Skip to main content

Advertisement

SpringerLink
Log in

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

  • Clinical Trial
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kubik-Huch RA (2006) Imaging the young breast. Breast 15(Suppl 2):S35–S40

    Article  PubMed  Google Scholar 

  2. Kolb TM, Lichy J, Newhouse JH (2002) Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. Radiology 225(1):165–175

    Article  PubMed  Google Scholar 

  3. Axelrod D, Smith J, Kornreich D, Grinstead E, Singh B, Cangiarella J, Guth AA (2008) Breast cancer in young women. J Am Coll Surg 206(3):1193–1203

    Article  PubMed  Google Scholar 

  4. Berg WA (2007) Beyond standard mammographic screening: mammography at age extremes, ultrasound, and MR imaging. Radiol Clin N Am 45(5):895–906, vii

    Article  PubMed  Google Scholar 

  5. Chapuis L, Hessler C (1989) Breast cancer before 36 years of age. Helv Chir Acta 55(6):895–902

    PubMed  CAS  Google Scholar 

  6. Di NB, Cassano E, Urban LA, Fedele P, Abbate F, Maisonneuve P, Veronesi P, Renne G, Bellomi M (2006) Radiological features and pathological-biological correlations in 348 women with breast cancer under 35 years old. Breast 15(6):744–753

    Article  Google Scholar 

  7. Foxcroft LM, Evans EB, Porter AJ (2004) The diagnosis of breast cancer in women younger than 40. Breast 13(4):297–306

    Article  PubMed  CAS  Google Scholar 

  8. Houssami N, Irwig L, Simpson JM, McKessar M, Blome S, Noakes J (2003) Sydney Breast Imaging Accuracy Study: comparative sensitivity and specificity of mammography and sonography in young women with symptoms. AJR Am J Roentgenol 180(4):935–940

    PubMed  Google Scholar 

  9. Kriege M, Brekelmans CT, Obdeijn IM, Boetes C, Zonderland HM, Muller SH, Kok T, Manoliu RA, Besnard AP, Tilanus-Linthorst MM, Seynaeve C, Bartels CC, Kaas R, Meijer S, Oosterwijk JC, Hoogerbrugge N, Tollenaar RA, Rutgers EJ, de Koning HJ, Klijn JG (2006) Factors affecting sensitivity and specificity of screening mammography and MRI in women with an inherited risk for breast cancer. Breast Cancer Res Treat 100(1):109–119

    Article  PubMed  Google Scholar 

  10. Max MH, Klamer TW (1984) Breast cancer in 120 women under 35 years old. A 10-year community-wide survey. Am Surg 50(1):23–25

    PubMed  CAS  Google Scholar 

  11. Mintzer D, Glassburn J, Mason BA, Sataloff D (2002) Breast cancer in the very young patient: a multidisciplinary case presentation. Oncologist 7(6):547–554

    Article  PubMed  Google Scholar 

  12. Jeffries DO, Adler DD (1990) Mammographic detection of breast cancer in women under the age of 35. Investig Radiol 25(1):67–71

    Article  CAS  Google Scholar 

  13. Wang J, Chang KJ, Kuo WH, Lee HT, Shih TT (2007) Efficacy of mammographic evaluation of breast cancer in women less than 40 years of age: experience from a single medical center in Taiwan. J Formos Med Assoc 106(9):736–747

    Article  PubMed  Google Scholar 

  14. Hulvat MC, Hansen NM, Jeruss JS (2009) Multidisciplinary care for patients with breast cancer. Surg Clin N Am 89(1):133–176, ix

    Article  PubMed  Google Scholar 

  15. Marie SG, Haslam SZ, Azzouz F (2003) Breast cancer among young African-American women: a summary of data and literature and of issues discussed during the Summit Meeting on Breast Cancer Among African American Women, Washington, DC, September 8–10, 2000. Cancer 97(1 Suppl):273–279

    Article  Google Scholar 

  16. Hisham AN, Yip CH (2003) Spectrum of breast cancer in Malaysian women: overview. World J Surg 27(8):921–923

    Article  PubMed  Google Scholar 

  17. Basro S, Apffelstaedt JP (2010) Breast cancer in young women in a limited-resource environment. World J Surg 34(7):1427–1433

    Article  PubMed  Google Scholar 

  18. Rosenberg RD, Yankaskas BC, Abraham LA, Sickles EA, Lehman CD, Geller BM, Carney PA, Kerlikowske K, Buist DS, Weaver DL, Barlow WE, Ballard-Barbash R (2006) Performance benchmarks for screening mammography. Radiology 241(1):55–66

