Yearly mammograms from age 40 save 71 percent more lives, study shows

A new study questions the controversial U.S. Preventative Service Task Force recommendations for breast cancer screening, with data that shows starting at a younger age and screening more frequently will result in more lives saved.

29 jan 2011--The study analyzed the same data looked at by the task force, which issued its guidelines on mammography screening in November 2009. The study authors compared the task force's recommendations for screening every other year in women 50-74 to American Cancer Society guidelines of screening every year in women 40-84.

The study was conducted by R. Edward Hendrick, Ph.D., clinical professor of radiology at the University of Colorado School of Medicine, and Mark Helvie, M.D., director of breast imaging at the University of Michigan Comprehensive Cancer Center. It appears in the February issue of the American Journal of Roentgenology.

Hendrick and Helvie used six model scenarios of screening mammography created by the Cancer Intervention and Surveillance Modeling Network. This is the same modeling data the task force considered. The authors compared task force guidelines to American Cancer Society guidelines.

They found that if women begin yearly mammograms at age 40, it reduces breast cancer deaths by 40 percent. When screening begins at 50 and occurs every other year, it reduces breast cancer deaths 23 percent.

The difference between these two screening strategies comes down to 71 percent more lives saved with yearly screening beginning at 40.

"Task force guidelines have created confusion among women, leading some to forego mammography altogether. Mammography is one of the few screening tools that has been proven to save lives and our analysis shows that for maximum survival, annual screening beginning at 40 is best. This data gives women more information to make an informed choice about the screening schedule that's best for them," says Helvie, professor of radiology at the U-M Medical School.

As part of their recommendation, the task force emphasized the potential harms mammography can cause – including pain during the screening exam and anxiety from false-positives, which can lead to additional imaging or biopsy.

The study authors found that on average women ages 40-49 who are screened annually will have a false-positive mammogram once every 10 years. They will get asked back for more tests once every 12 years and will undergo a false-positive biopsy once every 149 years.

"The task force overemphasized potential harms of screening mammography, while ignoring the proven statistically significant benefit of annual screening mammography starting at age 40," Hendrick says. "In addition, the panel ignored more recent data from screening programs in Sweden and Canada showing that 40 percent of breast cancer deaths are averted in women who get regular screening mammography. Our modeling results agree completely with these screening program results in terms of the large number of women lives saved by regular screening mammography."

More information: American Journal of Roentgenology, Vol. 196, W112-W116, February 2011

Provided by University of Michigan Health System

Mammograms Remain Best Way to Spot Breast Cancer

19 oct 2008-- Mammograms detect 80 percent to 90 percent of breast cancers in women without symptoms, and all women 40 and older should get a yearly mammogram, says the American Cancer Society (ACS) as it marks National Mammography Day on Friday, Oct. 17.
"Mammography remains the most effective screening test for the early detection of breast cancer available to women today," Dr. Otis W. Brawley, the ACS's chief medical officer, said in a society news release. "Women are strongly urged to schedule their mammograms yearly and to talk to their doctor regularly about their risk for breast cancer."
Early detection by mammography screening and improvements in treatment have contributed to a decline in the breast cancer death rate in the United States since 1990. However, recent evidence suggests that many women are getting mammograms at a later age, not scheduling them yearly, or aren't receiving appropriate and timely follow-up after positive breast cancer screening results.
Along with recommending yearly mammograms and clinical breast examinations for women over age 40, the ACS says that women ages 20 to 39 should undergo clinical breast examination at least once every three years. All women should be familiar with their breasts and immediately report any changes to their health care provider.
Women at high risk for breast cancer (greater than a 20 percent lifetime risk) should have an annual MRI and mammogram, and women at moderate risk (15 percent to 20 percent lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram, the ACS recommends.
More information
Women can access a free online "mammogram reminder tool" at the American Cancer Society.

