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News from CaSfA's Director


Evidence for Screening Mammography before the age of 50

Posted on September 18, 2013 at 10:09 AM
My invasive ductal carcinoma was diagnosed by routine mammography.  I know other women whose breast cancer was diagnosed after feeling a lump on self-exam.  So I did not agree with the U.S. Preventive Services Task Force (USPSTF) when it recommended the following changes in its breast cancer screening guidelines in 2009: 
 •   Routine screening of average-risk women should begin at age 50, instead of age 40. 
 •   Routine screening should end at age 74. 
 •   Women should get screening mammograms every two years instead of every year. 
 •   Breast self-exams have little value, based on findings from several large studies. 

Research out of MGH just published online September 9, 2013 from the journal Cancer, supports initiation of annual mammographic screening before age 50.
This study hypothesized that breast cancer deaths predominantly occurred in unscreened women.

To determine the survival benefit of women who have been screened, Cady and colleagues analyzed data on 7,301 patients who had newly diagnosed breast cancer during 1990 to 1999. Follow-up continued to 2007.

The authors also examined duration of screening interval, defining biennial screening as intervals of no more than 2 years. Women whose most recent screen occurred more than 2 years in the past were included in the unscreened group.

During the study there were 609 confirmed breast cancer deaths, 29% were among women who had been screened, whereas 71% were among unscreened women, including > 2 years since last mammogram (6%), or never screened (65%). Median age at diagnosis of fatal cancers was 49 years.

So the conclusion states:
“Most deaths from breast cancer occur in unscreened women. To maximize mortality reduction and life-years gained, initiation of regular screening before age 50 years should be encouraged.”

Kudos to the American Cancer Society, American College of Radiology and other organizations that have continued to recommend annual mammograms for women starting at age 40 despite the USPSTF policy.

Categories: breast cancer

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