There were 58,870 screening mammograms in 19,078 women with a history of early-stage (in situ or stage I-II invasive)
breast cancer and 58,870 matched (breast density, age group, mammography year, and registry) screening mammograms in 55,315 non-
PHBC women.
MAIN OUTCOME MEASURES: Within 1 year after screening, 655
cancers were observed in
PHBC women (499 invasive, 156 in situ) and 342
cancers (285 invasive, 57 in situ) in non-
PHBC women. Screening accuracy and outcomes in
PHBC relative to non-
PHBC women were
cancer rates of 10.5 per 1000 screens (95% CI, 9.7-11.3) vs 5.8 per 1000 screens (95% CI, 5.2-6.4),
cancer detection rate of 6.8 per 1000 screens (95% CI, 6.2-7.5) vs 4.4 per 1000 screens (95% CI, 3.9-5.0), interval
cancer rate of 3.6 per 1000 screens (95% CI, 3.2-4.1) vs 1.4 per 1000 screens (95% CI, 1.1-1.7), sensitivity 65.4% (95% CI, 61.5%-69.0%) vs 76.5% (95% CI, 71.7%-80.7%), specificity 98.3% (95% CI, 98.2%-98.4%) vs 99.0% (95% CI, 98.9%-99.1%), abnormal mammogram results in 2.3% (95% CI, 2.2%-2.5%) vs 1.4% (95% CI, 1.3%-1.5%) (all comparisons P < .001). Screening sensitivity in
PHBC women was higher for detection of in situ
cancer (78.7%; 95% CI, 71.4%-84.5%) than invasive
cancer (61.1%; 95% CI, 56.6%-65.4%), P < .001; lower in the initial 5 years (60.2%; 95% CI, 54.7%-65.5%) than after 5 years from first
cancer (70.8%; 95% CI, 65.4%-75.6%), P = .006; and was similar for detection of ipsilateral
cancer (66.3%; 95% CI, 60.3%-71.8%) and contralateral
cancer (66.1%; 95% CI, 60.9%-70.9%), P = .96. Screen-detected and interval
cancers in women with and without
PHBC were predominantly early stage.
CONCLUSION: Mammography screening in
PHBC women detects early-stage second breast
cancers but has lower sensitivity and higher interval
cancer rate, despite more evaluation and higher underlying
cancer rate, relative to that in non-
PHBC women.