    Article  PubMed  Google Scholar 

  19. Smigal C, Jemal A, Ward E, Cokkinides V, Smith R, Howe HL, Thun M (2006) Trends in breast cancer by race and ethnicity: update 2006. CA Cancer J Clin 56(3):168–183

    Article  PubMed  Google Scholar 

  20. Sandelin K, Apffelstaedt JP, Abdullah H, Murray EM, Ajuluchuku EU (2002) Breast Surgery International—breast cancer in developing countries. Scand J Surg 91(3):222–226

    PubMed  CAS  Google Scholar 

  21. Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P (2007) Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 18(3):581–592

    Article  PubMed  CAS  Google Scholar 

  22. Vorobiof DA, Sitas F, Vorobiof G (2001) Breast cancer incidence in South Africa. J Clin Oncol 19(18 Suppl):125S–127S

    PubMed  CAS  Google Scholar 

  23. Anderson BO, Shyyan R, Eniu A, Smith RA, Yip CH, Bese NS, Chow LW, Masood S, Ramsey SD, Carlson RW (2006) Breast cancer in limited-resource countries: an overview of the Breast Health Global Initiative 2005 guidelines. Breast J 12(Suppl 1):S3–S15

    Article  PubMed  Google Scholar 

  24. Dawson AE, Mulford DK, Taylor AS, Logan-Young W (1998) Breast carcinoma detection in women age 35 years and younger: mammography and diagnosis by fine-needle aspiration cytology. Cancer 84(3):163–168

    Article  PubMed  CAS  Google Scholar 

  25. Hankey BF, Miller B, Curtis R, Kosary C (1994) Trends in breast cancer in younger women in contrast to older women. J Natl Cancer Inst Monogr (16):7–14

  26. Foo CS, Su D, Chong CK, Chng HC, Tay KH, Low SC, Tan SM (2005) Breast cancer in young Asian women: study on survival. ANZ J Surg 75(7):566–572

    Article  PubMed  Google Scholar 

  27. Winchester DP, Osteen RT, Menck HR (1996) The National Cancer Data Base report on breast carcinoma characteristics and outcome in relation to age. Cancer 78(8):1838–1843

    Article  PubMed  CAS  Google Scholar 

  28. Chung M, Chang HR, Bland KI, Wanebo HJ (1996) Younger women with breast carcinoma have a poorer prognosis than older women. Cancer 77(1):97–103

    Article  PubMed  CAS  Google Scholar 

  29. Bassett LW, Ysrael M, Gold RH, Ysrael C (1991) Usefulness of mammography and sonography in women less than 35 years of age. Radiology 180(3):831–835

    PubMed  CAS  Google Scholar 

  30. Harper AP, Kelly-Fry E, Noe JS (1981) Ultrasound breast imaging-the method of choice for examining the young patient. Ultrasound Med Biol 7(3):231–237

    Article  PubMed  CAS  Google Scholar 

  31. Jackson VP, Reynolds HE, Hawes DR (1996) Sonography of the breast. Semin Ultrasound CT MRI 17(5):460–475

    Article  CAS  Google Scholar 

  32. Flobbe K, Nelemans PJ, Kessels AG, Beets GL, von Meyenfeldt MF, van Engelshoven JM (2002) The role of ultrasonography as an adjunct to mammography in the detection of breast cancer. A systematic review. Eur J Cancer 38(8):1044–1050

    Article  PubMed  CAS  Google Scholar 

  33. Berg WA, Gutierrez L, NessAiver MS, Carter WB, Bhargavan M, Lewis RS, Ioffe OB (2004) Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology 233(3):830–849

    Article  PubMed  Google Scholar 

  34. Ikeda DM, Andersson I (1989) Ductal carcinoma in situ: atypical mammographic appearances. Radiology 172(3):661–666

    PubMed  CAS  Google Scholar 

  35. Dershaw DD, Abramson A, Kinne DW (1989) Ductal carcinoma in situ: mammographic findings and clinical implications. Radiology 170(2):411–415

    PubMed  CAS  Google Scholar 

  36. Yang WT, Tse GM (2004) Sonographic, mammographic, and histopathologic correlation of symptomatic ductal carcinoma in situ. AJR Am J Roentgenol 182(1):101–110

    PubMed  Google Scholar 

  37. Soo MS, Baker JA, Rosen EL (2003) Sonographic detection and sonographically guided biopsy of breast microcalcifications. AJR Am J Roentgenol 180(4):941–948

    PubMed  Google Scholar 

  38. Rieber A, Merkle E, Bohm W, Brambs HJ, Tomczak R (1997) MRI of histologically confirmed mammary carcinoma: clinical relevance of diagnostic procedures for detection of multifocal or contralateral secondary carcinoma. J Comput Assist Tomogr 21(5):773–779

