Mammography in asymptomatic women aged 40-49 years

Silva, Flávio Xavier; Katz, Leila; Souza, Alex Sandro Rolland; Amorim, Melania Maria Ramos

doi:10.1590/S0034-8910.2014048005349

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Sumário

Original Articles • Rev. Saúde Pública 48 (6) • Dec 2014 • https://doi.org/10.1590/S0034-8910.2014048005349 copy

Mammography in asymptomatic women aged 40-49 years

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

To assess findings of mammography of and interventions resulting from breast cancer screening in women aged 40-49 years with no increased risk (typical risk) of breast cancer.

METHODS

This cross-sectional study evaluated women aged 40-49 years who underwent mammography screening in a mastology reference center in Recife, PE, Northeastern Brazil, between January 2010 and October 2011. Women with breast-related complaints, positive findings in the physical examination, or high risk of breast cancer were excluded.

RESULTS

The 1,000 mammograms performed were classified into the following Breast Imaging-Reporting and Data System (BI-RADS) categories BI-RADS 0, 232; BI-RADS 1, 294; BI-RADS 2, 294; BI-RADS 3, 16; BI-RADS 4A, 2; BI-RADS 5, 1. There was one case of grade II invasive ductal carcinoma and various interventions, including 469 ultrasound scans, 53 referrals to mastologists, 11 cytological examinations, and 8 biopsies.

CONCLUSIONS

Mammography screening in women aged 40-49 years with typical risk of breast cancer led to the performance of other interventions. However, it also resulted in increased costs without demonstrable efficacy in decreasing mortality.

Women; Mammography; Mass Screening; Breast Neoplasms, diagnosis; Cross-Sectional Studies

Variable	n	%
Age (years)
40 to 44	465	46.5
45 to 49	535	53.5
Ethnicity
Caucasian	137	23.2
Mixed	368	62.4
Black	75	12.7
East Asian	9	1.5
Indigenous	1	0.2
Origin
Recife Metropolitan Area	827	82.7
Other cities in the state	171	17.1
Other states	2	0.2
Education
Illiterate	13	2.2
1 to 3 years completed	104	17.7
4 to 7 years completed	186	31.7
8 to 11 years completed	191	32.6
≥ 12 years completed	92	15.7
Menarche
< 12 years	157	17.6
≥ 12 years	735	82.4
Menopausal status
Premenopausal	681	74.4
Postmenopausal	234	25.6
Use of hormone therapy
Yes	19	2.1
No	886	97.9
Use of oral contraceptives
Yes	58	6.4
No	847	93.6
Breastfeeding
Yes	547	74.4
No	188	25.6
Age at first pregnancy
Nulliparous	95	13.4
< 30 years	556	78.5
≥ 30 years	57	8.0

Mammographic findings	n	%
Breast density
Dense breasts	277	27.7
Moderately dense breasts	447	44.7
Breasts partially replaced by fat	120	12.0
Breasts completely replaced by fat	156	15.6
Nodules
Circumscribed nodules	65	91.5
Noncircumscribed nodules	6	8.5
Calcifications
Benign	291	98.6
Suspicious	3	1.0
Malignant	1	0.3
Asymmetry
Yes	63	6.3
No	937	93.7
Structural distortions
Yes	3	0.3
No	997	99.7
BI-RADS
0	232	23.2
1	454	45.4
2	294	29.4
3	16	1.6
4A	2	0.2
4B	0	–
4C	1	0.1
5	1	0.1

Methods and procedures	n	%
Ultrasound	469	46.9
Referral to mastologists	53	5.3
Cytological examination	11	1.1
Unsatisfactory	2	0.2
Nonproliferative lesions	5	0.5
Proliferative lesions without atypia	4	0.4
Proliferative lesions with atypia	0	–
Carcinoma	0	–
Biopsy	8	0.8
Histopathological findings
Nonproliferative lesions	2	0.2
Proliferative lesions without atypia	5	0.5
Proliferative lesions with atypia	0	–
In situ carcinoma	0	–
Invasive carcinoma	1	0.1

Variable	BI-RADS
	3-4-5		1-2		p	RP	95%CI

	n	%	n	%
Age (years)
45 to 49	11	2.7	400	97.3	0.90^a	1.06	0.44;2.52
40 to 44	9	2.5	347	97.5
Ethnicity
Caucasian	4	3.8	101	96.2	0.47^b	1.20	0.39;3.69
Others	11	3.2	336	96.8
Education
≥ 8 years	9	4.2	207	95.8	0.02^a	5.08	1.11;23.3
< 8 years	2	0.8	242	99.2
Menarche
< 12 years	3	2.6	112	97.4	0.52^b	1.14	0.33;3.92
≥ 12 years	13	2.3	553	97.7
Use of hormone therapy
Yes	0	0	18	100	0.64^b	–	–
No	17	2.5	660	97.5
Use of oral contraceptives
Yes	0	0	44	100	0.32^b	–	–
No	17	2.6	634	97.4
Breastfeeding
Yes	11	2.7	395	97.3	0.17^b	0.57	0.22;1.44
No	7	4.8	140	95.2
Age at first pregnancy
≥ 30 years	1	2.3	42	97.7	0.69^b	0.90	0.12;6.83
< 30 years	11	2.6	416	97.4
Parity
Nulliparity	5	6.7	70	93.3	0.07^b	2.61	0.95;7.20
≥ 1	12	2.6	458	97.4

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

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[1] Correspondence
: Melania Maria Ramos Amorim. Rua Neuza Borborema de Souza, 300 Santo Antônio. 58406-120 Campina Grande, PB, Brasil. E-mail: melania.amorim@gmail.com