Trends in breast biopsy pathology diagnoses among women undergoing mammography in the United States: A report from the Breast Cancer Surveillance Consortium

• Published in: Cancer 2015-05, Vol.121 (9), p.1369-1378
• Main Authors: Allison, Kimberly H., Abraham, Linn A., Weaver, Donald L., Tosteson, Anna N. A., Nelson, Heidi D., Onega, Tracy, Geller, Berta M., Kerlikowske, Karla, Carney, Patricia A., Ichikawa, Laura E., Buist, Diana S. M., Elmore, Joann G.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Aged; Aged, 80 and over; atypia; Biopsy; breast biopsy; Breast cancer; breast cancer diagnosis; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - epidemiology; Breast Neoplasms - pathology; breast pathology; Cancer; Cancer screening; Carcinoma, Ductal, Breast - diagnostic imaging; Carcinoma, Ductal, Breast - epidemiology; Carcinoma, Ductal, Breast - pathology; Carcinoma, Intraductal, Noninfiltrating - diagnostic imaging; Carcinoma, Intraductal, Noninfiltrating - epidemiology; Carcinoma, Intraductal, Noninfiltrating - pathology; Consortia; Diagnostic systems; ductal carcinoma in situ; Epidemiological Monitoring; false positive; Family medical history; Female; Genetics; Health risk assessment; Health risks; Humans; Incidence; Invasiveness; Lesions; Mammography; Medical diagnosis; Medical screening; Middle Aged; Oncology; Pathology; Radiography; Risk analysis; Risk Factors; Surveillance; Tissues; Trends; United States - epidemiology; Young Adult
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.29199

BACKGROUND Current data on the pathologic diagnoses of breast biopsy after mammography can inform patients, clinicians, and researchers about important population trends. METHODS Breast Cancer Surveillance Consortium data on 4,020,140 mammograms between 1996 and 2008 were linked to 76,567 pathology specimens. Trends in diagnoses in biopsies by time and risk factors (patient age, breast density, and family history of breast cancer) were examined for screening and diagnostic mammography (performed for a breast symptom or short‐interval follow‐up). RESULTS Of the total mammograms, 88.5% were screening and 11.5% diagnostic; 1.2% of screening and 6.8% of diagnostic mammograms were followed by biopsies. The frequency of biopsies over time was stable after screening mammograms, but increased after diagnostic mammograms. For biopsies obtained after screening, frequencies of invasive carcinoma increased over time for women ages 40‐49 and 60‐69, Ductal carcinoma in situ (DCIS) increased for those ages 40‐69, whereas benign diagnoses decreased for all ages. No trends in pathology diagnoses were found following diagnostic mammograms. Dense breast tissue was associated with high‐risk lesions and DCIS relative to nondense breast tissue. Family history of breast cancer was associated with DCIS and invasive cancer. CONCLUSIONS Although the frequency of breast biopsy after screening mammography has not changed over time, the percentages of biopsies with DCIS and invasive cancer diagnoses have increased. Among biopsies following mammography, women with dense breasts or family history of breast cancer were more likely to have high‐risk lesions or invasive cancer. These findings are relevant to breast cancer screening and diagnostic practices. Cancer 2015;121:1369–1378. © 2015 American Cancer Society. Based on diagnostic results of breast biopsies from the BCSC from women undergoing mammography between 1996 and 2008, the frequencies of biopsy after screening mammography did not change over time, whereas diagnoses of DCIS and invasive cancer increased, suggesting more targeted use of biopsy. Among biopsies following mammography, women with dense breasts or family history of breast cancer were more likely to have high‐risk lesions or invasive cancer.