INTRO:

Transplant centers typically require mammography (MMG) for women ≥ 40 as part of the evaluation process. The American Cancer Society recommends annual mammograms for the general population starting at 40 while the USPSTF recommends biennial mammography between age 50-74. Recently, the Swiss Medical Board has sparked further controversy by stating that they no longer recommend mammography-screening programs. We sought to determine characteristics of concern on MMG in the pretransplant renal failure population.

METHODS:

We retrospectively examined women undergoing kidney transplant evaluation at a single institution from 2006 to 2012 who were ≥ 40 (n=567) by 2012. Comparisons were based on demographics at transplant evaluation and MMG findings, with the outcome of interest defined as ductal carcinoma in situ (DCIS) or breast malignancy.

RESULTS:

We found that 19.0% of the screening mammograms during the evaluation period had a positive first impression requiring follow up compared to a reported rate of 9.6% in the general populace. Patients 40-49 and patients 50+ were found to have similar biopsy rates (8.6% vs. 5.6%, p=0.42) and rates of DCIS/malignancy (1.3% vs. 1.5%, p=0.42). Patient BMI, and smoking status did not independently impact the breast biopsy rate or total oncological findings. Black patients had an increased breast biopsy rate (OR=2.24, [1.02-4.89]), but did not have increased rate of DCIS/malignancy (OR=3.50, [0.70-17.51]). Patients with denser breasts (>50% fibroglandular tissue) were more likely to be younger, black, with increased BIRAD scores, and with a lower BMI [Table 1]. Such patients had increased biopsy events (OR=1.85, [1.16-2.95]), and increased risk of DCIS/malignancy (OR=1.64, [1.05-2.57]).

CONCLUSIONS:

Breast density is a risk factor for breast malignancy in patients with ESRD undergoing transplant. A lower threshold for biopsy may be warranted in patients who have both dense breasts and an indeterminate lesion (BIRADS-3). We recommend annual breast screening starting at age 40.

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