 73.4% (1,496/2,039), p 5 0.01]. The concomitant increased interval cancer risk remained significant after logistic regression adjustment for age and breast density (OR 5 1.5, 95% CI: 1.1-2.1). Comparing screen-detected cancers in women with and without prior breast surgery, no significant differences in estrogen receptor status (p 5 0.56), mitotic activity (p 5 0.17), proportions of large (T21) tumors (p 5 0.6) or lymph node positive tumors (p 5 0.4) were found. Also for interval cancers, no differences were found in estrogen receptor status (p 5 0.41), mitotic activity (p 5 0.39), proportions of large tumors (p 5 0.9) and lymph node positive tumors (p 5 0.5) between women with and without prior breast surgery. We conclude that sensitivity of screening mammography is significantly lower in women with previous benign breast surgery than without, but tumor characteristics are comparable both for screen detected cancers and interval cancers.Mammography screening aims to detect breast cancer at an early stage and several studies have shown that screening significantly reduces breast cancer mortality.1-3 Many countries have introduced regional or nationwide breast cancer screening programs in the last two decades. The Netherlands has a long history of screening mammography and their nationwide breast cancer screening program offers biennial screening mammography for women aged 50-75 years.Breast conserving treatment for breast cancer may cause rigorous mammographic changes, due to surgery and radiation therapy. [4][5][6] These changes frequently hamper the mammographic interpretation and may result in a lower sensitivity of mammography for breast cancer detection. On the other hand, post-treatment changes may simulate breast cancer at mammography and lead to an increase of false positive assessments and thus a lower specificity. The Dutch guidelines on breast cancer screening advise that mammographic follow-up for women after breast conserving therapy should take place in an outpatient hospital setting for a period of 5-10 years before returning to routine screening. 7Mammographic alterations occurring after breast surgery for benign disease and r...

Trends in frequency and outcome of high‐risk breast lesions at core needle biopsy in women recalled at biennial screening mammography, a multiinstitutional study

“…Although a recent US study found that reattendance to a screening mammography program is not lower in women with benign surgical excision after recall, 6 the use of this type of excision for diagnostic purposes should be kept to a minimum as it lowers the sensitivity of future screening mammography for cancer detection. 27 Tumor characteristics were generally more favorable for high-risk lesions upstaged to breast cancer than for cancers with an unequivocal diagnosis of malignancy at CNB, with a higher proportion of DCIS and the absence of lymph node positive invasive cancers in the first group in case of simultaneous sentinel lymph node biopsy. Tumor stage and grading of invasive cancers, as well as type of final surgical treatment, were comparable for both groups.…”

“…As the proportion of high‐risk lesions being upgraded to malignancy remained stable over the years, the increased excision rate of these lesions resulted in an increasing number of women with a benign outcome after diagnostic surgical excision. Although a recent US study found that reattendance to a screening mammography program is not lower in women with benign surgical excision after recall, the use of this type of excision for diagnostic purposes should be kept to a minimum as it lowers the sensitivity of future screening mammography for cancer detection …”

Trends in breast biopsies for abnormalities detected at screening mammography: a population-based study in the Netherlands

“…We have reported in earlier studies that benign breast surgery, including surgical biopsy, can result in a lower sensitivity for breast cancer detection at subsequent screening mammography (van Breest Smallenburg et al , 2012a; b). Furthermore, invasive assessments increase the unnecessary psychological distress of false-positive referrals (Brett and Austoker, 2001; Bond et al , 2012).…”

“…There are various breast biopsy procedures, including percutaneous fine-needle aspiration cytology (FNAC), percutaneous core-needle biopsy (CB) (ultrasound-guided or stereotactic vacuum-assisted) and invasive surgical biopsy. Surgical biopsies for diagnostic purposes should be omitted, as they increase unnecessary psychological distress in false-positive referrals (Brett and Austoker, 2001; Bond et al , 2012) and benign breast surgery complicates interpretation of subsequent mammograms due to postoperative changes (Brenner and Pfaff, 1996; Banks et al , 2004; Taplin et al , 2010; van Breest Smallenburg et al , 2012a). Surgical biopsy should also not be used for histological confirmation of a radiologically suspicious or malignant lesion.…”

Trends in incidence and detection of advanced breast cancer at biennial screening mammography in The Netherlands: a population based study

“…We expected to find a reduction of advanced cancers in our screened population over time, as a result of increasing experience of the screening radiologists, continuous quality assurance, introduction of additional film reading by technologists and the increased use of 2-view mammography at subsequent screening mammography [16,24]. The incidence rate of advanced screen detected cancers and advanced interval cancers remained constant in our study and this finding is in line with a recent meta-analysis of regional and nation-wide screening programs, where annual percent changes in advanced breast cancer were stable or even increasing back to pre-screening rates [13].…”