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· Incidence: 110/100,000
· Mortality: 22/100,000
· Lifetime risk:3.6%
Breast cancer is the leading cause of cancer mortality in women from 15-54, although 48% of new breast cancer cases and 56% of deaths occur in women age 65 and older cancer screening, prostate specific antigen, PSA, mammogram, mammography.
North American or Northern European
Older age
- 40-44: 127/100,000
- 50-54:229/100,000
- 60-64: 348/100,000
- 70-74: 450/100,000
Family history in a first degree relative
- Increases risk 2-3 fold
- For women less than 50, highest if relative had premenopausal breast cancer
Previous Breast cancer or carcinoma in situ
Atypical hyperplasia on breast biopsy
Associations with Breast Cancer
Exposure to high dose radiation
Late age at first pregnancy
Nulliparity
High socioeconomic status
Breast Cancer Screening: Test Accuracy
· Sensitivity: 75 to 88%
10-15% lower in women aged 40-49
· Specificity: 98.5% to 83%
· Adverse Effects of Screening
False positive rate of 7-10% (age 40-49)
False positive rate of 4.5-8% (age 50-59)
Increased anxiety in women requiring biopsy
Screening for Breast Cancer
· Routine Screening is recommended every 1-2 years with mammography for women aged 50-69.
· For women between 40-49, there is conflicting evidence regarding clinical benefit from mammography.
Controversy in Screening:
· Only one trial to test effectiveness in women between 40-49. mammography (multiple flaws)
· Why doesn't screening improve survival?
Lower sensitivity of mammography in younger women
Suboptimal screening intervals
Differential (less aggressive) treatment offered
Tumor biology is different
· Reasons to screen (40-49):
Patient preference
"High Risk" for breast cancer
"High Burden of Suffering"
Sensitivity of mammography improves
Treatment of Breast cancer improves