    Article  PubMed  CAS  Google Scholar 

  39. Fischer U, Kopka L, Grabbe E (1999) Breast carcinoma: effect of preoperative contrast-enhanced MR imaging on the therapeutic approach. Radiology 213(3):881–888

    PubMed  CAS  Google Scholar 

  40. Liberman L, Morris EA, Dershaw DD, Abramson AF, Tan LK (2003) MR imaging of the ipsilateral breast in women with percutaneously proven breast cancer. AJR Am J Roentgenol 180(4):901–910

    PubMed  Google Scholar 

  41. Orel SG, Schnall MD, LiVolsi VA, Troupin RH (1994) Suspicious breast lesions: MR imaging with radiologic-pathologic correlation. Radiology 190(2):485–493

    PubMed  CAS  Google Scholar 

  42. Pediconi F, Venditti F, Padula S, Roselli A, Moriconi E, Giacomelli L, Catalano C, Passariello R (2005) CE-magnetic resonance mammography for the evaluation of the contralateral breast in patients with diagnosed breast cancer. Radiol Med 110(1–2):61–68

    PubMed  Google Scholar 

  43. Brennan ME, Houssami N, Lord S, Macaskill P, Irwig L, Dixon JM, Warren RM, Ciatto S (2009) Magnetic resonance imaging screening of the contralateral breast in women with newly diagnosed breast cancer: systematic review and meta-analysis of incremental cancer detection and impact on surgical management. J Clin Oncol 27(33):5640–5649

    Article  PubMed  Google Scholar 

  44. Morris EA (2002) Breast cancer imaging with MRI. Radiol Clin N Am 40(3):443–466

    Article  PubMed  Google Scholar 

  45. Lehman CD, Gatsonis C, Kuhl CK, Hendrick RE, Pisano ED, Hanna L, Peacock S, Smazal SF, Maki DD, Julian TB, DePeri ER, Bluemke DA, Schnall MD (2007) MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med 356(13):1295–1303

    Article  PubMed  CAS  Google Scholar 

  46. Lord SJ, Lei W, Craft P, Cawson JN, Morris I, Walleser S, Griffiths A, Parker S, Houssami N (2007) A systematic review of the effectiveness of magnetic resonance imaging (MRI) as an addition to mammography and ultrasound in screening young women at high risk of breast cancer. Eur J Cancer 43(13):1905–1917

    Article  PubMed  CAS  Google Scholar 

  47. Morris EA, Liberman L, Ballon DJ, Robson M, Abramson AF, Heerdt A, Dershaw DD (2003) MRI of occult breast carcinoma in a high-risk population. AJR Am J Roentgenol 181(3):619–626

    PubMed  Google Scholar 

  48. Kriege M, Brekelmans CT, Boetes C, Besnard PE, Zonderland HM, Obdeijn IM, Manoliu RA, Kok T, Peterse H, Tilanus-Linthorst MM, Muller SH, Meijer S, Oosterwijk JC, Beex LV, Tollenaar RA, de Koning HJ, Rutgers EJ, Klijn JG (2004) Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med 351(5):427–437

    Article  PubMed  CAS  Google Scholar 

  49. Leach MO, Boggis CR, Dixon AK, Easton DF, Eeles RA, Evans DG, Gilbert FJ, Griebsch I, Hoff RJ, Kessar P, Lakhani SR, Moss SM, Nerurkar A, Padhani AR, Pointon LJ, Thompson D, Warren RM (2005) Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS). Lancet 365(9473):1769–1778

    Article  PubMed  CAS  Google Scholar 

  50. Lehman CD, Blume JD, Weatherall P, Thickman D, Hylton N, Warner E, Pisano E, Schnitt SJ, Gatsonis C, Schnall M, DeAngelis GA, Stomper P, Rosen EL, O’loughlin M, Harms S, Bluemke DA (2005) Screening women at high risk for breast cancer with mammography and magnetic resonance imaging. Cancer 103(9):1898–1905

    Article  PubMed  Google Scholar 

  51. Williams SM, Kaplan PA, Petersen JC, Lieberman RP (1986) Mammography in women under age 30: is there clinical benefit? Radiology 161(1):49–51

    PubMed  CAS  Google Scholar 

  52. Harris VJ, Jackson VP (1989) Indications for breast imaging in women under age 35 years. Radiology 172(2):445–448

    PubMed  CAS  Google Scholar 

  53. Brand IR, Sapherson DA, Brown TS (1993) Breast imaging in women under 35 with symptomatic breast disease. Br J Radiol 66(785):394–397

    Article  PubMed  CAS  Google Scholar 

  54. Hindle WH, Davis L, Wright D (1999) Clinical value of mammography for symptomatic women 35 years of age and younger. Am J Obstet Gynecol 180(6 Pt 1):1484–1490

