Sunday, October 17, 2010

Mammography Debate - When to Start Screening

At what age is it recommended for a woman to start routine mammograms:
A. 40 years old
B. 50 years old
C. Neither A or B
D. Both A and B.

Until last year, there was a uniform recommendation in the United States for women to start routine mammography for breast cancer screening at the age of 40 and then repeat every 1-2 years. However recently the US Preventive services Task Force (USPSTF) has issued new recommendations to start routine mammography screening at age 50, to repeat mammograms every 2 years between ages 50 - 74, and to end screening at age 74.

This recommendation is controversial. As a result there has been some confusion for both patients and physicians as to when a woman should consider getting her mammograms.

The USPSTF made their recommendation based on a review of published evidence of the efficacy of screening in lowering breast cancer mortality rates. These studies were identified through Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, MEDLINE January 2001 to December 2008. The reviewers found that film mammography is associated with reduced breast cancer mortality rates, especially in women 50 to 74 years old. Women aged 60 - 69 may have the greatest benefit. For women aged 40 to 49 years there was a 15% decrease in mortality.

However a new study from Sweden reports that mammography screening in women aged 40-49 years old showed a much greater reduction in mortality from breast cancer than has been previously reported. This data showed a 29% reduction in breast cancer mortality in this age group when screening was done. In this large study, more than 1 million women were involved, and they were monitored for 16 years. This study was done because of differences in counties in Sweden. Initially in 1986 Sweden targeted women aged 50 - 69 years but left it up to individual counties to determine if women 40 - 49 years old should be screened. About half of the counties invited women aged 40 - 49 years old to undergo screening and half did not. During the follow up period between 1986 - 2005, there were 619 deaths from breast cancer in women ho had been invited for screening, and 1205 deaths in women who had not undergone screening.

Currently in the U.S., most organizations recommend yearly mammograms beginning at age 40, including the American Cancer Society, the National Comprehensive Cancer Network, the American Medical Association, and the American College of Obstetricians and Gynecologists. It is only the USSPTF that does not recommend regular mammography in the 40 - 49 year age group.

For women between 40 - 49, it is best to speak with your physician. The decision may need to be made on an individualized basis. If a woman is considered to be at higher risk for breast cancer then an earlier mammography screening should be considered.

Answer - D.

Other related topics: