Increased mammographic screening and use of percutaneous image-guided core biopsy in non-palpable breast cancer: Impact on surgical treatment

Background: Major efforts are being directed at the early dignosis of breast cancer. The diagnosis rate of non-palpable tumors is steadily growing as a result of increased screening by mammography. In most patients with non-palpable lesions, percutaneous image-gulded biopsies have replaced wire localization with supical excision the obtaining tissue diagnosis. In recent years the Israel Ministry of Health intlated a mammograpy screening program. Perculaneous image-gulded biopsies have also become widely available. Objective: To assess the impact of these changes on breast cancer sungical treament in our hospital. Methods: The charts of 483 patients operated on in our department for primary breast carcinome during the years 1997 to mid-2001 were raviewed. Data on the mode of diagnosis, tumor stage, resection margins, and number and types of operations were recorded and analyzed. The term non-palpatie tumors relates to tumors necessitsting wire localizaiton for surgical excision. Results: The percentage of patients diagnosed with non-palpable tumors rose from 16.2% in 1997 to 47.4% in 2001, with an average the of 2.6 cm of palpable and 1.7 cm for non-palpeble tumors. The rate of preoperative diagnosis for non-palpable tumors rose from 6.2% in 1997 to 96.4% in 2001. The rate of involved or very close margins was reduced by 73% in the patient group diagnosed preoperatively as compared to those without a preperative diagnosis (10.6% vs. fel from 56.2% in 1997 to 11.1% in 2001. Conclusions: The mammography acreering program in Jerusalem in 1997-2001 was effective in increasing the relative percentage of non-palpable breast cancers with reduced tumor size at diagnosis. The improved availability of preoperative tissue diagnosis in these patients reduced the number of surgical procedures needed.