Newswise — Lannin and Wang, published June 8 in the New England Journal of Medicine, showed that younger women of screening age are more likely to develop aggressive breast cancers than older women. This added risk reinforces why women should start annual mammography screening at age 40.
“Aggressive cancers in women in their 40s must be identified early to be effectively treated. Letting these tumors grow even one extra year before screening greatly increases odds that the woman will die from breast cancer. Women 40-49 should be screened regularly,” said Debra Monticciolo, MD, FACR, chair of the American College of Radiology (ACR) Breast Imaging Commission.
“Giving the second-leading cancer killer in women a head start through reduced or delayed screening can be lethal for these women. Starting screening at age 40 remains the best policy,” said Wendy B. DeMartini, MD, president of the Society of Breast Imaging (SBI).
However, many breast cancer opinions stated in the Welch-Fisher perspective and the Lannin-Wang special report on overdiagnosis, survival and screening vs. treatment effectiveness are refuted by direct patient data in respected studies. These two papers published in the June 8 NEJM are based on assumptions, many of which are unsupported, rather than direct patient data and should not affect breast cancer screening policy.
Breast Cancer Experts Do Expect Breast Cancer Deaths to Drop as More Cancers are Found Early
Contrary to authors’ claims, breast cancer incidence rates did rise 1-1.3 percent per year prior to the start of widespread mammography screening in the mid/late 1980s. This fact negates their stated baseline for assessing overdiagnosis.
Since the 1980s, the U.S. breast cancer death rate, which had been stable for decades, has dropped 38 percent as more cancers are found early. Large studies (Otto et al, Coldman et al) show women who get regular mammograms cut their breast cancer death risk nearly in half. Annual screening results in more life-saving benefit than biennial screening for every age group.
Mammography Enables More Effective Treatment
A study in the British Medical Journal confirmed that early detection via mammography is critical to improved breast cancer survival, regardless of therapy advances. Studies show that even when women have access to the latest therapies, breast cancer deaths drop at a much higher rate in those who get mammograms. Better treatment alone does not explain plunging breast cancer deaths.
A study in the British Medical Journal based on direct patient data showed breast cancer overdiagnosis to be about 2 percent. This fits with American Cancer Society findings, which re-confirmed analyses by American College of Radiology (ACR) and Society of Breast Imaging (SBI) experts that high overdiagnosis claims (such as previously claimed by Welch) are inflated due to key methodological flaws in such studies.
Overdiagnosis is likely one to ten percent — largely due to inclusion of ductal carcinoma in situ (DCIS). These noninvasive cancers are often treated to avoid development of invasive cancers. Already low overdiagnosis will not be reduced by delayed/less frequent screening. Such cancers would be there at the next test. Breast cancers detected by screening do not disappear or regress if left untreated. No medical test can yet determine which cancers will or will not advance to kill the person afflicted.
Start Screening at age 40
The American Cancer Society, United States Preventive Services Task Force, the American College of Radiology (ACR) and Society of Breast Imaging (SBI) agree that the most lives are saved when women start annual mammograms at age 40.
The ACR, SBI, American Congress of Obstetricians and Gynecologists (ACOG), National Comprehensive Cancer Network and others recommend that women start yearly mammograms at 40.
To speak to an ACR representative, contact Shawn Farley at 703-648-8936 or [email protected].
To speak to an SBI representative, contact Kesha Willis at (703) 476-7480 – ext. 5480 or [email protected].