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Personalizing breast cancer screening

Kathleen Blanchard's picture
Mammogram guidelines

Researchers now suggest the frequency of mammograms should be personalized. The recommendation comes amidst controversy about annual screening versus every two years and at what age breast cancer screening should be started and stopped.

According to a new study, it may make sense to consider several factors, including a woman’s feelings, when deciding mammogram frequency.

What the analysis found was contrary to American Cancer Society and the US Preventive Task Force guidelines which recommend one breast cancer screening every 1 or 2 years for all women.

Breast density important consideration for mammogram

Steve Cummings, MD, of the San Francisco Coordinating Center at the California Pacific Medical Center Research Institute – part of the Sutter Health network who led a new study says:

"Most guidelines use age as the determining factor in when, and how often, a woman should get a mammogram. “What our study shows is that other factors, particularly breast density, are just as important, if not more so, in helping a woman decide what is most appropriate for her."

Whether a woman gets her first mammogram at age 40 or age 50 should be personalized, rather than “one size fits all”

Dr. John Schousboe of the Park Nicollet Institute and the University of Minnesota in Minneapolis, Minnesota and lead study author says mammography should not just be a clinical decision.

The researchers took breast density and risk factors into consideration in the analysis, including whether women never had a mammogram, had one yearly, every two years or every 3 to 4 years. From there they developed a model of cost effectiveness, also considering quality of life and how many extra mammograms it would take to prevent one death from breast cancer over a ten year period.

The findings for the analysis come from data included in the Breast Cancer Surveillance Consortium and Surveillance Epidemiology and End Results of the National Cancer Institute.

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According to the results, co-author Karla Kerlikowske, MD, MS, an expert in mammography at the University of California, San Francisco explains screening for breast cancer at age 40 would be prudent and cost effective for some women with a family history of a first degree relative with the disease.

The study team also notes a woman’s feelings should also be considered.

“For example some mammograms produce a ‘false positive’ result and these can cause a lot of worry for a woman. The effect of mammograms on a woman’s quality of life should be considered in her decision about when to be screened. If mammograms reassure you, then more often is ok. If they worry or bother you, then less frequent may be ok," said Schousboe.

Schousboe also explains yearly mammograms are not cost effective, even for women with dense breasts and other risk factors, compared to mammography every 2 years.

Dr. Susan Love, President of the Dr. Susan Love Research Foundation said, "This is exactly the type of analysis that we need if we are going to help women and doctors figure out the best schedule of screening for them. Personalized medicine extends beyond treatment to risk definition and appropriate screening schedules."

It makes sense to consider many factors for breast cancer screening. Whether a woman starts at age 40 with her first mammogram, or age 50 might vary, depending on risk factors and how a woman feels about the potential for false positive tests.

According to the study findings, only about 20 percent of women in their 40's have high breast density and a first degree relative with breast cancer. Those women should be screened at age 40.

After that, waiting two years between screenings, for those women, would be the same as a woman in her 50's who has average disease risk and receives a mammogram every two years.

For women with no risk factors, the authors say it should be fine to wait until age 50 for a mammogram.

Annals of Internal Medicine: July 5, 2011
vol. 155 no. 1 1-9
"Personalizing Mammography by Breast Density and Other Risk Factors for Breast Cancer: Analysis of Health Benefits and Cost-Effectiveness"
John T. Schousboe, MD, PhD; Karla Kerlikowske, MD, MS; Andrew Loh, BA; and Steven R. Cummings, MD

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