SCREENING MAMMOGRAPHY MAY REDUCE BREAST CANCER MORTALITY IN WOMEN 40 TO 49 YEARS OF AGE BUT DOES NOT BENEFIT THIS PATIENT GROUP AS MUCH AS IT DOES WOMEN 50 YEARS AND OLDER
Qaseem A, Snow V, Sherif K, Aronson M, Weiss KB, Owens DK. Screening mammography for women 40 to 49 years of age: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2007;146:511-515.
PubMed ID:
17404353.
A guideline from the Clinical Efficacy Assessment Subcommittee of the American College of Physicians examines the evidence concerning the risks and benefits of screening mammography and provides recommendations for the procedure’s use in women 40 to 49 years of age. According to the authors, screening mammography in this age group remains a topic of debate—a debate that the authors believe stems from variance in findings of recent meta-analyses. According to the authors, only 3 of the 8 currently published meta-analyses on this subject demonstrate a significant reduction in breast cancer mortality rates from screening mammography in women 40 to 49 years of age. The most recent meta-analysis found that performing screening mammography every 1 to 2 years in this age group leads to a 15% reduction in breast cancer mortality after 14 years of follow-up (relative risk 0.85; 95% confidence interval [CI], 0.73-0.99). The risks of mammography covered by the authors include false-positive results, procedure-related pain, radiation exposure, and diagnosis of cancer that would not have manifested clinically during the patient’s lifetime. The authors point to a wide range of findings with regard to false-positive rates. Outcomes associated with false-positive screenings include perceived increased susceptibility to breast cancer, and small increases in general depression and anxiety, although the authors report that anxiety generally resolves quickly after evaluation. The authors point out that no evidence directly links cancer with mammography-related radiation exposure.
The guideline’s recommendations for screening mammography in women 40 to 49 years of age include the following:
(1) Clinicians should perform periodic, individualized assessments of breast cancer risk in order to guide decisions about screening mammography.
(2) Clinicians should inform their patients about screening mammography’s potential benefits and harms.
CONCLUSION: The authors conclude that women 40 to 49 years of age do not benefit from screening mammography as much as women 50 years and older, but the procedure probably reduces breast cancer mortality in the younger age group. The authors note, however, that decisions about performing a screening mammography should be individually tailored to reflect each woman’s risk profile for breast cancer as well as her concerns about the procedure itself.
Class of
Evidence: E (ie, a Guideline or Expert Opinion)
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