wendieberg@gmail.com

Specific mammographic findings with <= 2% malignancy rate can be safely followed with imaging surveillance. However, this approach may not apply to women with a personal history of breast cancer (PHBC). This study assesses the cancer yield of BI-RADS 3 (BR3) assessments among women with personal history of breast cancer in the National Mammography Database (NMD).

This retrospective cohort HIPAA-compliant study included all women recalled from screening mammography followed by BR3 assessment at additional evaluation from 2009 to 2018, from 471 NMD facilities. We included only the first BR3 occurrence, for women who underwent biopsy or >= 2-year imaging follow-up or downgrade to BI-RADS 1 or 2 with >= 1-year follow-up. PHBC was determined by patient-report, facility-provided indication, or history of biopsy proven malignancy in the NMD. PPV3 = number of cancers over biopsies performed. Cancer yield (CY) = number of breast cancers per the number of women.

Among 67,995 women with BR3 findings, 2087 (3.1%) women had PHBC (median age 65 yrs; range 32-90). For women with PHBC, overall biopsy rate of BR3 lesions was 26.1% (545/2087), yielding 339 cancers, PPV3 62.2%, CY 16.2% (339/2087; 95%CI 14.7 to 17.8%). 850 women with PHBC were downgraded to BI-RADS 1 or 2 at follow-up visits, and 38 (4.5%) of those underwent biopsy, yielding 25 (65.8%) cancers, CY 2.9%. In comparison, for 65,908 women without PHBC, overall biopsy rate was 10.06% yielding 885 cancers, PPV3 13.3%, CY 1.34%. 44,358 women without PHBC were downgraded to BI-RADS 1 or 2 at follow-up visits, 111 of which were malignant, CY 0.25% (p<0.0001 vs. those without PHBC, both comparisons).

In the NMD, overall cancer yield for BI-RADS 3 findings in women with PHBC was 16.2%, far exceeding the acceptable rate of 2% and far exceeding the observed 1.34% rate among women without PHBC (p<0.0001). PPV3 in this group was also significantly greater than in women without PHBC, at 62.2% vs. 13.3% (p<0.0001), respectively. Even among lesions downgraded to BI-RADS 1 or 2 at follow-up, malignancy rate exceeded 2% among women with PHBC.

Imaging findings that would otherwise be considered BI-RADS 3 in average-risk women should generally prompt biopsy in woman with personal history of breast cancer.