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Performance analysis of screening mammography in Asian women under 40 years

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Abstract

Background

Screening mammography performance among young women remains uncertain in East Asia, where the proportion of young breast cancer patients is higher than that in Western countries. Thus, we analyzed the performance of screening mammography in women under 40 years in comparison with older age groups.

Methods

This retrospective study comprised 95,431 Asian women with 197,525 screening mammograms. The reference standard was determined by linkage to the national cancer registry data and the 12-month follow-up outcomes after the index mammogram. The performance metrics included sensitivity, specificity, cancer detection rate (CDR), positive predictive value (PPV), recall rate, and areas under the receiver operating characteristic curve (AUCs), with comparisons across age groups (30 s, 40 s, and ≥ 50 s).

Results

For young women aged < 40 years, sensitivity and AUC (95% confidence interval [CI]) of screening mammography were 60.4% (50.4–69.7) and 0.73 (0.68–0.77), respectively, with no significant difference compared to women in their 40 s (sensitivity: 64.0% [95% CI: 57.8–69.8], P = 0.52; AUC: 0.75 [95% CI: 0.73–0.78], P = 0.35). The CDR (95% CI) was 0.8 (0.6–1.1) per 1,000 mammograms for young women, poorer than 1.8 (1.6–2.1) per 1,000 mammograms for women in their 40 s (P < 0.001). The PPV and recall rate (95% CI) for young women were 0.6% (0.4–0.7) and 14.9% (14.6–15.1), poorer than 1.4% (1.2–1.6) and 13.3% (13.1–13.5) for women in their 40 s (P < 0.001), respectively.

Conclusion

The accuracy of screening mammography for young women in their 30 s was not significantly different from that for women in their 40 s, but the cancer detection and recall rates were poorer.

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Data availability

The data are not publicly available outside of the hospital because of Institutional Review Board restrictions (the data were not collected in a way that could be distributed widely). However, the analytical methods are available from the corresponding author upon request.

References

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–49. https://doi.org/10.3322/caac.21660.

    Article  PubMed  Google Scholar 

  2. Tabár L, Yen AM, Wu WY, Chen SL, Chiu SY, Fann JC, et al. Insights from the breast cancer screening trials: how screening affects the natural history of breast cancer and implications for evaluating service screening programs. Breast J. 2015;21:13–20. https://doi.org/10.1111/tbj.12354.

    Article  PubMed  Google Scholar 

  3. Monticciolo DL, Malak SF, Friedewald SM, Eby PR, Newell MS, Moy L, et al. Breast cancer screening recommendations Iiclusive of all women at average risk: update from the ACR and Society of Breast Imaging. J Am Coll Radiol. 2021;18:1280–8. https://doi.org/10.1016/j.jacr.2021.04.021.

    Article  PubMed  Google Scholar 

  4. Coldman A, Phillips N, Wilson C, Decker K, Chiarelli AM, Brisson J, et al. Pan-Canadian study of mammography screening and mortality from breast cancer. J Natl Cancer Inst. 2014. https://doi.org/10.1093/jnci/dju261.

    Article  PubMed  Google Scholar 

  5. Arleo EK, Hendrick RE, Helvie MA, Sickles EA. Comparison of recommendations for screening mammography using CISNET models. Cancer. 2017;123:3673–80. https://doi.org/10.1002/cncr.30842.

    Article  PubMed  Google Scholar 

  6. Hendrick RE, Helvie MA, Monticciolo DL. Breast cancer mortality rates have stopped declining in U.S. Women younger than 40 Years. Radiology. 2021;299:143–9. https://doi.org/10.1148/radiol.2021203476.

    Article  PubMed  Google Scholar 

  7. Yankaskas BC, Haneuse S, Kapp JM, Kerlikowske K, Geller B, Buist DS, et al. Performance of first mammography examination in women younger than 40 years. J Natl Cancer Inst. 2010;102:692–701. https://doi.org/10.1093/jnci/djq090.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Yap YS, Lu YS, Tamura K, Lee JE, Ko EY, Park YH, et al. Insights into breast cancer in the east vs the west: a review. JAMA Oncol. 2019;5:1489–96. https://doi.org/10.1001/jamaoncol.2019.0620.

    Article  PubMed  Google Scholar 

  9. Leong SP, Shen ZZ, Liu TJ, Agarwal G, Tajima T, Paik NS, et al. Is breast cancer the same disease in Asian and Western countries? World J Surg. 2010;34:2308–24. https://doi.org/10.1007/s00268-010-0683-1.

    Article  PubMed  PubMed Central  Google Scholar 

  10. DeSantis CE, Ma J, Gaudet MM, Newman LA, Miller KD, Goding Sauer A, et al. Breast cancer statistics, 2019. CA Cancer J Clin. 2019;69:438–51. https://doi.org/10.3322/caac.21583.

    Article  PubMed  Google Scholar 

  11. Lee EH, Kim KW, Kim YJ, Shin DR, Park YM, Lim HS, et al. Performance of screening mammography: a report of the alliance for breast cancer screening in Korea. Korean J Radiol. 2016;17:489–96. https://doi.org/10.3348/kjr.2016.17.4.489.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Chang Y, Kim BK, Yun KE, Cho J, Zhang Y, Rampal S, et al. Metabolically-healthy obesity and coronary artery calcification. J Am Coll Cardiol. 2014;63:2679–86. https://doi.org/10.1016/j.jacc.2014.03.042.

    Article  PubMed  Google Scholar 

  13. Chang Y, Ryu S, Choi Y, Zhang Y, Cho J, Kwon MJ, et al. Metabolically healthy obesity and development of chronic kidney disease: a cohort study. Ann Intern Med. 2016;164:305–12. https://doi.org/10.7326/M15-1323.

    Article  PubMed  Google Scholar 

  14. Siu AL. Screening for Breast Cancer: U.S. Preventive services task force recommendation statement. Ann Intern Med. 2016;164:279–96. https://doi.org/10.7326/m15-2886.

    Article  PubMed  Google Scholar 

  15. Ebell MH, Thai TN, Royalty KJ. Cancer screening recommendations: an international comparison of high income countries. Public Health Rev. 2018;39:7. https://doi.org/10.1186/s40985-018-0080-0.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Anders CK, Hsu DS, Broadwater G, Acharya CR, Foekens JA, Zhang Y, et al. Young age at diagnosis correlates with worse prognosis and defines a subset of breast cancers with shared patterns of gene expression. J Clin Oncol. 2008;26:3324–30. https://doi.org/10.1200/jco.2007.14.2471.

    Article  PubMed  Google Scholar 

  17. Anastasiadi Z, Lianos GD, Ignatiadou E, Harissis HV, Mitsis M. Breast cancer in young women: an overview. Updates Surg. 2017;69:313–7. https://doi.org/10.1007/s13304-017-0424-1.

    Article  PubMed  Google Scholar 

  18. DeSantis CE, Ma J, Gaudet MM, Newman LA, Miller KD, Goding Sauer A, et al. Breast cancer statistics. CA: A Cancer Clin. 2019;69:438–51. https://doi.org/10.3322/caac.21583.

    Article  Google Scholar 

  19. de Berrington Gonzalez A, Berg CD, Visvanathan K, Robson M. Estimated risk of radiation-induced breast cancer from mammographic screening for young BRCA mutation carriers. J Natl Cancer Inst. 2009;101:205–9. https://doi.org/10.1093/jnci/djn440.

    Article  Google Scholar 

  20. de Berrington González A, Reeves G. Mammographic screening before age 50 years in the UK: comparison of the radiation risks with the mortality benefits. Br J Cancer. 2005;93:590–6. https://doi.org/10.1038/sj.bjc.6602683.

    Article  Google Scholar 

  21. von Euler-Chelpin M, Lillholm M, Vejborg I, Nielsen M, Lynge E. Sensitivity of screening mammography by density and texture: a cohort study from a population-based screening program in Denmark. Breast Cancer Res. 2019;21:111. https://doi.org/10.1186/s13058-019-1203-3.

    Article  CAS  Google Scholar 

  22. Hong S, Song SY, Park B, Suh M, Choi KS, Jung SE, et al. Effect of digital mammography for breast cancer screening: a comparative study of more than 8 million Korean women. Radiology. 2020;294:247–55. https://doi.org/10.1148/radiol.2019190951.

    Article  PubMed  Google Scholar 

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Author information

Author notes

  1. Mi-ri Kwon and Yoosoo Chang have contributed equally to this work.

  2. Seungho Ryu and Shin Ho Kook contributed equally as lead authors and supervised the work.

Authors and Affiliations

  1. Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-Ro, Jongno-Gu, Seoul, 03181, Republic of Korea

    Mi-ri Kwon & Shin Ho Kook

  2. Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Samsung Main Building B2, 250 Taepyung-Ro 2Ga, Jung-Gu, Seoul, 04514, Republic of Korea

    Yoosoo Chang & Seungho Ryu

  3. Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Yoosoo Chang & Seungho Ryu

  4. Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea

    Yoosoo Chang & Seungho Ryu

  5. Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea

    Boyoung Park

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  1. Mi-ri Kwon
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Corresponding authors

Correspondence to Seungho Ryu or Shin Ho Kook.

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Conflict of interest

The authors have no conflicts of interest to declare.

Ethical approval

This study was designed to use the preexisting anonymized retrospective data collected during the health screening process linked to the cancer registry information and was approved by the Institutional Review Board (IRB no. 2022-03-045). All procedures were following the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The written informed consent was obtained from study participants for linkage to the national cancer registry data and the data utilization for the research.

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Cite this article

Kwon, Mr., Chang, Y., Park, B. et al. Performance analysis of screening mammography in Asian women under 40 years. Breast Cancer 30, 241–248 (2023). https://doi.org/10.1007/s12282-022-01414-5

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