New England Surgical Society

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52% Decline in Rhode Island Invasive Breast CancerMortality Since 1987: Mammography Prevents Mortality
Blake Cady
Rhode Island Cancer Registry, Department of Public Health, Providence, RI

Objective: In invasive breast cancer (IBC), understanding relationship between improved clinical presentation from mammographic screening to simplified surgery and decreased mortality.
Design: Rhode Island (RI) cancer registry (RICR) data utilizing mammography rates, invasive breast cancer size, lymph node metastases, grade, primary surgical procedures, and mortality between 1987 and 2016.
Setting: RICR data on RI female IBC in a state with one of the highest screening rates in the U.S.
Patients: All RI women diagnosed with IBC over 30 years, 1987-2016.
Interventions: None
Main Outcome Measures: Mortality decline and changes in initial surgery related to decreases in size, grade, and node metastases, resulting from high screening rates.
Results: Statistically significant improvements were recorded at breast cancer diagnosis: mean and median size decreased from 23.9mm to 19.6mm, and 20mm to 15mm, respectively. Grade 3 cancers decreased, 58% to 28%, while grades 2 and 1 increased, 26% to 50%, and 11% to 22% respectively. Patients with axillary lymph node metastases decreased, 37% to 27%; patients with more than 3 node metastases decreased, 17% to 4%. 55% of patients with node metastases had only one positive node by 2016. 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 decreased 52%, the largest decline in any state.
Conclusions: Earlier presentation at diagnosis by mammographic screening, not systemic therapy, accounts for most of the 52% RI mortality decline from IBC between 1987 and 2016. Earlier presentation at diagnosis by mammographic screening, not systemic therapy, accounts for most of the 52% RI mortality decline from IBC between 1987 and 2016.


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