New England Surgical Society

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53% Decline in Rhode Island Invasive Breast Cancer Mortality Since 1987: Mammography Prevents Mortality
Blake Cady1, *John P Fulton2
1Harvard Medical School, Brookline, MA;2Rhode Island Cancer Registry, Povidence, RI

Objective: In invasive breast cancer, understanding relationship between improved size, grade, and lymph node metastases from extensive mammographic screening to simplified surgery and decreased mortality.
Design: Rhode Island (RI) cancer registry (RICR) data utilized regarding mammography rates, invasive breast cancer size, lymph node metastases, grade, primary surgical procedures, and mortality between 1987 and 2015.
Setting: RICR data on female invasive breast cancer at diagnosis in RI with one of the highest screening rates in the U.S.
Patients: All RI women diagnosed with invasive breast cancer over 28 years.
Interventions:None
Main Outcome Measures: Mortality decline and modified initial surgery related to decreases in size, grade, and node metastases, resulting from high screening rates
Results: Over 28 years, statistically significant improvements occurred at breast cancer diagnosis: mean and median size decreased from 23.9mm to 19.6mm, and 20mm to 15mm, respectively. Grade 3 cancers decreased, 57% to 28%, while grades 2 and 1 increased, 26% to 50%, and 12% to 22% respectively. Patients with axillary lymph node metastases decreased, from 37% to 26%; patients with >3node metastases decreased, 17% to 4%. 56% of patients with node metastases had only one positive node by 2014. Breast conservation increased, from 28% to 70%, median number of lymph nodes removed by axillary surgery decreased from 14 to 3, both changes associated with greatly reduced surgical morbidity. Mortality dropped 53%, the largest decline of any state.
Conclusions: Earlier presentation at diagnosis by mammographic screening, not systemic therapy, accounts for most of the 53% RI mortality decline from invasive breast cancer between 1987 and 2015.


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