ASPO Abstracts

Breast biopsy patterns and findings among older women undergoing screening mammography: what is the impact of age and comorbidity?

Authors: Advani SM, Abraham L; Buist DB; O'Meara, ES; Miglioretti, DL; Sprague, BL; Henderson, LM; Onega T; Schousboe, JT; Zhang, D; Demb J; Walter, LC; Kerlikowske, K; Braithwaite D

Category: Early Detection & Risk Prediction
Conference Year: 2020

Abstract Body:
Purpose: The goal of this project is to assess rates of biopsy and biopsy findings among older women undergoing screening mammography by age and comorbidity. Method: We included 171,636 women ages 66-99 years with at least one screening mammogram from the Medicare-linked Breast Cancer Surveillance Consortium (BCSC) during 1999-2010. We calculated percentage of screens followed by biopsy within 90 days by age and comorbidity. Further, we assessed trends in biopsy rates using the Cochran–Armitage trend test. Results: Among 527,254 screening mammograms, 6587(1.2%) were followed by biopsy within 90 days. Whereas the proportion of screens followed by any biopsy did not vary significantly by age (ages 66-74: 1.3%, ages 75-84:1.2%, ages 85-99:1.2%; ptrend=0.07), the proportions increased with increasing Charlson Comorbidity score (CCS) for women ages 66-74 and 75-84 (ages 66-74:CCS0:1.2%,CCS1:1.3%,CCS≥2: 1.6%; ptrend=<0.001 and ages 75-84:CCS0:1.2%,CCS1:1.3%,CCS≥2:1.3%; ptrend=0.01) but not ages 85-99 (CCS0:1.1%,CCS1:1.2%,CCS≥2:1.4%; ptrend=0.16). The proportion of screens followed by benign biopsy increased with increasing CCS for women ages 66-74 and 75-84 (ages 66-74:CCS0:0.77%,CCS1:0.88%, CCS≥2:0.94%; ptrend<0.001 and ages 75-84:CCS0:0.62%,CCS1:0.75%,CCS≥2:0.78%; ptrend=0.001) but not ages 85-99 (CCS0:0.48%, CCS1:0.57%, CCS≥2:0.61%, ptrend=0.23). The proportion of biopsies with a result of invasive cancer did not vary significantly by CCS in any age group ([ages 66-74: CCS0:28.4%, CCS1:25.5%, CCS≥2:30.8%; ptrend=0.93]; [ages 75-84:CCS0:37.2%,CCS1:36.0%,CCS≥2:32.0%; ptrend=0.15]; [ages 85-99:CCS0:46.8%,CCS1:43.5%,CCS≥2:43.8%; ptrend=0.60]). Conclusions: The proportion of screens followed by biopsy and the proportion of screens with a benign finding increased with comorbidity burden among women ages 65-74 and 75-84 years, highlighting potential harm from high rates of benign findings among older women undergoing screening mammography.

Keywords: Screening, Older Women, Biopsy, Benefits, Harms