Menopausal Status Could Guide Breast Cancer Screening Frequency

An analysis of different breast cancer screening schedules suggests that biennial mammograms may be acceptable for postmenopausal women, but that premenopausal women likely need more frequent screening, according to a recent study published in JAMA Oncology.

The study analyzed data from Breast Cancer Surveillance Consortium facilities on 15,440 women with breast cancer.

Premenopausal women diagnosed with breast cancer following a biennial screening schedule were more likely to have tumors with less favorable prognostic characteristics-bigger tumors of stage IIB or greater, lymph node involvement-compared with women undergoing annual screening (relative risks, 1.11–1.28; P  < .05).

Postmenopausal women not treated with hormonal therapy who were diagnosed with breast cancer after biennial or annual screening had a similar proportion of tumors with unfavorable prognostic characteristics.

The results of the study suggest that menopausal status may be a more useful guide for breast cancer screening scheduling compared to chronologic age, according to authors led by Diana L. Miglioretti, PhD, of the University of California-Davis School of Medicine.

Most of the women in the study were 50 years of age or older (85.4%), white (78.1%), and postmenopausal (63.6%). All women were diagnosed within 1 year of an annual or within 2 years of a biennial mammogram. Women who received biennial screening were more likely to fall into the youngest and oldest age groups-those between 40 and 49 years old or between 70 and 85 years old-and were less likely to have a family history of breast cancer.

“Our findings,” the authors wrote, “add to evidence about the potential benefits and harms of screening that policymakers can use to set guidelines about screening intervals and women can use when making personal screening decisions with their clinicians.”

While the American Cancer Society, the US Preventive Services Task Force (USPSTF), and the American College of Obstetricians and Gynecologists, recommend different ages for the initiation of breast cancer screening-age 45, 50, and 40, respectively-and different screening schedules, all emphasize the need for tailored screening based on a woman’s family and medical history to balance screening benefits and potential harms.

“This study and others have clearly demonstrated that with less frequent mammography, the tumors will be bigger and have a slightly more advanced stage,” writes Wendy Y. Chen, MD, MPH, of Brigham and Women’s Hospital and the Dana-Farber Cancer Institute, in an accompanying commentary. “Efforts should be focused on a better understanding of how screening interacts with tumor biology with a better understanding of the types of interval cancers and sojourn times and how these characteristics differ by age and/or menopausal status.”