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Mammograms May Not Be Fool-Proof at Catching Second Cancers
Date:2/22/2011

1.7 percent of those with a breast cancer history.

The interval cancer rate was 3.6 per 1,000 screenings in those with a history and 1.4 per 1,000 in those without, the investigators found.

Women with a history of breast cancer were also more likely to be called back for additional imaging or biopsies: 18 percent called back, compared with 8.3 percent of the others.

"I think it's mostly positive news," Miglioretti said. "Of the ones that are missed, most of them are early stage." It points to the need, she said, for women to remain vigilant about screening after their breast cancer treatment -- and to report any symptoms to their doctor immediately.

Dr. William Audeh, medical director of the Samuel Oschin Cancer Center and the Wasserman Breast Cancer Risk Reduction Program at Cedars-Sinai Medical Center in Los Angeles, described the findings as "not at all surprising." He reviewed the study but was not involved in it.

After surgery and radiation, he said, a woman's breasts have changed, and there is a greater chance that a radiologist will think that something is abnormal simply because of the changes. "That helps explain the false positives," Audeh said.

And though mammography did not catch all cancers in the women with a breast cancer history, the study still points out the value of the test, he said.

Robert Smith, director of cancer screening for the American Cancer Society, agreed.

"Despite poorer performance compared with women without a prior history of breast cancer, overall screening mammography was effective at detecting the majority of breast cancer in women with a [history] at an early favorable stage, with the majority of tumors being diagnosed as ductal carcinoma in situ or stage 1," Smith said.

A trend among cancer specialists, Audeh said, is to tailor follow-up for a woman who has had breast cancer. For those who have dense breasts and are younger than 50, for example, "we can alternate mammogra
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