Background: Mammography screening is not recommended for women under age 40. The American Cancer Society recommends clinical breast exam about every 3 years and breast self-exam as an option for women starting in their 20s. It is not clear what method is best for women at high risk.

Methods: We conducted a prospective cohort study of all women presenting with primary breast cancer, aged 21-39, biopsy confirmed Stage 0-IV from 1990-2008 identified and tracked by our registry. Clinical presentation characteristics including age, race, TNM stage converted to AJCC 6, first degree relative, family and pregnancy history, histologic type and method of detection by patient (PtD), physician (PhysD) or mammography (MgD) were chart abstracted at the time of diagnosis. A first degree relative is a mother, father, son, daughter or sibling with a BC diagnosis. Cases with unknown or other method of detection (n=7) were removed (n=602). For analysis purposes patient and physician detected cases were combined into one manually detected category. Forward conditional stepwise regression was used to test association significance with detection method and the Kaplan-Meier method was used for disease free survival (DFS) analysis.

Results: Women aged 21-39 represented 7% of the patients in our community based cancer center registry database. We did not observe any change in detection method over time with 12% MgD, 7% PhysD and 81% PtD. The majority of MgD cases were in the 30-34 (26%) and 35-39 (65%) year old age groups (Pearson chi square = 11.11, p=.011). 81% of the PhysD/PtD breast cancers were visible on subsequent mammography. 31% of the 74 MgD cases were stage 0 vs. 2.5% of the 528 PhysD/PtD cases. In a conditional logistic regression model with MgD BC yes/no as the binary outcome, age at diagnosis and having a first degree relative with breast cancer were significantly associated with mammography detection. DFS was significantly better in the MgD group (log rank test = 6.10, p=.014).

Conclusions: Mammography detection in 20-39 year old breast cancer patients is associated with age > 30 years and presence of a BC affected first degree relative. Disease specific survival is significantly better in the mammography detected group largely due to lower stage at diagnosis. These results indicate mammography may be a reasonable option for screening high risk women aged 30-39.

Figure available in online version.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-01-01.