    Article  PubMed  CAS  Google Scholar 

  55. Sickles EA, Miglioretti DL, Ballard-Barbash R, Geller BM, Leung JW, Rosenberg RD, Smith-Bindman R, Yankaskas BC (2005) Performance benchmarks for diagnostic mammography. Radiology 235(3):775–790

    Article  PubMed  Google Scholar 

  56. Meyer JE, Kopans DB, Oot R (1983) Breast cancer visualized by mammography in patients under 35. Radiology 147(1):93–94

    PubMed  CAS  Google Scholar 

  57. de Shaw PE, Marsteller LP, Eden BV (1990) Breast cancers in women 35 years of age and younger: mammographic findings. Radiology 177(1):117–119

    Google Scholar 

  58. Bassett LW, Gold RH (1988) The evolution of mammography. AJR Am J Roentgenol 150(3):493–498

    PubMed  CAS  Google Scholar 

  59. Miles A, Cockburn J, Smith RA, Wardle J (2004) A perspective from countries using organized screening programs. Cancer 101(5 Suppl):1201–1213

    Article  PubMed  Google Scholar 

  60. Liberman L (2004) Breast cancer screening with MRI—What are the data for patients at high risk? N Engl J Med 351(5):497–500

    Article  PubMed  CAS  Google Scholar 

  61. Robertson CL (1993) A private breast imaging practice: medical audit of 25,788 screening and 1,077 diagnostic examinations. Radiology 187(1):75–79

    PubMed  CAS  Google Scholar 

  62. Sickles EA, Ominsky SH, Sollitto RA, Galvin HB, Monticciolo DL (1990) Medical audit of a rapid-throughput mammography screening practice: methodology and results of 27,114 examinations. Radiology 175(2):323–327

    PubMed  CAS  Google Scholar 

  63. Tuncbilek I, Ozdemir A, Gultekin S, Ogur T, Erman R, Yuce C (2007) Clinical outcome assessment in mammography: an audit of 7,506 screening and diagnostic mammography examinations. Diagn Interv Radiol 13(4):183–187

    PubMed  Google Scholar 

  64. Apffelstaedt JP, Steenkamp V, Baatjes K (2008) Performance data of screening mammography at a dedicated breast health centre. S Afr Med J 98(12):950–953

    PubMed  CAS  Google Scholar 

  65. Lu W, Schaapveld M, Jansen L, Bagherzadegan E, Sahinovic MM, Baas PC, Hanssen LM, van der Mijle HC, Brandenburg JD, Wiggers T, De Bock GH (2009) The value of surveillance mammography of the contralateral breast in patients with a history of breast cancer. Eur J Cancer 45(17):3000–3007

    Article  PubMed  Google Scholar 

  66. Kollias J, Evans AJ, Wilson AR, Ellis IO, Elston CW, Blamey RW (2000) Value of contralateral surveillance mammography for primary breast cancer follow-up. World J Surg 24(8):983–987

    Article  PubMed  CAS  Google Scholar 

  67. Mellink WA, Holland R, Hendriks JH, Peeters PH, Rutgers EJ, van Daal WA (1991) The contribution of routine follow-up mammography to an early detection of asynchronous contralateral breast cancer. Cancer 67(7):1844–1848

    Article  PubMed  CAS  Google Scholar 

  68. Ji J, Hemminki K (2007) Risk for contralateral breast cancers in a population covered by mammography: effects of family history, age at diagnosis and histology. Breast Cancer Res Treat 105(2):229–236

    Article  PubMed  Google Scholar 

  69. Vaittinen P, Hemminki K (2000) Risk factors and age-incidence relationships for contralateral breast cancer. Int J Cancer 88(6):998–1002

    Article  PubMed  CAS  Google Scholar 

  70. Chen Y, Thompson W, Semenciw R, Mao Y (1999) Epidemiology of contralateral breast cancer. Cancer Epidemiol Biomark Prev 8(10):855–861

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medial Faculty, Breast Clinic, University of Stellenbosch, PO Box 19063, Tygerberg, Cape Town, 7505, South Africa

    Liezel Taylor, Sarinah Basro, Justus P. Apffelstaedt & Karin Baatjes

Authors
  1. Liezel Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarinah Basro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Justus P. Apffelstaedt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Karin Baatjes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Justus P. Apffelstaedt.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Taylor, L., Basro, S., Apffelstaedt, J.P. et al. 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. Breast Cancer Res Treat 129, 99–106 (2011). https://doi.org/10.1007/s10549-011-1630-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-011-1630-z

Keywords

Search

Navigation