MONDAY, Sept. 9 (HealthDay News) -- New breast cancer research
reveals a significant death rate among women under 50 who forgo
regular mammograms and casts doubt on recent screening guidelines
from a U.S. panel of experts.
The findings support the merit of regular mammograms, especially
for younger women, said study researcher Dr. Blake Cady, professor
emeritus of surgery at Harvard Medical School and Massachusetts
General Hospital in Boston.
"I would propose that women start screening at age 40," Cady said. Younger women tend to have faster-growing, more aggressive tumors, experts say.
When mammograms should start and how often they should be
repeated has been a controversial subject. In 2009, the U.S.
Preventive Services Task Force, a panel of experts that makes
recommendations about health practices, said women aged 50 to 74
should get screening mammograms every two years. Women under 50,
the panel said, should talk to their doctors and decide whether to
be screened based on potential benefits, such as early detection,
and harms, including over-treatment and anxiety caused by
The American Cancer Society and other organizations, however,
have continued to recommend annual screening beginning at age 40
for women at average risk. More than 40,000 women die of breast
cancer in the United States each year.
For the new study, published online Sept. 9 in the journal
Cancer, researchers evaluated more than 600 breast cancer
deaths, looking back at mammography records and other details.
Seventy-one percent of the deaths occurred among unscreened
women, most of them younger, Cady found. Half of all the breast
cancer deaths occurred in women under age 50, while only 13 percent
of the women who died of breast cancer were 70 and older.
For the study, Cady and his colleagues tracked invasive breast
cancer cases from their diagnoses, between 1990 and 1999, until
2007. Patients were treated at Partners HealthCare hospitals in
Boston. The researchers had access to mammography use, surgery and
pathology reports, and dates of death.
Cady's team used a technique called "failure analysis," in which
scientists look back to see what might have gone wrong. "It's the
converse of a randomized trial, which starts at point A and follows
people until the end of the study," Cady said. "We follow people
who have died and go backward to their original diagnosis and find
out the details."
Women were described as unscreened if they had never had a
mammogram or it had been more than two years since their last
The findings confirmed the benefits of earlier screening, some
"[The study] presents a very compelling argument in favor of screening beginning at age 40 on an annual basis," said Dr. Barbara Monsees, chairwoman of the American College of Radiology Breast Imaging Commission, who was not involved in the research. "It corroborates what we have known for a long time."
Overall, the study also showed an increase in breast cancer
survival coinciding with the emergence of mammography. Half of
women diagnosed with breast cancer in 1969 died within 13 years
after diagnosis, compared to about 9 percent of those diagnosed
between 1990 and 1999 who were included in this study.
Although some experts have credited the decline in breast cancer
death rates to improved treatments, the study shows that's not the
whole story, Monsees said. "This paper shows the decline is
primarily due to earlier detection and better screening," she
Frequent screening is even more important in younger women than
in older woman, she added. Tumors in older women typically grow
slower than in younger women.
The bottom line: "Screening doesn't reduce the risk of getting
breast cancer, but it does reduce the risk of dying from it,"
Robert Smith, director of screening for the American Cancer
Society, offered this perspective: "Regular screening was
associated with a much, much lower likelihood of dying [from breast
cancer]," compared to no screening or long-ago screening.
One-third of deaths among those who did get screened regularly
were attributed to "interval cancers," those detected in between
the mammograms done every two years. Although this shows that
getting regular mammograms doesn't entirely eliminate the risk of
dying from breast cancer, Smith said, "the message here is that
mammography is a good part of your prevention plan."
If the cancer is detected early, options for breast-conserving
surgery are greater and the risk of dying from the cancer is
reduced, he said.
To learn more about mammography, visit the
American Cancer Society.
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