Mammography for breast cancer screening
Over the past 20 years, there has been active discussion in the medical community about whether the benefits of mammography outweigh the risks. This debate was sparked again when two Danish scientists reviewed the evidence on mammography. They felt many randomized controlled trials on mammography were too flawed to give good information. They did not include these trials in their analyses. Using only the data from the remaining studies, they concluded mammograms did not lower a woman's chance of dying from breast cancer [44-45]. In the most recent update, researchers concluded (despite some problems with certain studies), the evidence as a whole showed mammography likely reduces the risk of death from breast cancer [11].
Most major health organizations feel mammography saves lives. Although there may be some problems with certain studies, the evidence still shows mammography is a valuable screening tool.
Differences in screening recommendations for women ages 40 to 49
Mammography in women 40 to 49 saves lives, but the benefit for these younger women is less than in older women.
Most major health organizations, including Susan G. Komen for the Cure®, the American Cancer Society and the National Cancer Institute, feel the modest survival benefits of mammography in women ages 40 to 49 outweigh the risks of false positive results. All recommend regular mammograms for women aged 40 to 49.
The U.S. Preventive Services Task Force meta-analysis of eight randomized controlled trials found mammography modestly reduced the risk of breast cancer mortality (death) in women 40 to 49 [18]. They found that to prevent one breast cancer death, 1,904 women 40 to 49 would need to be screened with mammography [18].
Weighing the benefits and risks, the Task Force does not recommend routine mammography for women 40 to 49 [22]. The Task Force encourages women 40 to 49 to talk to their health care provider and make informed decisions about when to start mammography screening [22]. The American College of Physicians also recommends mammography decisions for a woman 40 to 49 be based on her breast cancer risk profile and her own preferences (after she weighs the potential benefits and harms of screening mammography) [23].
Read more from our Chief Scientific Advisor, Dr. Eric Winer, as he comments on the issue of mammography leading to over-diagnosis and over-treatment.
Over-treatment of ductal carcinoma in situ (DCIS)
There are valid concerns about over-diagnosis and over-treatment of ductal carcinoma in situ (DCIS, a non-invasive breast cancer) with mammography screening. Since the introduction of mammography, the number of women diagnosed with DCIS has increased.
Although DCIS is non-invasive, without treatment, the abnormal cells could turn into invasive cancer over time. Left untreated, it is estimated about 20 to 30 percent of low grade DCIS may progress to invasive breast cancer [107]. Higher grade DCIS may be more likely to turn into invasive cancer if left untreated.
At this time, there is no way to tell which cases of DCIS will go on to invasive cancer and which will not. Therefore, women with DCIS are treated with lumpectomy (also called breast conserving surgery) plus radiation therapy or mastectomy. Some women are also treated with hormone therapy.
Because not all cases of DCIS will become invasive breast cancer, some women with DCIS may be "over-treated”. There is ongoing research into the factors that may be linked to recurrence. However, at this time, the standard of care is to treat each case of DCIS.
What does this mean for you?
Despite some ongoing debate, mammography is still the best screening tool used today for the early detection of breast cancer.
While any health decision is a personal one that involves weighing benefits and risks, most health organizations recommend women get regular mammograms. Komen recommends yearly mammograms starting at age 40.
Read more from our Chief Scientific Advisor, Dr. Eric Winer, as he comments on the issue of mammography leading to over-diagnosis and over-treatment.
Updated 09/01/11
