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4 February 2003 | Volume 138 Issue 3 | Pages 168-175
Background: The relationships among breast density, age, and use of hormone replacement therapy (HRT) in breast cancer detection have not been fully evaluated.
Objective: To determine how breast density, age, and use of HRT individually and in combination affect the accuracy of screening mammography.
Design: Prospective cohort study.
Setting: 7 population-based mammography registries in North Carolina; New Mexico; New Hampshire; Vermont; Colorado; Seattle, Washington; and San Francisco, California.
Participants: 329 495 women 40 to 89 years of age who had 463 372 screening mammograms from 1996 to 1998; 2223 women received a diagnosis of breast cancer.
Measurements: Breast density, age, HRT use, rate of breast cancer occurrence, and sensitivity and specificity of screening mammography.
Results: Adjusted sensitivity ranged from 62.9% in women with extremely dense breasts to 87.0% in women with almost entirely fatty breasts; adjusted sensitivity increased with age from 68.6% in women 40 to 44 years of age to 83.3% in women 80 to 89 years of age. Adjusted specificity increased from 89.1% in women with extremely dense breasts to 96.9% in women with almost entirely fatty breasts. In women who did not use HRT, adjusted specificity increased from 91.4% in women 40 to 44 years of age to 94.4% in women 80 to 89 years of age. In women who used HRT, adjusted specificity was about 91.7% for all ages.
Conclusions: Mammographic breast density and age are important predictors of the accuracy of screening mammography. Although HRT use is not an independent predictor of accuracy, it probably affects accuracy by increasing breast density.
Editors' Notes
Context
Contribution
Implications
–The Editors
Author and Article Information
From Dartmouth Medical School, Lebanon, New Hampshire; Group Health Cooperative, Seattle, Washington; University of North Carolina, Chapel Hill, North Carolina; Veterans Affairs Medical Center, San Francisco, California; University of New Mexico, Albuquerque, New Mexico; University of Vermont, Burlington, Vermont; AMC Cancer Research Center, Denver, Colorado; and National Cancer Institute, Bethesda, Maryland.
Grant Support: By cooperative agreements UO1CA63731, UO1CA63736, UO1CA63740, UO1CA69976, UO1CA70013, UO1CA70040, UO1CA86076, UO1CA86082, and R01CA80888 from the National Cancer Institute as part of the National Cancer Institute's Breast Cancer Surveillance Consortium.
Requests for Single Reprints: Patricia A. Carney, PhD, Department of Community & Family Medicine, Dartmouth Medical School, 1 Medical Center Drive, HB 7925, Lebanon, NH 03756; e-mail, Patricia.A.Carney{at}dartmouth.edu.
Current Author Addresses: Dr. Carney: Department of Community & Family Medicine, Dartmouth Medical School, 1 Medical Center Drive, HB 7925, Lebanon, NH 03756.
Drs. Miglioretti, Rutter, Abraham, and Taplin: Center for Health Studies, Group Health Cooperative, Suite 1600, 1730 Minor Avenue, Seattle, WA 98101-1448.
Dr. Yankaskas: Department of Radiology, CB #7515, MRI, University of North Carolina, 106 Mason Farm Road, Chapel Hill, NC 27599-7515.
Dr. Kerlikowske: Department of Medicine and Epidemiology & Biostatistics, Suite 600, University of California, San Francisco, 74 New Montgomery, San Francisco, CA 94105.
Dr. Rosenberg: Department of Radiology—Health Sciences Center, University of New Mexico, Albuquerque, NM 87131.
Dr. Geller: University of Vermont, Health Promotions Research, Vermont Cancer Center, One South Prospect Street, Burlington, VT 05401-3498.
Dr. Dignan: Kentucky Prevention Research Center, 2365 Harrodsburg Road, Suite B100, Lexington, KY 40504-3381.
Dr. Cutter: University of Nevada at Reno Applied Research Facility, Mail Stop 199, Reno, NV 89557.
Dr. Ballard-Barbash, Applied Research Program—EPN 4005, National Cancer Institute, 6130 Executive Boulevard, Bethesda, MD 20892-7344.
