New study shows value of mammography

Late last year, the U.S. Preventive Services Task Force changed their book of evidence-based guidelines for mammography screening in a way that caused significant disagreement in the medical community.

The task force recommended against routine mammography screening for women before age 50 years and suggested that this breast cancer screening end at age 74 years. The guidelines also recommended changing the screening interval from one year to two years.

Now, new data from a large Swedish study show that mammography screening in women aged 40 to 49 years results in a much greater reduction in mortality from breast cancer than has been previously reported.

The new data from Sweden found a 26 percent reduction in breast cancer death rate among the women in the 40 to 49 year age group who were invited for screening, and a 29 percent reduction in those who actually underwent the screening (not all those who were invited participated).

Published online in Cancer, the Swedish data on women 40 to 49 years represents the largest study of mammography in this age group, with more than one million women involved and an average follow-up of 16 years.

When Sweden introduced a nationwide mammography program in 1986, it targeted women 50 to 69 years of age. However, it was left it to individual counties to decide whether or not to also invite women 40 to 49 years to be screened. The study came about because of differences in counties’ decision regarding this screening.

About half of the counties invited women in their 40s and half did not (the control group). The invitations to screening were issued every two years, so from the ages of 40 to 49 years, these women would have undergone about five rounds of screening.

During the follow-up period, from 1986 and 2005, there were 619 deaths from breast cancer among the women who had been invited for screening, and 1,205 deaths in the control group.

The data considered by the U.S. task force last year were based on a meta-analysis of eight randomized trials showing only a 15 percent reduction in death rate. However, many of the studies were old, having been conducted more than 20 years ago.

The Swedish study suggests that the benefit is almost twice as high as the estimate used by the task force.

Currently in the U.S., most organizations recommend yearly mammograms beginning at age 40, including the American Cancer Society, the National Comprehensive Cancer Network, the American Medical Association, the American College of Surgeons, and the American College of Obstetricians and Gynecologists.

It is only the task force that does not recommend regular mammography in the 40 to 49 year age group, but recommends screening every two years for women 50 to 74 years of age. However, there are other countries that also use the age of 50 as the threshold at which to begin mammography screening, such as in the United Kingdom.

The new study drew strong reactions from the American College of Radiology and several other organizations, all of which support starting screening with mammography at age 40 years. However, unlike the Swedish study, they recommend yearly mammograms from age 40 instead of every other year.

While even the task force says screening women in their 40s is a viable option, and the American Cancer Society says it is effective enough that every woman should be screened starting at age 40, none of us should be completely satisfied. Further research to find better screening and diagnostic tools and better treatments are needed to make this current discussion a footnote in cancer history.

It is also very important to remember that these guidelines are for low-risk women with no personal or family history of breast cancer. For women with a strong family or personal history of breast cancer, genetic testing should be considered. Women at highest risk should consider bilateral mastectomies with or without implants, which is statistically the best way to avoid breast cancer death.

Effectiveness of population-based service screening with mammography for women ages 40 to 49 years: evaluation of the Swedish Mammography Screening in Young Women (SCRY) cohort.

The good doctor couldn't provide the name of one author, but she said it was in Cancer. The time frame is right. IIRC, Amanda Gardner of HealthDay News' story with this info didn't provide a name of an author either.

I wrote about screenings in my blog but the long and short of it is if you are a collectivist, you compare the lives saved to the costs and make decisions based on whether the number of lives saved is "worth it" according to some arbitrary standard.

If you are an individualist you don't advocate just writing off peoples' lives as expendable to the greater good. Instead, we believe people should decide for themselves what's best.

The collectivist believes in cutting costs by denying care based on the notion of limited resources. The individualist believes in providing enough care for everyone based on the response of the free market. The result of that is that there will naturally be a lot of "excess" testing. So what?

The two views are completely incompatible which is why there can never be a compromise on Obamacare.

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