Recent Studies May Offer Clarity On Mammogram Guidelines

By  //  May 2, 2012

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Breast Cancer Screening

(Video by CBSNewsOnline from November 2009)

EDITOR’S NOTE:  All breast cancer screening guidelines agree that women ages 50 to 74 should get mammographic screening, but recommendations for women in their 40s have been highly controversial since the U.S. Preventive Services Task Force ignited the debate in 2009 by calling for no routine mammography before age 50. 

The Task Force cited the higher false positive rate of mammographic findings in younger women, which led to “unnecessary” biopsies and in some cases harm, and recommended focusing screening efforts in women younger than 50 based on their risk for breast cancer.

Two studies published in the May 1 issue of the Annals of Internal Medicine address breast cancer risk factors as a determinant for screening women aged 40 to 49 years.

One of the studies found that women aged 40 to 49 years with at least a 2-fold increased risk of breast cancer have similar harm-benefit ratios for every-other year screening mammography as do average-risk women aged 50 to 74 years.

A mammogram of a fatty breast (left) and a dense breast (right). Large areas of dense tissue appear white on a mammogram, which can mask tumors and make them more difficult to detect.

The other study concluded that extremely dense breasts made up of substantially more glandular tissue than fat, or having a mother or sister diagnosed with breast cancer were each associated with at least a 2-fold increase in risk for breast cancer in women aged 40 to 49 years.  Thus, by focusing breast cancer screening efforts in the 40-49 year age range on women at greatest risk for breast cancer, the number of women harmed would decrease and the number benefiting would increase.

A first-degree family history of breast cancer has historically and is unquestionably an indication for early age screening.

However, as referenced in the excerpted article below by Melissa Healy, the key risk factor of breast density needs better definition if it is to be a helpful indicator for women and their doctors.

Based on the findings of these two studies the logical recommendation would be for women to have their first screening mammogram at age 40 to determine breast density and the need for screening over the next ten years, but until radiologists and breast specialists establish standards based on digital mammographic software that defines and grades breast density, sending all 40-year-old women to have their breast density assessed would be premature.

LATIMES.COM–After several years of upheaval over the best way to conduct breast cancer screening, researchers are working to find clarity over when women should begin getting mammograms, how often and at what cost. A pair of new studies clears up some of the uncertainty by finding that women who have a mother or sister diagnosed with breast cancer, or those who have unusually dense breast tissue, should have their first test at age 40 and repeat the exam at least once every other year.

For these women, who face at least twice the average risk of developing breast cancer in their 40s, the benefits of routine screening between the ages of 40 and 49 outweigh the risk of false alarms and unnecessary work-ups that might otherwise put them at greater risk than doing nothing, researchers report in Tuesday’s edition of Annals of Internal Medicine.

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