Author Contributions: Conception and design: P.A. Carney, B.C. Yankaskas, K. Kerlikowske, S.H. Taplin, M. Dignan, R. Ballard-Barbash.
Analysis and interpretation of the data: P.A. Carney, D.L. Miglioretti, B.C. Yankaskas, K. Kerlikowske, L.A. Abraham, G. Cutter, R. Ballard-Barbash.
Drafting of the article: P.A. Carney, D.L. Miglioretti, K. Kerlikowske, L.A. Abraham, M. Dignan, R. Ballard-Barbash.
Critical revision of the article for important intellectual content: P.A. Carney, D.L. Miglioretti, B.C. Yankaskas, K. Kerlikowske, C.M. Rutter, B.M. Geller, S.H. Taplin, M. Dignan, G. Cutter, R. Ballard-Barbash.
Final approval of the article: P.A. Carney, D.L. Miglioretti, B.C. Yankaskas, K. Kerlikowske, C.M. Rutter, B.M. Geller, L.A. Abraham, S.H. Taplin, M. Dignan, G. Cutter.
Provision of study materials or patients: P.A. Carney, D.L. Miglioretti, B.C. Yankaskas, K. Kerlikowske, R. Rosenberg, S.H. Taplin, M. Dignan, Statistical expertise: D.L. Miglioretti, C.M. Rutter, L.A. Abraham, G. Cutter.
Obtaining of funding: P.A. Carney, B.C. Yankaskas, K. Kerlikowske, R. Rosenberg, G. Cutter, B.M. Geller, S.H. Taplin.
Administrative, technical, or logistic support: P.A. Carney.
Collection and assembly of data: P.A. Carney, B.C. Yankaskas, K. Kerlikowske, R. Rosenberg, B.M. Geller, and M. Dignan. ARTICLE
Individual and Combined Effects of Age, Breast Density, and Hormone Replacement Therapy Use on the Accuracy of Screening Mammography
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D. L. Miglioretti, C. M. Rutter, B. M. Geller, G. Cutter, W. E. Barlow, R. Rosenberg, D. L. Weaver, S. H. Taplin, R. Ballard-Barbash, P. A. Carney, et al. Effect of Breast Augmentation on the Accuracy of Mammography and Cancer Characteristics JAMA, January 28, 2004; 291(4): 442 - 450. [Abstract] [Full Text] [PDF]
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K. Kerlikowske, D. L. Miglioretti, R. Ballard-Barbash, D. L. Weaver, D. S.M. Buist, W. E. Barlow, G. Cutter, B. M. Geller, B. Yankaskas, S. H. Taplin, et al. Prognostic Characteristics of Breast Cancer Among Postmenopausal Hormone Users in a Screened Population J. Clin. Oncol., December 1, 2003; 21(23): 4314 - 4321. [Abstract] [Full Text] [PDF]
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R. Smith-Bindman, P. W. Chu, D. L. Miglioretti, E. A. Sickles, R. Blanks, R. Ballard-Barbash, J. K. Bobo, N. C. Lee, M. G. Wallis, J. Patnick, et al. Comparison of Screening Mammography in the United States and the United Kingdom JAMA, October 22, 2003; 290(16): 2129 - 2137. [Abstract] [Full Text] [PDF]
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K. Kerlikowske, R. Smith-Bindman, B.-M. Ljung, and D. Grady Evaluation of Abnormal Mammography Results and Palpable Breast Abnormalities Ann Intern Med, August 19, 2003; 139(4): 274 - 284. [Abstract] [Full Text] [PDF]
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R. T. Chlebowski, S. L. Hendrix, R. D. Langer, M. L. Stefanick, M. Gass, D. Lane, R. J. Rodabough, M. A. Gilligan, M. G. Cyr, C. A. Thomson, et al. Influence of Estrogen Plus Progestin on Breast Cancer and Mammography in Healthy Postmenopausal Women: The Women's Health Initiative Randomized Trial JAMA, June 25, 2003; 289(24): 3243 - 3253. [Abstract] [Full Text] [PDF]
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P. H. Gann and M. Morrow Combined Hormone Therapy and Breast Cancer: A Single-Edged Sword JAMA, June 25, 2003; 289(24): 3304 - 3306. [Full Text] [PDF]
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