Low Mammography Rate for Older Breast Cancer Survivors May Cost Lives

BOSTON, July 24 -- Only a minority of older breast cancer survivors undergoes recommended yearly surveillance mammography, but for those who do, the risk of dying from the disease is cut by almost a third, researchers found.
In a large observational study, each additional surveillance mammogram for breast cancer survivors ages 65 and older was associated with a 31% lower risk of breast cancer mortality (95% confidence interval 18% to 48%), said Timothy L. Lash, D.Sc., of Boston University, and colleagues.
But, only 41% of the women had had at least four mammograms over five years of follow-up, despite access to care, they reported in the July 20 issue of the Journal of Clinical Oncology.
These results "suggest that as many as 500,000 older women will die of their breast cancers" because of suboptimal mammography surveillance, said Jeanne Mandelblatt, M.D., M.P.H., of Georgetown University, in an accompanying editorial.
The American Society of Clinical Oncology recommends annual surveillance mammography for all women who survive breast cancer.
However, there has been no clinical trial evidence to support this guideline. Furthermore, older women have typically been excluded from even screening mammography trials, so it was not known whether they would benefit.
The researchers aimed to close this gap by studying 1,846 stage I and II breast cancer patients ages 65 and older who were insured through six integrated health care delivery systems in the Cancer Research Network.
The investigators reviewed medical records, examined patient databases, and checked the National Death Index. They matched each of the 178 women who died of breast cancer during the first five years of follow-up to four survivors for a total of 634 controls.
Among survivors, only 2.0% had at least four surveillance mammograms during the five years of follow-up. Over the mean 31.8 months of follow-up, 40% had no surveillance mammography and 32% had only one.
Overall, each additional surveillance mammogram was associated with a significant reduction in the likelihood of breast cancer mortality despite matched risk between groups and adjustment for change in comorbidity from baseline (odds ratio 0.69, 95% CI 0.52 to 0.92).
The mortality reduction per mammogram was even greater for the following groups:
Women with stage I disease (adjusted OR 0.55, 95% CI 0.33 to 0.90)
Women who underwent mastectomy (adjusted OR 0.60, 95% CI 0.41 to 0.88)
Women in the oldest, 80 and over age group (adjusted OR 0.43, 95% CI 0.22 to 0.84)
Among women who had a local breast cancer recurrence, those who died were less likely to have had a surveillance mammogram in the prior year than those who survived (38% versus 79%, P=0.02).
As expected, "given that mammograms can only detect tumors in the breast," surveillance mammograms did not appear to have a significant effect on survival for women with regional or distant recurrences.
However, the 213 women who died from non-breast cancer causes also appeared to have a significant mortality benefit from each additional surveillance mammogram compared with their matched controls (adjusted OR 0.68, 95% CI 0.56 to 0.83).
While this may cause some skepticism that surveillance mammograms are not the real cause of the mortality benefit, the researchers noted, the test could confer benefits beyond just detection.
For example, they wrote, it may make women more aware of early signs or symptoms of recurrence, they wrote, "which may be associated with earlier detection of the recurrence and improved prognosis."
Therefore, "the reduced mortality rate likely results from the effect of detecting local recurrences or second primary breast cancer at an earlier stage with better prognosis, combined with the effect of better medical care in general," the researchers concluded.
These findings should bolster physicians' confidence in recommending and reinforcing the value of surveillance mammograms to all their patients, Dr. Mandelblatt said.
"Physician recommendation of proven effective interventions remains one of our strongest tools in the war against cancer," she added.
The study was funded by the National Cancer Institute. The researchers and Dr. Mandelblatt reported no conflicts of interest.Additional source: Journal of Clinical OncologySource reference: Lash TL, et al "Mammography Surveillance and Mortality in Older Breast Cancer Survivors" J Clin Oncol 2007;25:3001-3006. Additional source: Journal of Clinical OncologySource reference: Mandelblatt J "To Screen or Not to Screen Older Women for Breast Cancer: A New Twist on an Old Question or Will We Ever Invest in Getting the Answers?" J Clin Oncol 2007;25:2991-2992.

False-positive mammograms have negative effects

Thu Apr 12, 2007 8:52AM EDT
By Martha Kerr
NEW YORK (Reuters Health) - Women who are told their mammogram shows a possible cancer that turns out to be a false alarm are likely to suffer anxiety for a long time, according to a new study.
"U.S. women who get a false-positive are more likely to come back for their next routine screen," lead author Dr. Noel T. Brewer, of the University of North Carolina at Chapel Hill, told Reuters Health. "On the face of it, this seems like a good thing, but scaring women for long periods of time to get them to screen again does not seem like the best approach."
Brewer and colleagues conducted an analysis of 23 studies showing the effects of false-positive results of mammography on women. The studies involved a total of 313,967 women aged 40 and older.
Women who were given a false-positive mammogram result performed breast self-exams more frequently than other women, the investigators report in the Annals of Internal Medicine.
http://www.reuters.com/article/healthNews/idUSCOL24516520070412?feedType=RSS