According to researchers at the University of Washington, the benefits of mammography extend to women older than 75 years, and the findings have the potential to change public health recommendations for breast cancer screening.

The study authors noted that women aged 75 years and older are not represented in mammography screening effectiveness studies.

As a result of the lack of data, the United States Preventive Services Task Force has not issued a ruling on whether insurance coverage of mammography screening for women aged 75 years and older is warranted. The benefits of mammography, however, have been well validated in younger women between the ages of 50 and 74 years. The lack of a recommendation in older women carries negative ramifications because it affects insurance coverage and treatment decisions.

Judith A. Malmgren, PhD, and colleagues prospectively tracked 1162 women with biopsy-confirmed breast cancer between 1990 and 2011. Malmgren is an affiliate assistant professor in epidemiology at the University of Washington School of Public Health. Investigators tracked the patient characteristics, including the stage of breast cancer at diagnosis, as well as mortality outcomes.

Over the 21-year study, investigators noted an increase in the percentage of new breast cancer diagnoses identified using mammography in patients older than 75 years. In this age group, the percentage of new breast cancers recognized through mammography increased from just under half (49%) of patients between 1990 and 1994, to more than two-thirds (70%) of patients between 2010 and 2011.

Tumors identified through mammography were more likely to be small, stage 0 or I, and cancers were more likely to have the favorable treatment characteristic of expressing estrogen receptors.

Moreover, as the detection method shifted to mammography over time, the stage of detection grew significantly (

 = .007) earlier, with the proportion of patients with stage 0 cancers increasing from 3% of new diagnoses in 1990 through 1994 to 18% of new diagnoses between 2010 and 2011. Over the same period, the percentage of patients with stage III cancers at diagnosis fell from 18% to 10%.

Earlier detection through mammography was also associated with improved survival. The 5-year relapse-free survival rate of patients with mammography-detected breast cancer was 96%—significantly (

 <.001) higher than the 87% 5-year relapse-free survival rate observed in patients who first detected breast cancer through other methods.

This study may lead to an update of recommendations in breast cancer screening in the United States, and may change insurance coverage policies for mammography screening in women aged 75 years and older.

			Malmgren JA, Parikh J, Atwood MK, Kaplan HG. Improved prognosis of women aged 75 and older with mammography-detected breast cancer [published online August 6, 2014]. 

			United States Preventive Services Task Force. 

http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrgen.htm

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Study Supports Mammography in Women 75 Years and Older

 Researchers in Taiwan have found an increase in the risk for head and neck cancers among patients with diabetes mellitus (DM). In patients with a new diagnosis of DM, head and neck cancer was 47% more likely to occur than in the control population—equating to a rate of 8.1 cases per 10,000 person-years in individuals with DM versus 5.5 cases per 10,000 person-years in patients without DM.

Kuo-Shu Tseng, PhD, and colleagues at the Tainan University of Technology used an insurance claims database to analyze the records from a total of 89,089 patients with a new diagnosis of DM. Each patient with DM was matched with a patient without a DM-related health claim.  In discussing the findings, the study authors concluded, “Because we adequately controlled for the confounding factors, our findings disclose a higher incidence of [head and neck cancer] in patients with DM and highlight the importance of monitoring patients with DM for [head and neck cancer].”

In the population studied, head and neck cancer of the oral cavity was the most likely diagnosis, with an annual incidence of 0.41%, followed by nasopharyngeal cancer (0.11%) and oropharyngeal cancer (0.06%).

Other studies have found similar associations between DM and head and neck cancer. In a 2012 meta-analysis by Stott-Miller et al, investigators pooled data from 12 studies comprising 6448 patients with head and neck cancer and 13,747 control patients.

After adjusting for age, education level, sex, race/ethnicity, study center, cigarette smoking, alcohol use, and body mass index, the relationship between DM and head and neck cancer was not significant (odds ratio [OR], 1.09; 95% CI, 0.95—1.24).  However, when analyzing data from patients with DM who had never smoked, investigators identified a significant 59% increase in the risk of developing head and neck cancer (OR, 1.59; 95% CI, 1.22–2.07).

In a seemingly contradictory finding, a 2010 study by Gaudet et al found that the risk of head and neck cancer appeared to decline as body mass index increased in a multicountry registry study. The Gaudet study included data from 12,716 patients with head and neck cancer and 17,438 control patients. These findings were thought to be a result of weight loss associated with incident cases of head and neck cancer, rather than a true protective effect due to a higher body mass index.

Considering that two meta-analyses show evidence of a relationship between DM and head and neck cancer, screening patients with DM for symptoms of head and neck cancer may help healthcare professionals detect cases earlier, which may enable more effective treatment.

			Tseng K-S, et al. Increased risk for head, neck cancers in patients with diabetes [published online July 24, 2014]. 

			Stott-Miller M, Chen C, Chuang SC, et al. History of diabetes and risk of head and neck cancer: a pooled analysis from the international head and neck cancer epidemiology consortium. 

			Gaudet MM, Olshan AF, Chuang SC, et al. Body mass index and risk of head and neck cancer in a pooled analysis of case-control studies in the International Head and Neck Cancer Epidemiology (INHANCE) Consortium. 

Researchers in Taiwan have found an increase in the risk for head and neck cancers among patients with diabetes mellitus (DM).

Michael R. Page, PharmD, RPh

Articles

Study Supports Mammography in Women 75 Years and Older

Does Diabetes Add to Risk for Head and Neck Cancer?