Mammograms from age 40 save lives

A new study questions the controversial U.S. Preventive Services Task Force recommendations for breast cancer screening, with data that shows starting at a younger age and screening more frequently will result in more lives saved.The study analyzed the same data looked at by the task force, which issued its guidelines on mammography screening in November 2009. The study authors compared the task force’s recommendations for screening every other year in women 50-74 to American Cancer Society guidelines of screening every year in women 40-84.The study was conducted by R. Edward Hendrick, Ph.D., clinical professor of radiology at the University of Colorado School of Medicine, and Mark Helvie, M.D., director of breast imaging at the University of Michigan Comprehensive Cancer Center. It appears in the February issue of the American Journal of Roentgenology.Hendrick and Helvie used six model scenarios of screening mammography created by the Cancer Intervention and Surveillance Modeling Network. This is the same modeling data the task force considered. The authors compared task force guidelines to American Cancer Society guidelines.They found that if women begin yearly mammograms at age 40, it reduces breast cancer deaths by 40 percent. When screening begins at 50 and occurs every other year, it reduces breast cancer deaths 23 percent. The difference between these two screening strategies comes down to 71 percent more lives saved with yearly screening beginning at 40.”Task force guidelines have created confusion among women, leading some to forego mammography altogether. Mammography is one of the few screening tools that has been proven to save lives and our analysis shows that for maximum survival, annual screening beginning at 40 is best. This data gives women more information to make an informed choice about the screening schedule that’s best for them,” says Helvie, professor of radiology at the U-M Medical School.As part of their recommendation, the task force emphasized the potential harms mammography can cause—including pain during the screening exam and anxiety from false-positives, which can lead to additional imaging or biopsy.The study authors found that on average women ages 40-49 who are screened annually will have a false-positive mammogram once every 10 years. They will get asked back for more tests once every 12 years and will undergo a false-positive biopsy once every 149 years.”The task force overemphasized potential harms of screening mammography, while ignoring the proven statistically significant benefit of annual screening mammography starting at age 40,” Hendrick says. “In addition, the panel ignored more recent data from screening programs in Sweden and Canada showing that 40 percent of breast cancer deaths are averted in women who get regular screening mammography. Our modeling results agree completely with these screening program results in terms of the large number of women lives saved by regular screening mammography.”

Comments

  1. James Reif - MD 1984

    Hopefully this will “undo” some of the damage from the USPSTF recommendations.

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  2. Janet Quaine - 1986

    I would not have made it to the 50 year mammogram…I had stage IV breast cancer detected at my 45 year mammogram…my second mammogram

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  3. Tsu-Yin Wu - 1999

    Thank you so much for publishing this paper which will also provides evidence and strong advocates for those groups who need to start mammogram in their 40\’s. For example, Chinese/Taiwanese women get breast cancer at much younger age compared; in their early 40\’s. Starting mammograms on their 50\’s will only be so detrimental to this group.

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  4. William White - 1971

    Battling statistics. This article is not enough to answer the question of what we want to do as a society. A mother of teenagers dying unnecessarily in her 40s is a tragedy. See the editorials about the issue in the New England Journal to get a sense of how many women need to be screened to help one. Sometimes in medical literature the percentage decrease in an event grossly overstates the real benefit

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  5. Mark Walker - 1986

    Most physicians like myself didn’t follow the recommendations of the task force anyway as we saw through the unfortunate mess they created with their ill-worded report. They had little support behind the recommendations. Now we just need to do a thorough job informing the public and reassuring the women in this country that regular mammograms at age 40 are helpful. Hopefully this will also keep the insurance companies from trying to cut back on reimbursement, which is just what Obamacare was trying to do with the Task force recommendations.

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  6. Phillip Shepard - 1968 Med

    RE Tsu-Yin Wu – 1999 comment. A doctor’s wife I know had Breast Ca at 30, she was Japanese from Okinawa; she survived. I’ve been in Cambodia the past eight years. Last year saw a 35 yr old terminally ill with Ca and another 39 years old with bilateral tumors, the one quite advanced had already spread to node. Today just saw ee year old who has positive biopsy. Screening is generally not available here. It would appear that Asian women may indeed get Ca of Breast at younger age and should be screened earlier.

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