TITLE:
Failure to Engage in Breast Screening and Risk Assessment Results in More Advanced Stage at Diagnosis
AUTHORS:
Alison Johnston, Sharon Curran, Michael Sugrue
KEYWORDS:
Breast Cancer, Breast Cancer Detection, Breast Screening, Breast Outcomes
JOURNAL NAME:
Advances in Breast Cancer Research,
Vol.4 No.2,
April
9,
2015
ABSTRACT: Background:
Although well established, population based screening and family risk
assessment for breast cancer have come under increasing scrutiny. The concept
of over diagnosis is increasingly cited in cancer publications. This study
assessed the impact of failure to screen or risk assess patients attending with
a new diagnosis of breast cancer. Methods: A retrospective review was undertaken of 200 consecutive patients
diagnosed with breast cancer between January 2010 and September 2012 at
Letterkenny Hospital. Appropriate screening was defined as biennial in those
aged 50 - 66 and in those 40 - 49 with moderate/high family history risk (NICE
criteria or IBIS criteria). Patient
demographics, screening history, diagnosis date and stage (TNM) weredocumented. Patients with previous
breast cancer were not included (n = 17). Results: 200 consecutive patients,
whose mean age was 61 (range 28 - 99), were studied. 112/200 (56%) met no
criteria for screening or family history assessment, and 88/200 (44%) met
criteria for either screening (in 56) or family history assessment (in 32).
61/88 (69.3%) meeting criteria did not have a mammogram or risk assessment. The
stage of breast cancer was significantly earlier in those screened
appropriately, with early stage cancer in n = 111/139 (79.9 %) and late in n =
28/139 (20.1%), compared with 38/61 (62.3%) and 23/61 (37.7%) in those failing
to be screened appropriately (p = 0.01χ2df1). Conclusion:Failure to engage in breast screening
and risk assessment resulted in more advanced stage at diagnosis.