Nov 30, 2011

Annual Mammography Is Essential for Women in Their 40s

Women in their 40s with no family history of breast cancer are just as likely to develop invasive breast cancer as women with a family history, according to research presented here at the Radiological Society of North America 97th Scientific Assembly and Annual Meeting.

The finding offers conclusive evidence that women 40 to 49 years of age should be screened yearly with mammography, Stamatia V. Destounis, MD, from Elizabeth Wende Breast Care, Rochester, New York, told reporters at a press briefing.

This flies in the face of the 2009 recommendation by the US Preventive Services Task Force that came out against screening for women in their 40s.

In fact, just last week, a Canadian task force issued new guidelines recommending against screening women in this age group, and extending the interval between mammography screening in women 50 to 74 years to as much as 3 years.

“All these task forces are coming out saying don’t screen, don’t do breast self-exam, don’t do clinical breast exam. It’s just ridiculous,” Dr. Destounis told Medscape Medical News.

She and her team performed a retrospective review of all patients who underwent screening mammography at their center from 2000 to 2010. During that period, 6154 cancers were found in 5813 women.

Of these cancers, 1116 (18.1%) were found in women 40 to 49 years of age, and 373 were diagnosed as a result of mammography screening. The remainder were diagnosed because the women presented with symptoms such as pain, a lump, nipple discharge, and skin changes.

When the researchers focused on the women who had their cancers detected on screening mammography, they found that 144 (39%) had a family history of breast cancer and 228 (61%) did not; in the case of 1 woman, family history was unknown.

All but 1 of the patients went on to have surgery. In the women with no family history, the percentage of invasive breast cancer was 64%; in the women with a family history, the percentage was 63.2%.

The researchers also found that 31% of the women with a family history and 29% without a family history had positive lymph nodes.

“Our conclusion is that family history really doesn’t seem to impact the rate of invasive disease or metastatic rate in this patient cohort,” Dr. Destounis noted.

“Obviously, we know that the risk of getting breast cancer increases per decade. We get that. But 40- to 49-year-old women get breast cancer, too. They get diagnosed with screening mammography, and a considerable number of these are invasive cancers. The groups against screening say we do not have to screen them, but we do have to screen them. These women have a considerable percentage of cancers that are invasive and a considerable number of lymph nodes that are positive,” she said.

Breast Cancer Risk in Younger Women Higher Than Previously Thought

Nina A. Mayr, MD, a radiation oncologist from Ohio State University, Columbus, toldMedscape Medical News that the study confirms what many people have suspected.

“Many of us believe that the breast cancer risk of younger women in their 40s is much higher than we probably thought, and the recurrence rate is also higher,” she said.

“I see these young women. They didn’t have a mammogram and then they come in with a cancer that is very large. Many of these women still have children at home, so the socioeconomic cost of breast cancer is very high,…much higher than for in a woman in her 70s. I think these aspects are very important and they tend to be overlooked,” Dr. Mayr said.

Critics who oppose screening mammography say that those who are in favor of it have a vested interest in doing mammograms, but Dr. Mayr denied that this is the case.

“If we were talking about a very expensive nuclear medicine test or an expensive surgical procedure that makes a lot of money, they might have a point. But mammograms do not make much money,” she said.

In fact, academic centers and private practices find it extremely difficult to find people who want to do mammography, she noted.

“The cost of a mammogram is about $75. It is a procedure that incurs a lot of liability, so the financial yield is low and the liability is high…. If you want to derive a lot of financial benefit, you do not want to do mammography.”

Dr. Destounis reports financial relationships with Siemens, Fujifilm Holdings Corporation, Hologic, Koning Corporation, Koninklijke Philips Electronics NV, and Matakina International Limited. Dr. Mayr has disclosed no relevant financial relationships.

Radiological Society of North America (RSNA) 97th Scientific Assembly and Annual Meeting: Abstract SST01-01. Presented November 29, 2011.

— Fran Lowry

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