Time for a re-evaluation of mammography in the young? Results of an audit of mammography in women younger than 40 in a resource restricted environment

Abstract

Mammography in younger women is considered to be of limited value. In a resource restricted environment without access to magnetic resonance imaging (MRI) and with a high incidence of breast cancer in the young, mammography remains an important diagnostic tool. Recent technical advances and better regulation of mammography make a reassessment of its value in these conditions necessary. Data of all the mammograms performed at a tertiary hospital and private breast clinic between January 2003 and July 2009 in women less than 40 years of age were collected. Indications were the presence of a mass, follow-up after primary cancer therapy, and screening for patients perceived at high risk due to a family history or the presence of atypical hyperplasia. Data acquired were as follows: Demographics, prior breast surgery, indication for mammography, outcome of mammography, diagnostic procedures, and their results. Of 2,167 mammograms, 393 were performed for a palpable mass, diagnostic mammography. In these, the overall cancer detection rate was 40%. If the mammography was reported as breast imaging reporting and data system (BIRADS(®)) 5 versus BIRADS(®) 3 and 4 versus BIRADS(®) 1 and 2, a final diagnosis of malignancy was established in 96, 48, and 5%, respectively. Of 367 mammograms done for the follow-up after primary treatment of breast cancer, seven cancers were diagnosed for a detection rate of 1.9%. Of 1,312 mammograms performed for screening, the recall rate was 4%; the biopsy rate 2%, and the cancer diagnosis rate 3/1,000 examinations. In contrast to past series, this series has shown that recent advances in mammography have made it a useful tool in the management of breast problems in young women, notably in a resource-restricted environment. Women for screening should be selected carefully.

Will Adherence to New Guidance Lead to Missed Cancer Diagnoses? Evaluation of Limiting Symptomatic Mammograms to Over Forties

“…This change in guidance follows the results of several studies showing poor performance of mammography in younger patients; with sensitivity rates at detecting malignancy reported as low as 40% . This is predominantly a result of high breast density within this group, compared to older women .…”

“…This change in guidance follows the results of several studies showing poor performance of mammography in younger patients; with sensitivity rates at detecting malignancy reported as low as 40% . This is predominantly a result of high breast density within this group, compared to older women . However, USS has consistently shown good sensitivity (80–94%) at detecting cancer within the same group, proving to be a valuable tool in initial triple assessment (clinical, radiological and histological evaluation) .…”

“…Mammography has been shown to have varying sensitivities in the symptomatic setting, with the overall sensitivity in the range of 65–90% . Several studies have shown that the sensitivity of this diagnostic modality is significantly influenced by the density of the breast tissue . Younger patients (<40) often have more dense breast tissue than older female patients.…”

Mammography reporting at Tygerberg Hospital, Cape Town, South Africa

“…These analyses are routinely subjected to peer review, which confirms that the quality of reading and reporting conforms to international best radiological practice and has resulted in several publications. [4][5][6][7] Despite an invitation to do so, [4] similar independent confirmation of high standards of mammography interpretation by our SA radiologist colleagues is lacking.…”

“…These analyses are routinely subjected to peer review, which confirms that the quality of reading and reporting conforms to international best radiological practice and has resulted in several publications. [4][5][6][7] Despite an invitation to do so, [4] similar independent confirmation of high standards of mammography interpretation by our SA radiologist colleagues is lacking.Uncritically and rigidly taking over service delivery models of well-resourced environments is counterproductive in a developing country. Services in resource-restricted environments must often be delivered by the willing and capable instead of those with the qualifications deemed necessary in wealthier settings.…”