February 19, 2001. Copyright 2001. Graphic News. All rights reserved.

CONTROVERSY OVER RIGHT AGE TO START MAMMOGRAM SCREENING

LONDON, February 19, Graphic News: SCREENING mammography has been shown to reduce breast cancer mortality among women aged 50-69 years. However, its appropriateness for younger women at average risk of breast cancer remains controversial. 

Jolie Ringash, working with the Canadian Task Force on Preventive Health Care and writing in the latest edition of the Canadian Medical Association Journal, has reviewed the evidence regarding the effectiveness of screening mammography -- a low-dose X-ray that can detect breast cancer at an early stage, up to two years before it is large enough to be felt.

The task force failed to find conclusive evidence to include or exclude mammograms from the periodic health examination of women under age 50.

Instead, it recommended that, upon reaching 40, women be told about the potential benefits and risks and helped to decide when they wish to begin screening.

In contrast, medical organizations in the United States stress that breast cancer can be detected at an early, treatable stage. Incidence increases with age, rising sharply after age 40.

The more widespread use of regular screening mammography has been a major contributor to recent improvements in the breast cancer survival rate. A 1997 survey showed that on average, 58 percent of U.S. women age 50 and older had received a mammogram within the last year and over two million breast cancer survivors are alive in America today.

The American National Alliance of Breast Cancer Organizations (NABCO) points out that one in nine women will develop breast cancer in her lifetime -- up from one in 14 in 1960. This year, a breast cancer will be newly diagnosed every three minutes, and a woman will die from breast cancer every 13 minutes.

Although mammography is now the most frequent means of discovering breast cancer, lumps and breast irregularities are often found by women themselves.

In the U.S., over 80 percent of biopsied breast abnormalities are proven benign, but NABCO stresses that any breast lump must be evaluated by a physician. Currently, 62 percent of breast cancers are discovered at an early, ÒlocalizedÓ stage, and five-year survival after treatment for early-stage breast cancer is 96 percent. 

In Europe the British National Health Service provides free breast screening every three years for all women in the UK aged 50 and over. The programme, which was set up in 1988  -- the first population screening programme of its kind in the world -- now screens over one-and-a-quarter million women each year.

In the UK -- where one in 11 women will develop breast cancer over a lifetime -- women aged 40-50 are not offered routine screening. Because breast tissue is more dense in women who have not reached the menopause, it may be more difficult to detect small cancers.

As women go past the menopause, the glandular tissue in their breasts changes and breast tissue is increasingly made up only of fat. This makes interpretation of the mammograms more reliable.

In Britain a research trial is in progress to assess the possible effectiveness of routine screening for women over the age of 40 by mammography.
/ENDS

Sources: Canadian Medical Association Journal, National Alliance of Breast Cancer Organizations, NHS