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Study backs mammography screening in women under 50
By Edward Susman

November 29, 2011 -- CHICAGO - In a study of women ages 40 to 49 screened with mammography, the risk of finding invasive breast cancer was similar regardless of whether a woman had a family history of the disease, indicating that this age group would benefit from annual screening.

"Family history does not seem to impact the rate of invasive disease in this cohort," said Dr. Stamatia Destounis, radiologist and managing partner of Elizabeth Wende Breast Care, at a press briefing at the RSNA 2011 meeting. "We were intrigued and surprised by the data," she said, noting that common wisdom suggests that women with a family history would be at greater risk that women without a family history of breast cancer.

"It supports what we mammographers do," she said. "We know it is important to screen women in their 40s."

In 64% of the cases, women without a family history of breast cancer were diagnosed with an invasive form, compared with 63.2% of women who had a close relative with a history of breast cancer (p = 0.8695), according to Destounis.

When to begin breast cancer screening is a controversial topic of late, she said, with organizations such as the American Cancer Society (ACS) suggesting that age 40 is appropriate for annual mammography, whereas the U.S. Preventive Services Task Force (USPSTF) in 2009 recommended that women routinely get screening mammograms every other year starting at age 50.

This study indicates that age 40 is appropriate -- and that it is appropriate for all women, not just those deemed at high risk due to family history, genetics, and other factors, she noted.

Destounis and colleagues reviewed 10 years of data from the Elizabeth Wende Breast Care database, identifying 6,154 cancers in 5,813 patients; 1,116 cancers were observed among 1,071 women ages 40 to 49.

She said that 373 of the cancers were detected during screening procedures: 144 among women with a family history of the disease and 228 among women with no family history of the disease.

"There are very few mammographers who feel differently about the need to screen at 40 years of age," said Dr. Gary Whitman, professor of radiology at MD Anderson Cancer Center, who moderated the briefing.

"Disseminating this information will help people in clinical decision-making," he added. "Ultimately, you would like to modify what the task force has done or make sure that other organizations that are writing guidelines are aware of this data."

"We want to diagnose tumors early," Destounis said. "We want our patients to survive."

Cancer screening guidelines need reform, November 21, 2011

Canadian task force advises less frequent breast screening, November 21, 2011

Breast cancer risk: It's not all in the family, November 1, 2011

ACR lashes back at mammo study, October 27, 2011

New study lowers estimate of lives saved by breast screening, October 24, 2011


Copyright © 2011 AuntMinnie.com

Last Updated np 12/9/2011 10:55:37 AM

4 comments so far ...
11/30/2011 5:30:58 PM
telemed
There is a good case for NEVER using mammography in women with a family history unless you know she is not BRCA positive---and most women have not been tested.
 
There is evidence (but it is conflicting) that BRCA impairs repair of DNA after any ionizing radiation...if that is true, then the very women who get more mammos (women with a bad family history) should probably never get one.....instead ultrasound, MRI and other non-risky techniques.
 
I am amazed that this information is virtually unknown to radiology.
11/30/2011 7:14:54 PM
Flounce
...
12/6/2011 7:08:05 AM
Mammo Jock
The radiosensitivity of BRCA 1 and 2 women IS well known...so is the incredibly high incidence of Breast Cancer in this population, so there is a complex benefit/risk trade-off. My own personal trade-off is to perform mammographic screening FIVE ( not ten) years before the age of the primary affected relative. For example, if a women's mother developed breast cancer at age 43, I would start the daughter's screening at age 38, to catch most family-scynchonized cancers without a huge extra, early radiation dose. I also use single view screening for all my patients under 30 who qualify under this algorithm.
 
 
12/6/2011 9:54:44 AM
Dr.Sardonicus
Two letters:
MR
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