Risk Factors for Symptomatic Awareness of Breast Cancer Despite a Prior Negative Screening Mammogram

Background: It is generally known that mammography screening improves survival and reduces mortality from breast cancer by detecting the disease at an early stage when treatment is more effective. Despite improvements in uptakes of mammography screening, however, not all breast cancers are detected by mammograms. Some women become aware of their breast cancer through symptoms. We conducted a population-based study of the risk factors for symptomatic awareness of breast cancer among women with primary in situ or invasive breast cancer. Patients were eligible if they self-reported having had a mammogram within two years prior to either the symptom or imaging that led to the diagnosis of breast cancer. Information on patient demographics, tumor and biological characteristics, and healthcare system characteristics were collected using computer-assisted interviews. The final sample for analysis was 737 patients. Results: Among women with a recent negative mammography screen, non-Hispanic (nH) blacks and Hispanics, younger women, women with negative estrogen receptor (ER) and progesterone receptor (PR) markers, and patients with dense breasts are more likely to report symptomatic detection than nH whites, older patients, women with one or both positive ER and PR markers, and patients with fatty breasts. Tumor and biological factors (i.e., hormone receptor status and histologic grade) and breast density are strongly associated with symptomatic detection. Conclusion: Our results suggest that minorities are at risk for higher burden of disease due to late stage diagnosis (which is a consequence of the method of detection). Abnormal or suspicious mammograms in high-risk groups (e.g., being a minority, or having highly dense breasts, etc.) should warrant immediate and closer follow-up because of the likelihood of these cancers turning out to be symptomatic and consequently more advanced and aggressive. Monitoring detection patterns can serve as useful indicators of the efficacy of intervention programs designed to reduce mortality by early disease detection. Finally, although the impact was not statistically significant, improving the quality of the services available in facilities that predominantly serve minorities who come from relative disadvantage might also help alleviate the disparity.