New Screening Mammography Guidelines Affect Women in
Their Forties
< Apr. 04, 2007 > -- Not
all women in their 40s should be routinely screened for breast cancer, says the
American College of Physicians (ACP).
New mammography guidelines issued by the
ACP for women 40 to 49 years old suggest that any decision to undergo the
exam should be based on a discussion between a woman and her physician.
The ACP is one of several
medical groups that have put forward ideal intervals for mammography screenings
for breast cancer. However, there is no consensus among the groups for women in
their 40s.
For example, the American Cancer
Society (ACS) recommends annual mammograms for women beginning at age 40.
The National Cancer Institute (NCI) recommends
that women in their 40s and older should have a screening mammogram on a regular
basis, every one to two years. And the US Preventive
Services Task Force recommends screening mammography every one to two
years for women 40 and older, noting there was not enough evidence to specify
the best screening interval for women 40 to 49.
Breast cancer is the most common cancer among women, other
than skin cancer. It is the second-leading cause of cancer death in women, after
lung cancer. An estimated 178,000 women in the US will be diagnosed with
invasive breast cancer in 2007, and about 40,000 women will die from the disease
this year, according to the American Cancer Society.
ACP developed the guideline
to present the available evidence for screening mammography to physicians and
women between the ages of 40 and 49 and to increase their understanding of the
benefits and risks of screening mammography in women within this age group.
"We designed our screening mammography guideline based on
scientific evidence," says Dr. Lynne Kirk, president of
ACP. "It will empower women between the ages of 40 and 49 to become part
of the decision-making process and to encourage them to discuss with their
physicians the benefits and risks of mammograms."
The guideline states that, according to the evidence
studied, breast cancer risk is not evenly distributed in women between the ages
of 40 and 49. Thus the benefits of screening mammography are not uniformly
applicable in women in this age group. Therefore, women 40 to 49 years of age
need to take into account their level of risk and the possible benefits and
harms of screening mammography.
"I hope what (the new guidelines) will do is allow women to
have the sorts of conversation that discusses for them personally, the risks and
benefits of a screening mammogram," says Dr. Kirk.
The discussion should ideally include a family history of
breast cancer, whether the woman has had a previous breast biopsy to check for
cancer, and other factors, adds Dr. Kirk, a professor of internal medicine at
the University of Texas Southwestern Medical Center at Dallas.
"We had not done a specific recommendation on women 40 to
49," she says. "We had recommended for women 50 and over, every year or every
other year."
Dr. Kirk says she does not think the new guidelines will
discourage women from having the exam. "My guess is, a lot of women will choose
to have a mammogram based on this discussion," she says.
Among the risks of mammogram for younger women is the
possibility of undue anxiety when a test result is questionable and the patient
is sent for a biopsy, and that biopsy produces a false-positive result, Dr. Kirk
says. "That risk is certainly much higher in low-risk women 40 to 49," she says.
The ACP committee in charge
of drafting the guidelines reviewed 117 studies to evaluate the evidence on the
risks and benefits of mammography screening for women in the 40-to-49 age group.
In an editorial accompanying the guidelines, the authors
conclude that "no simple recommendation applies to all women in their 40s." The
best strategy, they write, is for physicians to listen carefully to patients and
to communicate to them "the benefits and limitations of our imperfect tests."
The new guidelines, meant to be used by practicing
physicians, are published in the Annals of Internal
Medicine, a publication of the ACP.
Dr. Cheryl Perkins, senior clinical adviser for
Susan G. Komen for the Cure, a Dallas-based organization devoted to
fighting breast cancer (formerly known as the Susan G.
Komen Breast Cancer Foundation), said setting mammogram guidelines for
women in the 40-to-49 age range is difficult.
"It's a very diverse age group," she says. "Some are still
child-bearing, some are perimenopausal, some are menopausal."
Dr. Perkins says the new ACP
guidelines "won't trigger a change in our recommendations at this point in time.
We continue to recommend annual screening for women 40 and over."
"Cancer that occurs in women still in their childbearing
years can be more aggressive than cancers in the postmenopausal group," she
adds.
Always consult your physician for more information.
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According to a new study published in the
Journal of Clinical Oncology, breast cancer death rates in the US have
declined, particularly among women with estrogen receptor (ER)-positive tumors
and women younger than age 70.
About 75 percent of breast cancer cases are ER-positive -
which means their tumors respond to circulating estrogen - and the average age
of breast cancer patients at the time of diagnosis is 62.
The study looked at national data on almost 235,000 cases
of invasive female breast cancer.
The researchers found that death rates declined by 24
percent between 1990 and 2003; from a peak of 33 deaths per 100,000 women per
year to 25 per 100,000 per year.
Among women younger than 70, the death rate declined 38
percent for those with ER-positive tumors, compared with 19 percent for those
with ER-negative tumors.
Among women 70 and older, the death rate declined 14
percent for those with ER-positive tumors but did not decline for those with
ER-negative tumors.
"These trends in breast cancer mortality since 1990 are
likely attributable to at least two important factors: the use of tamoxifen
after surgery, which substantially reduces the risk of recurrence in ER-positive
tumors only; and widespread use of screening mammography, which is more likely
to detect the slow-growing tumors that tend to be ER-positive," says study lead
author Dr. Ismail Jatoi, director of the Breast Cancer Center in the Department
of Surgery at the National Naval Medical Center.
The study did not investigate why there was less of a
decline in breast cancer death rates among older women.
However, the researchers note that previous studies
suggested that older women are less likely to receive adjuvant therapy for
breast cancer.
Always consult your physician for more information.
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