Improved breast cancer screening and treatment may have saved many lives.

A study using data from the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute published in Cancer estimated as many as 600,000 breast cancer deaths were avoided since 1989 in women aged 40 to 84 years thanks screening and treatment advances. 

The authors report that from 1975 to 1990, female breast cancer mortality rates in the United States increased by 0.4% per year. Since 1990, breast cancer mortality rates have fallen between 1.8% and 3.4% per year, a decrease that is attributed to increased mammography screening and improvements in treatment.

The authors concluded that since 1989, between 384,000 and 614,500 breast cancer deaths have been averted because of widespread use of screening mammography and advances in the treatment of breast cancer.

Race and ethnicity play a role in the outcome of patients with Breast Cancer

Javaid et al report in a JAMA article the findings of an observational study of women diagnosed with invasive breast cancer from 2004 to 2011, that were identified in the Surveillance, Epidemiology, and End Results (SEER) 18 registries database (N = 452 215).   The patients belonged in 8 racial/ethnic groups, who had small-sized tumors of 2.0 cm or less with biological aggressiveness (triple-negative cancers, lymph node metastases, and distant metastases).

The odds ratio for being diagnosed at stage I compared with a later stage and the hazard ratio for death from stage I breast cancer by racial/ethnic group were determined.

Breast cancer stage at diagnosis and 7-year breast cancer–specific survival, adjusted for age at diagnosis, income, and estrogen receptor status was assessed.

Of 373 563 women with invasive breast cancer, 268 675 (71.9%) were non-Hispanic white; 34 928 (9.4%), Hispanic white; 38 751 (10.4%), black; 25 211 (6.7%), Asian; and 5998 (1.6%), other ethnicities. Mean follow-up time was 40.6 months (median, 38 months). Compared with non-Hispanic white women diagnosed with stage I breast cancer (50.8%), Japanese women (56.1%) were more likely to be diagnosed and black women (37.0%) were less likely to be diagnosed. Actuarial risk of death from stage I breast cancer at 7 years was higher among black women (6.2%) than non-Hispanic white women (3.0%), and lower among South Asian women (1.7%). Black women were more likely to die of breast cancer with small-sized tumors (9.0%) than non-Hispanic white women (4.6%); the difference remained after adjustment for income and estrogen receptor status.

Among US women diagnosed with invasive breast cancer, the likelihood of diagnosis at an early stage, and survival after stage I diagnosis, varied by race and ethnicity.

Little gain from supplemental ultrasound in women with dense breasts

Since many US states require by law that mammography providers inform women with dense breasts about the option of supplemental screening.  Sprague et al reported in the Ann Intern Med the cost-effectiveness of supplemental ultrasonography screening for women with dense breasts using data from SEER (Surveillance, Epidemiology, and End Results Program). 

Breast cancer deaths averted, quality-adjusted life-years (QALYs) gained, biopsies recommended after a false-positive ultrasonography result, and costs.

They found that supplemental ultrasonography screening after a negative mammography result for women aged 50 to 74 years with heterogeneously or extremely dense breasts averted 0.36 additional breast cancer deaths (range across models, 0.14 to 0.75 deaths), gained 1.7 QALYs (range, 0.9 to 4.7 QALYs), and resulted in 354 biopsy recommendations after a false-positive ultrasonography result (range, 345 to 421 recommendations) per 1000 women with dense breasts compared with biennial screening by mammography alone. Supplemental ultrasonography screening for only women with extremely dense breasts cost $246 000 per QALY gained (range, $74 000 to $535 000 per QALY gained).

They concluded that supplemental ultrasonography screening for women with dense breasts would substantially increase costs while producing relatively small benefits.