It seems as if every new study on mammography or breast cancer screening guidelines fuels yet another controversy about the right approach to this process for many women.
This time, the May issue of Annals of Internal Medicine features two investigations into screening mammography that reinforce its benefit for women ages 40-49 who have certain risk factors.
In one study, researchers conducted systematic reviews and analysis of more than 60 previous studies that investigated risk factors for breast cancer in 40 to 49 year-old women. Family history, first degree relatives (mother, sister) with breast cancer, and breast density were among the considerations.
As reported in the Los Angeles Times, a second study used computer models to simulate screenings for 44,000 women at ages 40 and 50. Comparisons of rate of false alarms, breast cancer diagnosis and mortality between the two groups were conducted to determine health outcomes.
In women ages 40 and 49, the researchers found that the only ones who stood to benefit were those whose breast cancer risk was approximately twice the normal rate for their age group. This was the same benefit versus drawback rate as women 50 to 74 years old who are screened every other year.
Both the meta-analysis and computer simulation showed that it may be appropriate for women in their forties to begin regular screening, if they fall within certain criteria. Extremely dense breasts and first-degree relatives with breast cancer were each associated with at least twice the risk for breast cancer for women in the 40 to 49 age group. The researchers concluded that the benefits of screening outweighed the downsides of false positives or additional radiation exposure due to the higher disease risk in this cohort.
The 50-plus screening recommendation from the U.S. Preventive Services Task Force, an independent group of experts that make recommendations on federal health policy, caused enormous controversy several years ago when new guidelines were suggested. Yet just a year later, reports on a Swedish study again ignited controversy and confusion. That study found that women who began screening at age 40 had a 26 percent lower rate of death from breast cancer than those who began at age 50.
What many front-line health providers now say is what most have recommended all along – sit down with your physician, review your own health history and that of close relatives and make a decision that is best for you.
As noted by Reuters Health, an editorial accompanying these studies by Otis Brawley, M.D., Chief Medical Officer of the American Cancer Society pointed out that the latest data further supports the need for personalized care, rather than “one size fits all” guidelines.
After weighing the risks and benefits, he wrote, it’s ultimately a decision that needs to be made by a woman and her doctor. This strategy could potentially save more lives than medicine’s current approach to mammography screening.