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Individual and Combined Effects of Age, Breast Density, and Hormone Replacement Therapy Use on the Accuracy of Screening Mammography

Patricia A. Carney, PhD; Diana L. Miglioretti, PhD; Bonnie C. Yankaskas, PhD; Karla Kerlikowske, MD; Robert Rosenberg, MD; Carolyn M. Rutter, PhD; Berta M. Geller, EdD; Linn A. Abraham, MS; Steven H. Taplin, MD, MPH; Mark Dignan, PhD; Gary Cutter, PhD; and Rachel Ballard-Barbash, MD, MPH
[+] Article and Author Information

From Dartmouth Medical School, Lebanon, New Hampshire; Group Health Cooperative, Seattle, Washington; University of North Carolina, Chapel Hill, North Carolina; Veterans Affairs Medical Center, San Francisco, California; University of New Mexico, Albuquerque, New Mexico; University of Vermont, Burlington, Vermont; AMC Cancer Research Center, Denver, Colorado; and National Cancer Institute, Bethesda, Maryland.


Grant Support: By cooperative agreements UO1CA63731, UO1CA63736, UO1CA63740, UO1CA69976, UO1CA70013, UO1CA70040, UO1CA86076, UO1CA86082, and R01CA80888 from the National Cancer Institute as part of the National Cancer Institute's Breast Cancer Surveillance Consortium.

Requests for Single Reprints: Patricia A. Carney, PhD, Department of Community & Family Medicine, Dartmouth Medical School, 1 Medical Center Drive, HB 7925, Lebanon, NH 03756; e-mail, Patricia.A.Carney@dartmouth.edu.

Current Author Addresses: Dr. Carney: Department of Community & Family Medicine, Dartmouth Medical School, 1 Medical Center Drive, HB 7925, Lebanon, NH 03756.

Drs. Miglioretti, Rutter, Abraham, and Taplin: Center for Health Studies, Group Health Cooperative, Suite 1600, 1730 Minor Avenue, Seattle, WA 98101-1448.

Dr. Yankaskas: Department of Radiology, CB #7515, MRI, University of North Carolina, 106 Mason Farm Road, Chapel Hill, NC 27599-7515.

Dr. Kerlikowske: Department of Medicine and Epidemiology & Biostatistics, Suite 600, University of California, San Francisco, 74 New Montgomery, San Francisco, CA 94105.

Dr. Rosenberg: Department of Radiology—Health Sciences Center, University of New Mexico, Albuquerque, NM 87131.

Dr. Geller: University of Vermont, Health Promotions Research, Vermont Cancer Center, One South Prospect Street, Burlington, VT 05401-3498.

Dr. Dignan: Kentucky Prevention Research Center, 2365 Harrodsburg Road, Suite B100, Lexington, KY 40504-3381.

Dr. Cutter: University of Nevada at Reno Applied Research Facility, Mail Stop 199, Reno, NV 89557.

Dr. Ballard-Barbash, Applied Research Program—EPN 4005, National Cancer Institute, 6130 Executive Boulevard, Bethesda, MD 20892-7344.

Author Contributions: Conception and design: P.A. Carney, B.C. Yankaskas, K. Kerlikowske, S.H. Taplin, M. Dignan, R. Ballard-Barbash.

Analysis and interpretation of the data: P.A. Carney, D.L. Miglioretti, B.C. Yankaskas, K. Kerlikowske, L.A. Abraham, G. Cutter, R. Ballard-Barbash.

Drafting of the article: P.A. Carney, D.L. Miglioretti, K. Kerlikowske, L.A. Abraham, M. Dignan, R. Ballard-Barbash.

Critical revision of the article for important intellectual content: P.A. Carney, D.L. Miglioretti, B.C. Yankaskas, K. Kerlikowske, C.M. Rutter, B.M. Geller, S.H. Taplin, M. Dignan, G. Cutter, R. Ballard-Barbash.

Final approval of the article: P.A. Carney, D.L. Miglioretti, B.C. Yankaskas, K. Kerlikowske, C.M. Rutter, B.M. Geller, L.A. Abraham, S.H. Taplin, M. Dignan, G. Cutter.

Provision of study materials or patients: P.A. Carney, D.L. Miglioretti, B.C. Yankaskas, K. Kerlikowske, R. Rosenberg, S.H. Taplin, M. Dignan, Statistical expertise: D.L. Miglioretti, C.M. Rutter, L.A. Abraham, G. Cutter.

Obtaining of funding: P.A. Carney, B.C. Yankaskas, K. Kerlikowske, R. Rosenberg, G. Cutter, B.M. Geller, S.H. Taplin.

Administrative, technical, or logistic support: P.A. Carney.

Collection and assembly of data: P.A. Carney, B.C. Yankaskas, K. Kerlikowske, R. Rosenberg, B.M. Geller, and M. Dignan.


Ann Intern Med. 2003;138(3):168-175. doi:10.7326/0003-4819-138-3-200302040-00008
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This study of pooled mammography registry data revealed several important findings. First, we observed that both breast density and age were important independent predictors of the sensitivity and specificity of screening mammography. Sensitivity and specificity were highest in older women, especially those older than 80 years of age, for whom sensitivity achieves the target of 85% set by the Agency for Healthcare Research and Quality (AHRQ) (formerly the Agency for Health Care Policy and Research) in 1994 (29). Mammography is most effective in detecting cancer in this group of women. The accuracy of mammography in women 50 to 79 years of age was lower than that recommended by AHRQ. Sensitivity and specificity were lowest in younger women with radiographically dense breasts who used HRT. In addition, we found that after adjustment for breast density, HRT use was not significantly associated with sensitivity. These findings suggest that the overall decrease in sensitivity associated with HRT use is due to increases in radiographic breast density that occur in some women who use HRT. Women with dense breasts, regardless of whether they use HRT, should be informed that mammography will be less likely to detect breast cancer.

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Figure.
Mean cancer rates, sensitivity, and specificity, by age, breast density, and current hormone replacement therapy (HRT) use.

Sensitivity and cancer rates were not plotted for women between 40 and 44 years of age with dense breasts who used HRT because there were only two women with cancer in this group.

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Summary for Patients

The Effects of Age, Breast Density, and Hormone Therapy on the Accuracy of Screening Mammograms

The summary below is from the full report titled “Individual and Combined Effects of Age, Breast Density, and Hormone Replacement Therapy Use on the Accuracy of Screening Mammography.” It is in the 4 February 2003 issue of Annals of Internal Medicine (volume 138, pages 168-175). The authors are PA Carney, DL Miglioretti, BC Yankaskas, K Kerlikowske, R Rosenberg, CM Rutter, BM Geller, LA Abraham, SH Taplin, M Dignan, G Cutter, and R Ballard-Barbash.

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