In our experience,
the mean diameter of breast cancers in symptomatic patients was superior than in screening patients,
and the difference was statistically significant.
the mean diameter found in symptomatic patients,
both with mammography and ultrasound,
correspond to a T2 stage according to TNM,
while the mean diameter found in screening patients correspond to a T1 stage.
the difference found is not only statistically,
but also clinically significant.
This finding is concordant with previously published papers   ,
and is crucial in elderly women,
since early stage lesions are associated with improved prognosis and can often avoid chemotherapy: a great therapeutic advantage in a group of women with a very high rate of comorbidities  .
Screening women were 3 years younger than symptomatic ones,
Since we had not available reliable information about previous examinations,
we cannot argue anything.
it is interesting that screening patients,
compared to symptomatic ones,
could benefit of the diagnosis in advance.
The distribution of histological subtypes was not statistically different in the two groups.
we found 3 in situ ductal carcinomas among screening patients (10.7%) and only 1 intraductal papillary carcinoma among symptomatic patients (2.6%): as it is already known ,
the detection rate of in situ carcinomas is higher when screening mammography is performed.
a higher rate of in situ breast cancers result in a reduction of systemic therapies.
the distribution of unifocal,
multifocal and multicentric disease was comparable and non-statistically different between symptomatic and screening patients.
it is known that the clinical and prognostic significance of multifocal and multicentric disease is not fully understood.
it would seem that the presence of more than one synchronous unilateral tumor would portend a worse prognosis when compared with unifocal counterparts.
while studies have consistently shown a correlation between multifocality and multicentricity and the rate and extent of lymph node metastases ,
the literature is divided on whether there is a corresponding impact on survival outcomes .
In the absence of compelling evidence to dictate otherwise,
the convention according to the current TNM-staging guidelines has been to stage and treat multifocal and multicentric patients according to the diameter of the largest lesions,
without taking other foci of disease into consideration,
and according to the extent of lymph node involvement .
We had 4 false negative mammographic examinations in symptomatic patients,
while only in 1 woman without symptoms mammographic examination was false negative: in all false negative cases,
breast density was increased (BIRADS C or D) and accounted for the wrong diagnosis.
Our study has some limitations: mainly,
it is retrospective,
the sample size in relatively small,
mammography or ultrasound were not available in all cases.
in our clinical activity ultrasound is performed always after mammography,
thus its diagnostic performance is increased in our study.
in our experience screening with mammography and ultrasound in elderly women is useful,
since it results in a diagnosis at an earlier stage and,
as a consequence,
it gives the chance to use effective and less-aggressive therapies,
with positive effects on the quality (but possibly also on the quantity) of life.