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Survival Better When Breast Cancer Detected Through Mammography

August 17, 2005

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Need another reason to get that mammography?

Women whose breast cancer was detected by screening mammography had a significantly better prognosis than those whose cancer was found another way - even if the cancer had already spread to their lymph nodes, say researchers at The University of Texas M. D. Anderson Cancer Center who looked at outcomes from randomized screening studies of more than 150,000 women.

A likely reason for that finding is that mammography can detect tumors that are both slower growing and less biologically lethal than those found symptomatically, say the researchers, who published their findings in the current issue of the Journal of the National Cancer Institute.

The study is important because the survival benefit seen in this analysis is much greater than one would expect for screen-detected breast cancer, says the study's lead author Donald Berry, Ph.D., chair of the Department of Biostatistics and Applied Mathematics.

Berry is well known for his work in designing breast cancer clinical trials sponsored by the National Cancer Institute and for his research in evaluating the effects of screening mammography.

"We know that screening picks up many tumors before they can be detected in other ways and women may benefit from early treatment, but the advantage we found is much larger than what would be expected from the so-called stage shift that is associated with screening mammography," Berry says.

Based on the results, Berry suggests that method of detection should be considered when a treatment plan for newly diagnosed breast cancer is being devised, and that this information also should be collected by researchers conducting clinical trials of experimental therapeutic strategies.

"That information may be just as important as other variables, such as the number of positive lymph nodes. If you don't account for method of detection, the results may not be as accurate as they would be otherwise," Berry says.

"The important message here for clinicians and patients is that breast cancer detected through mammography has a substantially better survival prognosis," he says. "Of two women who have the same age, size of tumors, and similar stage of cancer and spread to lymph nodes, the one whose cancer was detected with mammography has a reason to be happier than the woman whose cancer was detected symptomatically," Berry says.

While that sounds like good news for some patients, Berry says the conclusion should not be over interpreted.

"The paradox is that this result does not mean screening is beneficial," he says. "Without screening, some of the women would not have been diagnosed with breast cancer at all, and in that group, some of them could have avoided surgery and treatment without detriment. The rub is that we don't know which ones they are."

This issue has long plagued screening mammography, especially when the detected tumors are very small and have not spread. But this study appears to add a new element to the debate, Berry says. "Our conclusions apply generally, and are as important in node-negative breast cancer as they are in node-positive disease," he says.

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