Should Mammography Start Earlier?

Breast cancer deaths more common in unscreened women

(RxWiki News) While breast cancer survival has increased impressively over the past several decades, nearly 40,000 women — including women younger than age 50 — will lose their lives to the disease this year. Could screening have saved some of these lives?

A new analysis has revealed that most of the women who died of breast cancer had not received mammogram screening. Furthermore, most of the deaths occurred in women who were diagnosed with the disease under the age of 50.

As a result of these findings, the authors are suggesting that women younger than age 50 need to be regularly screened for breast cancer.

"Develop a breast cancer screening schedule with your physician."

Blake Cady, MD, professor of surgery (emeritus) at Harvard Medical School in Boston, and his colleagues performed what’s called a “failure analysis” to look backwards from death to learn more about disease diagnosis.

Breast cancer screening recommendations have changed recently. A baseline (initial) mammogram used to be recommended at the age of 40 for women with average risks of breast cancer, followed by annual screens.

In 2009, the US Preventive Services Task Force (USPSTF) proposed that screening be limited to women between the ages of 50 and 74.

The USPSTF recommendation was based on avoiding over-diagnosis and over-treatment of breast cancers that may never cause a problem in the patient’s lifetime.

The authors pointed out that mammography has been shown to save lives.

In 1969, before mammography was being used, about half of the women diagnosed with breast cancer were still alive 12.5 years later. Of the women diagnosed with breast cancer between 1990 and 1999, less than 10 percent (9.3 percent) of women had died 12.5 years following their diagnosis.

For this study, the researchers reviewed information about 609 women who were diagnosed with invasive breast cancer between 1990 and 1999, were followed until 2007 and ultimately died specifically from breast cancer.

These deaths occurred among 7,301 women who received a breast cancer diagnosis during the 1990s.

The reviewed data included demographics (age, race, income, education, etc.), mammography history, lab reports and dates when recurrence or death occurred.

The researchers uncovered the following:

  • 29 percent of women who died from invasive breast cancer had undergone mammography.
  • 71 percent of those who died had not been screened within two or more years prior to diagnosis.
  • 50 percent of the deceased were under the age of 50 at the time they were diagnosed with breast cancer, with the median (middle) age at diagnosis being 49 years.
  • 13 percent of the deaths occurred in women over the age of 70.

These results confirm those of an earlier analysis. “One previous retrospective failure analysis of invasive breast cancer revealed that 72 percent of deaths from disease occurred in the 15 percent of women not regularly screened,” the authors wrote.

"This study did not say that more young women in our population are developing breast cancer," Cary Kaufman, MD, a breast surgeon and specialist at Bellingham Regional Breast Center in Washington state, told dailyRx News.

"In general, about 22 percent of breast cancers occur under the age of 50. Rather, of the 9 percent of women that they confirmed died from breast cancer (609 known breast cancer deaths out of 7,301 patients), a large proportion of them (50 percent) were younger women due to their common development of more aggressive forms of breast cancer and the common lack of screening mammography in that age group," said Dr. Kaufman, who was not involved in this study.

Due to the USPSTF recommendation that breast cancer screenings begin at age 50, Dr. Kaufman concluded, "We have a future concern that less women under 50 will obtain screening which may lead to more breast cancer deaths in women between 40 and 50 years old."  

“Our findings suggest decreasing the intensity of efforts to screen women older than 69 years while concomitantly emphasizing efforts to screen younger women in particular,” the study's authors concluded.

Findings from this review were published September 9 in the journal Cancer.

No funding or conflict of interest information was disclosed.

Review Date: 
September 6, 2013