FRIDAY, April 29 (HealthDay News) -- A pair of studies released
Friday could shake up the debate on whether or not American women
should begin regular mammography screening in their 40s.
One study, presented at the annual meeting of the American
Society of Breast Surgeons in Washington, D.C., found that
screening women aged 40 to 49 with mammograms detected smaller
breast cancers, with less chance of spread to the lymph nodes, than
relying on clinical breast exams alone.
That finding runs counter to controversial recommendations
issued late in 2009 by the U.S. Preventive Services Task Force
(USPSTF), which advised that women at average risk for breast
cancer do not have to begin regular mammography screening until age
50. Instead, the federal panel of experts advised that the decision
for or against mammography for women in their 40s be individualized
after a patient-doctor discussion.
A second study presented at the same meeting on Friday suggests
that the USPSTF guidelines would unfavorably impact minority women
in their 40s.
Dr. Paul Dale, chief of surgical oncology at the University of
Missouri-Columbia and lead author of the study looking at early
detection, said his view on the issue is clear: "I think women in
their 40s should get mammography."
In their study, Dale and his colleagues looked at the medical
records of almost 1,600 women treated at the university medical
center for breast cancer over a 10-year time period. The
researchers focused on 311 women aged 40 to 49.
Of these, 47 percent were diagnosed via mammography, while 53
percent were diagnosed without mammography (for example, by
symptoms of breast cancer).
Those diagnosed by mammogram had smaller tumors -- an average of
2 centimeters in diameter versus 3 centimeters, the team found.
They also had less chance of the tumor having already moved into
the lymph nodes, where it becomes more difficult to treat. While
about 25 percent of those who had mammograms had lymph node
involvement, almost 56 percent of those who did not have
mammography showed this type of cancer spread.
When the researchers focused on the five-year disease-free
survival of women in their 40s, Dale found 94 percent of the
mammogram-detected group had disease-free survival compared to 71
percent in the non-mammogram group. The rate of overall survival
(disease-free or not) at five years was 97 percent for those in the
mammogram group versus 78 percent for women in the other group.
According to Dale, the findings suggest that women in their 40s
who develop breast cancer "are going to do better if they have a
In the second study, researchers analyzed a large database of
nearly 47,000 American women with breast cancer. Of that, 22.6
percent were aged 40 to 49, while 77.4 percent were 50 to 74.
About 66 percent of the patients were white, about 15 percent
were Hispanic, about 13 percent were Asian or Pacific Islanders and
about 6 percent were black.
"We looked at a population of women who only had early breast cancer, and compared the younger, 40 to 49 -- not recommended [routinely] to have screening -- with an older population," explained Dr. Sharon Lum, associate professor of surgery at the Loma Linda University School of Medicine in Loma Linda, Calif.
"What we found was in the younger, 40 to 49, group there was a greater proportion of minority women [with early cancers] than in the older group [of the same ethnicities]," she said.
Therefore, according to Lum, "if you exclude younger women from
screening mammography, it could disproportionately affect minority
Dr. Otis Brawley, the chief medical and scientific officer for
the American Cancer Society, reviewed both studies but was not
involved in either.
"I do believe we should start [screening mammograms] at 40," said Brawley, who is also professor of oncology and epidemiology at Emory University School of Medicine in Atlanta. The American Cancer Society continues to recommend that all women begin screening mammograms at age 40, he said.
Even so, Brawley said he has some issues with the new
mammography research. For instance, the five-year survival time
studied in the Dale study is just not long enough, he suggested. A
better approach is to study what experts call a "mortality
endpoint," to find the number of people per every 1,000 who died in
the screening group versus the non-screened group.
"That typically takes more than five years," he explained.
Furthermore, all research presented at medical meetings should
be viewed with a grain of salt, Brawley said. It's in the first
stages of research, and has not yet been subjected to rigorous
debate and review by other medical experts.
In that respect, these should be considered tentative findings,
For her part, Dr. Virginia Moyer, current chair of the USPSTF,
said the public often misreads the panel's controversial 2009
guidelines, thinking no one 40 to 49 should have a mammogram.
not what the recommendation says," she stated. "It says that
the decision should be individualized, taking patient context into
account, including the patient's values regarding benefits and
As to the new studies, "the first study confirms what we already
know, and the second study points out that our knowledge in
specific groups of women remains incomplete," said Moyer, professor
of pediatrics and head of academic general pediatrics at Baylor
College of Medicine and the Texas Children's Hospital, in
Moyer said it is known that, on average, mammogram screening
results in some benefit. But, "for women in the 40- to 49-year-old
age group, this benefit appears to be quite small, and has to be
balanced against the known risks, which are greater in younger than
in older women," she said. Among those potential risks are
false-positive results, and the undue anxiety and unnecessary
biopsies that can result, Moyer noted.
For more details on the 2009 guidelines, head to the
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