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Purpose: Many studies suggest increased body mass index (BMI) is associated with worse breast cancer outcomes, but few account for variability in screening, access to treatment, and tumor differences. We examined the association between BMI and risk of breast cancer recurrence, breast cancer-specific mortality, and all-cause mortality, and evaluated whether tumor characteristics differ by BMI among a mammographically screened population with access to treatment., Methods: Using a retrospective cohort study design, we followed 485 women aged ≥40 years diagnosed with stage I/II breast cancer within 24 months of a screening mammogram occurring between 1988 and 1993 for 10-year outcomes. BMI before diagnosis was categorized as normal (<25 kg/m(2)), overweight (25-29.9 kg/m(2)), and obese (≥30 kg/m(2)). Tumor marker expression was assessed via immunohistochemistry using tissue collected before adjuvant treatment. Medical records were abstracted to identify treatment, recurrence, and mortality. We used Cox proportional hazards to separately model the hazard ratios (HR) of our three outcomes by BMI while adjusting for age, stage, and tamoxifen use., Results: Relative to normal-weight women, obese women experienced increased risk of recurrence (HR 2.43; 95 % CI 1.34-4.41) and breast cancer death (HR 2.41; 95 % CI 1.00-5.81) within 10 years of diagnosis. There was no association between BMI and all-cause mortality. Obese women had significantly faster growing tumors, as measured by Ki-67., Conclusions: Our findings add to the growing evidence that obesity may contribute to poorer breast cancer outcomes, and also suggest that increased tumor proliferation among obese women is a pathway that explains part of their excess risk of adverse outcomes.

Background: There is little information on the quality of breast self-examination (BSE) and associated outcomes., Method: We conducted a retrospective cohort study of 27,421 women enrolled in a Pacific Northwest health plan. We linked responses regarding BSE quality from a questionnaire to subsequent screening and diagnostic efforts., Results: A total of 75% of the women performed BSE. We rated BSE quality as adequate in 27%. Women who reported higher BSE duration, frequency, and quality were more likely to have diagnostic mammograms. Participants ultimately diagnosed with breast cancer (N = 300) were significantly less likely to report performing BSE. Tumor size and stage were not associated with BSE behavior., Conclusion: A high proportion of women perform BSE, but few do so adequately. We found no evidence for benefit of BSE. It is time to ask whether systematic BSE performance should continue to be encouraged.

Objective: The purpose of our study was to accurately describe facility characteristics among community-based screening and diagnostic mammography practices in the United States., Materials and Methods: A survey was developed and applied to community-based facilities providing screening mammography in three geographically distinct locations in the states of Washington, Colorado, and New Hampshire. The facility survey was conducted between December 2001 and September 2002. Characteristics surveyed included facility type, services offered, charges for screening and diagnostic mammography, information systems, and interpretation methods, including the frequency of double interpretation., Results: Among 45 responding facilities, services offered included screening mammography at all facilities, diagnostic mammography at 34 facilities (76%), breast sonography at 30 (67%), breast MRI at seven (16%), and nuclear medicine breast scanning at seven (16%). Most facilities surveyed were radiology practices in nonhospital settings. Eight facilities (18%) reported performing clinical breast examinations routinely along with screening mammography. Only five screening sites (11%) used computer-aided detection (CAD) and only two (5%) used digital mammography. Nearly two thirds of facilities interpreted screening mammography examinations on-site, whereas 91% of facilities interpreted diagnostic examinations on-site. Only three facilities (7%) interpreted screening examinations on line as they were performed. Approximately half of facilities reported using some type of double interpretation, although the methods of double interpretation and the fraction of cases double-interpreted varied widely across facilities. On average, approximately 15% of screening examinations and 10% of diagnostic examinations were reported as being double-interpreted., Conclusion: Comparison of this survey's results with those collected a decade earlier indicates dramatic changes in the practice of mammography, including a clear distinction between screening and diagnostic mammography, batch interpretation of screening mammograms, and improved quality assurance and medical audit tools. Diffusion of new technologies such as CAD and digital mammography was not widespread. The methods of double-interpretation and the fraction of cases double-interpreted varied widely across study sites.

Background: Breast-conserving surgery (BCS) with radiation (BCSR) requires a multidisciplinary care approach between surgeons and radiation oncologists., Methods: This retrospective cohort study examined the use of preoperative radiation oncology consultation and whether use of or distance to this care was associated with treatment choice among 1188 women age > or = 65 years who were diagnosed with local or regional breast carcinoma in Washington State in 1994 and 1995. Study outcomes included rates of BCSR; BCS alone; and mastectomy; and radiation therapy among women who underwent BCS., Results: Only 29% of patients in the current study consulted with a radiation oncologist preoperatively, and less than half of the patients (46.6%) consulted with either a medical oncologist or a radiation oncologist. Among women who underwent either BCSR or mastectomy, the odds of undergoing BCSR among women who had a preoperative radiation oncology consultation were 6.7 times the odds of women who did not have the consultation (P < or = 0.001). Similarly, the odds of receiving radiation therapy among women who underwent BCS and had a preoperative radiation oncology consultation were 5 times the odds of women who did not have the consultation (P < 0.001). The 3.4% of women who lived > 50 miles from the radiation therapy center had the lowest BCSR rate (15.8%) and had the lowest radiation therapy rate among women who underwent BCS (54.5%), although these findings were not statistically significant in adjusted analyses., Conclusions: A preoperative visit with a radiation oncologist was associated strongly with BCSR use. More should be done to evaluate the role of multidisciplinary consultation in the decision to use BCSR., (Copyright 2004 American Cancer Society.)

Clinical breast examination (CBE) is one of the most common breast cancer screening modalities, but factors that affect its sensitivity are not well understood. We examined the association between CBE sensitivity and tumor, breast and personal characteristics among members of a managed care organization's Breast Cancer Screening Program (BCSP). The study population was 468 screened women 40 years and older diagnosed with invasive breast cancer between 1988 and 1994 within 1 year of a screening CBE. Logistic regression was used to evaluate the likelihood of a true positive versus a false negative CBE result, after adjustment for age, body weight and tumor size. CBE sensitivity increased with larger tumor size (17% for tumors < or = 0.5 cm and 58% for tumors > or = 2.1 cm, adjusted p for trend < 0.001) and decreased with higher body weight (48 and 23% for the lowest and highest quartiles, adjusted p for trend < 0.001). CBE was more sensitive in Asian women compared to white women (88% v.s. 35%, adjusted p = 0.04) and in current users of estrogen and progesterone combination therapy compared to never/former users (52% v.s. 33%, adjusted p = 0.08). There was an inverted U-shaped association between age and CBE sensitivity (40-49: 26%, 50-59: 48%, 60-69: 36%, 70-79: 33%, 80+: 18%, significant for oldest and youngest groups v.s. age 50-59 years). These findings suggest certain groups of women, for example, obese women and younger women, receive less benefit from CBE.