WEDNESDAY, Feb. 22 (HealthDay News) -- Breast cancers in women
aged 40 to 49 that are diagnosed by mammograms have a better
prognosis than those detected by doctors or the women themselves, a
new study indicates.
"They have an earlier diagnosis, earlier stage, better prognosis," said study author Judith Malmgren, an affiliated professor of epidemiology at the University of Washington School of Public Health and Community Medicine. She is also president of HealthStat Consulting Inc. in Seattle.
The new study, like previous ones, re-ignites the ongoing debate
about the best age to start routine mammograms and the best
screening interval. It appears in the March issue of the journal
In 2009, the U.S. Preventive Services Task Force issued
mammogram recommendations. It recommends women aged 50 to 74 who
are at average risk for breast cancer have a mammogram done every
two years. It also suggests that women aged 40 to 49 at average
risk discuss the pros and cons with their doctors and decide on an
individual basis if and when to start screening.
Meanwhile, other organizations, including the American Cancer
Society, recommend women begin mammograms at age 40 and continue to
have them annually.
Malmgren and her colleagues evaluated nearly 2,000 women who had
breast cancer. All were aged 40 to 49 when they were treated
between 1990 and 2008.
The researchers looked at the method of diagnosis, whether by
mammogram or if the cancer was found by the doctor or the woman.
They also took these into account: the cancer's stage at diagnosis;
type of treatment; annual follow-up; recurrence; and survival.
Over the 18-year period, the number of breast cancers diagnosed
at very early stages increased 66 percent, while the number of more
advanced cancers (stage 3) decreased by 66 percent.
Those whose cancers were detected by mammogram rose from 28
percent in 1990 to 58 percent in 2008. The number of cancers
detected by doctor or patients declined from 73 percent in 1990 to
42 percent in 2008.
Women whose cancers were detected by mammograms were more likely
than the doctor- or patient-detected cancers to have lumpectomy or
other breast-conserving surgery: 67 percent vs. 48 percent. The
women whose cancers were detected by mammograms were less likely to
be given chemotherapy.
While 4 percent of women whose cancer was found on mammogram
died during a follow-up period that ranged from one to 20 years, 11
percent of those whose cancers were found by the doctor or the
When the researchers looked only at invasive cancers, 92 percent
of the women whose cancer was found on mammogram survived without
recurrence at five years; 88 percent of the other group did.
"I don't think the U.S. Preventive Services Task Force is looking at the whole picture," Malmgren said. "They are concentrating on the harms."
Among them, according to the 2009 guidelines, are
false-positives, which can lead to anxiety and unnecessary
Malmgren, a breast cancer survivor, says more focus should be
placed on the benefit of early diagnosis, because it often means
less treatment is needed.
There was a decrease found in cancers being diagnosed at later
stages in those whose cancers were found on mammograms. "That's
where the money is," Malmgren said.
Dr. Virginia Moyer, chair of the U.S. Preventive Services Task
Force and a professor of pediatrics at Baylor College of Medicine,
reviewed the study. "The findings make sense," she said.
They found that cancers can be detected earlier by mammogram. "A
screening test, if it can't find something earlier than [by]
clinical presentation, is a poor test," she said.
However, she said, the study does not provide support for all
women aged 40 to 49 to have routine mammograms.
When considering its recommendation, the task force took all
available evidence into account, including published studies, Moyer
noted. "The data from randomized trials and modeling show there is
a very modest improvement in mortality with mammograms from 40 to
49," she said.
"Because it is so modest and there are risks, people need to make their own decision," Moyer said.
To learn more about
mammograms, go to the U.S. National Cancer Institute.
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