At risk women not having mammograms


Women who have been treated for ductal carcinoma in situ (DCIS) tend to stop following the recommended guidelines for mammography screening over time, despite the fact that they still have a higher-than-average risk for recurrence and development of a new DCIS in the other breast.

This finding, published recently in the Journal of Clinical Oncology, is drawn from a study of more than 3,000 women who underwent breast-conserving surgery for DCIS between 1990 and 2001. Breast-conserving surgery is a procedure in which only the abnormal cells, or tumor, plus a margin – an area of normal cells surrounding the abnormal cells – are removed.

DCIS is a noninvasive condition in which abnormal cells are found in the lining of a breast duct. These abnormal cells have not yet spread outside the duct to other tissues in the breast. Some physicians consider this a “precancerous condition,” while others classify it as very early-stage breast cancer.

DCIS may progress to become invasive cancer and spread to other tissues, although it is not yet known how to predict whether a DCIS will become invasive. DCIS is clearly the precursor of invasive breast cancer.

According to the research team, headed by Dr. Larissa Nekhlyudov of Harvard Medical School in Boston, mammography screening rates were 79 percent during the first year of follow-up, 69 percent in the fifth year, declining to 61 percent in the tenth year.

The investigators also found that among women observed for 5 years, those who were likely to have regular mammograms were women diagnosed between the ages of 60 to 69 years, users of menopausal hormone therapy at diagnosis, and were treated after surgery with radiation alone or with radiation followed with tamoxifen. Obese women were less likely to adhere to recommendations for mammography screening.

The findings were similar for women followed for 10 years, the authors report.

Because DCIS is considered to be a precursor of invasive breast cancer, it is particularly important for these women to undergo regular surveillance for recurrence of DCIS or progression to invasive breast cancer, Nekhlyudov’s group cautions.

They suggest that health care delivery centers monitor these patients to ensure that they follow the recommended mammography guidelines after breast-conserving surgery for DCIS.

Source: Reuters Health