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Breast Cancers In Older Women Less Virulent

December 20, 2011
Written by: , Filed in: Breast Imaging
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For an older woman, there’s a good chance that any breast cancer detected by mammography will be a low-risk type, according to a new study by researchers at The University of California, San Francisco, and the Netherlands Cancer Institute in Amsterdam.

The researchers also found that the advent of mammography seems to have led to an increase in the detection of such cancers.

The researchers compared the biology of tumors found more than 20 years ago, before mammography became routine, with that of tumors detected five years ago, after widespread mammography screening had been implemented.

They found that for the pre-mammography group, 59.4 percent of detected cancers had a poor prognosis while only 40.6 percent had a good prognosis. For the post-mammography group, 42 percent of cancers had a poor prognosis while 58 percent had a good prognosis.

Regarding cancers detected through mammography screening, the news was even better: 33 percent were poor-prognosis tumors while 67 percent were good-prognosis tumors.

The study was published online in Breast Cancer Research and Treatment in September.  It concludes: “The significant increase in this fraction of the lowest risk tumors does indeed corroborate the notion that we may be detecting, today, some tumors that might not come to clinical attention in the absence of screening.”

“A significant number of screen-detected tumors are very low risk,” said Laura Esserman, MD, the lead author, as quoted in a UCSF news release. “It shows that we have an opportunity to improve care by using molecular predictors to recognize who has these ultra-low risk, or idle, tumors and safety minimize treatment.”

Dr. Esserman is director of the Carol Franc Buck Breast Care Center at the UCSF Helen Diller Family Comprehensive Cancer Center.

The researchers used MammaPrint, an FDA-approved diagnostic test designed to assess the risk that a breast tumor will metastasize. MammaPrint developer Laura J. van ’t Veer, PhD, was senior author of the study. Dr. van ’t Veer leads the breast oncology program at UCSF’s cancer center.

Regarding the implications of the study, Dr. Esserman said:

This information should also help inform radiologists and surgeons about how aggressive we should be in recommending biopsy for low-risk abnormalities seen on mammograms.

Specifically, she said, “If most of the cancer we find is low risk, then we may very well be able to test a less aggressive approach for the very low-suspicion findings on mammograms that turn out to be benign. Simple follow-up may be the better approach.”

The study also concludes that as women grow older, they might not need annual mammograms.: “With age, the biology of tumors shifts to lower risk lesions and slower growth fractions, making 2 year intervals reasonable.”

Related seminar: Breast & Women’s Imaging Seminar


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