To Screen Or Not To Screen? That Is The Question Part Two
Remember the controversy that sparked from the 2009 USPSTF that recommended against screening women < 50 years old with mammograms? The new recommendation issued by the USPSTF in 2011 is to decrease the screening mammograms in women 50-74 years of age from yearly to every two years and no screening for women < 50 years of age.
Interestingly, a study just reported at the annual meeting of the radiological society of North America showed conclusive finding recommending annual screening mammography in women 40-49 years of age in addition to women > 50 years of age. Out of 6,154 breast cancers diagnosed over a 10-year period (2000 to 2010) 1,116 (18%) were diagnosed in women 40-49 years of age.
ASCO (American Society of Clinical Oncology) and ACS (American Cancer Society) recommend yearly screening mammograms starting at age 40 and continue doing so as long as individuals are in good health. Yearly, MRI and mammogram is recommended for high-risk women.
It is very interesting to notice that the USPSTF panel never includes oncologists. Let's just tell it like it is, these are tough times and it is necessary to “cut costs.” Interestingly, on the ASCO post after the new recommendations from USPSTF come out Dr. Derek Raghavan M.D, P.H.D. questions the need for this task force to exist at all. Unfortunately, the current statistics show that only 53% of women > 40 years of age have screening mammograms. The ACS goal for 2015 is to increase breast cancer screening in women > 40 years of age to 90%.
The sensitivity to digital mammography compared to film screen mammography in women 40-49 years of age is 82% versus 75%. In women age 50-59 is 85% versus 80% and in women age 60 to 65 is 89% versus 83%. Digital mammography is also cost effective since there are fewer number of recalls compared to film mammography.
The relative risk reduction in breast cancer mortality is 15% by using mammography. Non-mammography identified tumors are usually larger, with higher nodal involvement and worse cancer specific mortality.
The rough yearly incidence of breast cancer is ~240,000 new cases and ~39,000 will die of the disease. If you have a history of atypical hyperplasia, family history of breast cancer, difficult to examine breasts, have been on post menopausal estrogen you must continue to have yearly mammograms, for all other patients keep in mind that ASCO and ACS continue to recommend yearly mammograms.