ASPO Abstracts
Changes to screening recommendations and their impact on breast cancer incidence by stage in young women
Category: Early Detection & Risk Prediction
Conference Year: 2023
Abstract Body:
Purpose: In November 2009, the United States Preventive Services Task Force (USPSTF) recommended against clinicians teaching women how to perform breast self- examinations (BSEs). This change largely impacts young women (i.e., age <40 years) who currently have no breast cancer screening guidelines. Since young women are more likely to be diagnosed with advanced stage breast cancer, we examined whether there were differences in breast cancer incidence by stage in young women before and after this change in USPSTF screening recommendations. Methods: We used data from the United States Cancer Statistics, which includes cancer surveillance data from the Centers of Disease Control and Prevention's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Age-adjusted incidence rates for breast cancer in women age <40 years by stage (i.e., in situ, localized, regional, distant) were calculated for the 2005-2009 and 2011-2015 time periods and compared using incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Results: Compared to 2005-2009 (i.e., before the recommendation), the proportion of distant breast cancer among young women in 2011-2015 (i.e., after the recommendation) increased from 5.65% to 6.65% while the proportion of in situ carcinoma decreased from 13.18% to 11.74% (p<0.0001). In addition, after the guideline change, the incidence rate of distant breast cancer increased by 18% (IRR=1.18, 95% CI 1.12-1.23) while the incidence rate of in situ carcinoma decreased by 10% (IRR=0.90, 95% CI 0.87-0.93). Conclusions: There was a higher incidence of distant breast cancer in young women after the USPSTF recommended against BSE instruction. This may be due to delays in breast cancer diagnosis given that this guideline change could have resulted in fewer educational conversations about breast cancer between young women and their providers although temporal changes in breast cancer risk factors and stage classification are certainly possible. More research to identify subgroups of young women who may benefit the most from BSE instruction (e.g., those with a family history, risk factors) is warranted.
Keywords: breast cancer, screening, incidence, USPSTF, young women