Breast cancer detection method among 20- to 49-year-old patients at a community based cancer center: 1990-2008

Our research goal is to report on method of breast cancer detection among young women from a prospective cohort study of primary breast cancer patients, aged 20-49 years, 1990-2008 (n = 2579). Clinical presentation characteristics including race, TNM stage, first degree relative family history, histologic type and method of detection by patient (PtD), physician (PhysD), or mammography (MamD) were chart abstracted. Forward conditional stepwise regression was used to for association with detection method and Kaplan-Meier for relapse free survival (RFS) analysis. Among 20- to 39-year olds (n = 602) no change in detection method occurred over time with 12% MamD, 7% PhysD, and 81% PtD. Among 40- to 49-year olds, MamD BC increased over time (28% to 58%) and PtD BC decreased (63-36%) (Pearson X(2) = 72.72, p < .001). Among 20-39/40- to 49-year old MamD cases 31%/32% were stage 0 versus 2%/6% of the PhysD/PtD cases. In two separate conditional logistic regression models, older age at diagnosis and first degree relative BC history were associated with MamD BC for 20- to 39- and 40- to 49-year olds. Five-year MamD BC RFS was superior for both age groups (20-39: 94%, 40-49: 94%) compared to PtD BC rates (20-39: 80%, p = .016; 40-49: 88%, p < .001). For PtD BC 20- to 39-year olds had worse RFS (5 year 80%, 10 year 75%) than 40- to 49-year olds (5 year 88%, 10 year 82%) (p = .002) but RFS was equivalent for MamD cases by age. The majority of breast cancers among women 20-49 years were patient detected and mammography detection occurred rarely among youngest women. Lower stage and superior survival among MamD patients support mammography for detecting disease in high risk women aged 30-39 years and 40-49 years.