Mammographic patterns and bias in breast cancer detection

Wolfe's finding that some mammographic patterns (P2 and DY) are associated with an increased risk of breast cancer has been challenged by some authors who suggest that this is due to denser patterns concealing cancers present on the first examination: these cancers, it is argued, are diagnosed in later years, creating the spurious impression of increased cancer incidence. The authors examined this hypothesis in a series of patients with breast cancer but failed to find any evidence that the diagnosis was subject to systematic delay in patients with the P2 or DY pattern. Moreover, studies of a hypothetical model showed that bias in the detection of breast cancer was unlikely to account for more than a small increase in apparent cancer incidence. Thus it appears unlikely that such a bias is responsible for the risk of breast cancer observed in patients with these mammographic patterns.