Abstract P5-04-02: Comparative analysis between screening mammography performed in patients at usual risk and patients at high risk for breast cancer in the early detection program for breast cancer in Brazil
Authors: ANTONINI MARCELO , PANNAIN GABRIEL D. , FERRARO ODAIR , LOPES REGINALDO G. COELHO , MATTAR ANDRE , REAL JULIANA M. 
Published: March 2023

Introduction: Breast cancer is currently considered a public health problem, being the most frequent in women in Brazil. In the past, and in places where screening programs are not very successful, the diagnosis was made during the clinical examination, being carried out late, which compromised the prognosis and survival of the patient. To avoid late diagnosis, an attempt is made to have the strategy of appropriate screening programs that make an early detection by applying the test to the asymptomatic population and identifying lesions in the pre-clinical stage. Objectives: To analyze the incidence of reports highly suggestive of malignancy in patients undergoing mammography in Brazil between 2013 and 2021. Methodology: A retrospective and analytical cross-sectional study of the notifications available in the cancer information system (SISCAN) was carried out. The incidence of report notifications by the Breast Imaging Reporting Data System (BI-RADS) classification system was compared between high-risk and normal-risk women for breast cancer. In addition to the information regarding the BI-RADS report, they were analyzed comparing epidemiological data between high-risk and normal-risk women. Other variables analyzed were the age group of the screened population and the size of the nodule according to the BI-RADS. Results: In the period analyzed from 2013 to 2021, 16,065,383 screening mammograms were performed and reported in Brazil. Of these, 13,167,259 mammograms were performed on women at normal risk, while 2,898,124 mammograms were performed on women reported as high risk. To analyze the difference between the reports in women at usual risk and those at high risk, the relative risk between them and the number necessary to cause harm was calculated, having found a relative risk of 0.5412 (CI 95 % 0.5341 - 0.5483) in B4 and a relative risk of 0.433 (95% CI 0.4203 - 0.4462). As for the number needed to deal damage, it was observed 203 (95% CI 198 - 209) for B4 and 788 (95% CI 754 - 825) for B5. Discussion: Although the need for breast cancer screening programs to reduce mortality is already well established, some aspects of screening do not have much consensus. In our study, as proposed in the literature, the incidence of reports suggestive of malignant breast lesions was higher in high-risk women. This finding may be consistent with the fact that women with risk factors are more likely to develop breast cancer than those with usual risk. Some studies show that exams from high-risk patients tend to be examined in greater detail, in order to have a higher false positive rate than low-risk patients, just as low-risk patients have a higher false negative rate. Conclusions: Our study showed an increased prevalence of reports suggestive of malignancy in high-risk patients when compared to usual-risk patients. Such findings may mean that high-risk patients have a higher prevalence of malignancy, but also that clinicians review the examinations of high-risk patients more carefully, increasing the rate of reports suggestive of malignancy in these patients.

Reports of mammograms performed in the target population and in high-risk women in Brazil between 2013 and 2021

Risco relativo a depender do tamanho do nódulo e o laudo BI-RADS entre mulheres de alto risco e risco habitual

Citation Format: MARCELO ANTONINI, GABRIEL D. PANNAIN, ODAIR FERRARO, REGINALDO G. COELHO LOPES, ANDRE MATTAR, JULIANA M. REAL. Comparative analysis between screening mammography performed in patients at usual risk and patients at high risk for breast cancer in the early detection program for breast cancer in Brazil [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-04-02.