Many high-risk women aren’t getting appropriate breast cancer screening

Many high-risk women aren’t getting appropriate breast cancer screening

Many women younger than 40 who are at high risk for breast cancer are not getting appropriate screening, according to findings published October 11 in the American Journal of Surgery.  

Researchers led by Christine Pestana, MD, from Wake Forest Baptist Health in Winston-Salem, NC, found that of the women younger than 40 in their study, only about 3% underwent appropriate screening despite over one in three meeting high-risk criteria.  

“This analysis highlights a significant discrepancy between those meeting criteria for high-risk screening and those who underwent appropriate screening,” the Pestana team wrote. 

Several health societies, including those in radiology, recommend annual screening mammography to start at age 40 for women with an average risk of developing breast cancer. However, guidelines by the National Comprehensive Cancer Network (NCCN) recommend screening young women with an increased breast cancer risk, meaning a 20% or greater lifetime risk. 

Pestana and colleagues evaluated their health system’s institutional rates of high-risk screening in young breast cancer patients prior to their diagnosis. They investigated risk scores from the Tyrer-Cuzick model and characteristics of breast cancer patients younger than 40, using data collected between 2013 and 2018. 

In all, the team included data from 92 women with an average age of 34.5 in the study. It found that only 3.3 % (n = 3) of the women underwent appropriate screening mammography, despite 35.8 % meeting the high-risk threshold. The group also reported that 74 of the women had their breast cancer discovered via a palpable breast mass.  

“This suggests that the current implementation of screening guidelines may not be adequate,” Pastena and co-authors wrote. 

The team also found that almost all patients (98.9%) underwent genetic testing, with pathogenic mutations identified in 36.5 % of the women. Additionally, 15.3% of the women tested (n = 13) had BRCA1/2 mutations. 

Most of the women (n = 53) underwent bilateral mastectomy as their preferred surgical choice, while 22 underwent unilateral mastectomy and 13 underwent lumpectomy. Six of the women opted not to undergo surgery at all. 

Finally, the researchers found that Black women were more likely to present with advanced-stage disease, at 17.6% compared with white women at 3.3% (p = 0.03). 

“Underutilization of screening has been attributed to decreased awareness among health care providers regarding guidelines for high-risk screening and genetics referral, lack of familiarity with conducting a detailed breast cancer risk assessment, the inaccessibility of centers with onsite MRI or experienced genetic counselors,” the study authors wrote. 

Citing previous studies, the authors also suggested that screening MRI could help detect more cancers for high-risk women. The studies demonstrated that MRI in this area is more sensitive than mammography, able to detect breast cancers at earlier stages, and increases breast cancer survival for high-risk patients.