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Breast Screening in 40s Proposed Based on Risk (CME/CE)

MedPageToday, 2012

ignited the debate in 2009 by calling for no routine mammography before age 50, citing the higher false positive rate in younger women.
Risk-based screening could mitigate concerns over the high ratio of harm to benefit for that age group, Otis W.
Brawley, MD, of the American Cancer Society in Atlanta, wrote in an editorial accompanying the Annals papers.
"If screening efforts could focus on women at greatest risk for breast cancer, the number of women harmed would decrease and the number benefiting would increase," he explained.
That strategy would potentially save more lives than current practice, while also improving logistics and use of healthcare resources, Brawley argued.
Risk-tailored guidelines -- though likely to be challenging for the public and healthcare providers -- are the next step, he suggested.
"There may be recommendations that some women at very high risk get annual testing, some at intermediate risk get biennial testing, and some at normal risk start screening at a later age," he wrote in the editorial.
Van Ravesteyn's group used data from the Surveillance, Epidemiology, and End Results (SEER) program, the Breast Cancer Surveillance Consortium, and other sources to generate a model for assessing risks and benefits of screening at different age ranges.
Altogether, biennial screening of women ages 50 to 74 yielded per 1,000 women: 6.3 breast cancer deaths averted 109 life-years gained 883 false-positive findings
For women in their 40s to reach the same ratio of 8.3 for false-positives to life-years gained, they would have to be at 1.9-fold elevated relative risk of breast cancer at minimum, the researchers found.
Annual screening and digital mammography were associated with more harm in terms of false-positives.