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P&S Journal

P&S Journal: Fall 1995, Vol.15, No.3
Clinical Advances: By Lynne Christensen
Research Review Questions Effectiveness of Mammograms for Younger Women

Common wisdom in gynecologic practice calls for yearly mammograms for women over age 50, and particularly for those women with a family history of breast cancer. More controversial is whether breast cancer screening is appropriate for women ages 40 to 49. The American Cancer Society recommends mammograms for all women over 40. However, the National Cancer Institute changed its policy in 1994 and now recommends routine screening for women over age 50 and younger women only if they have a family history of breast cancer.

In the June issue of the American Journal of Public Health, Dr. Alfred I. Neugut, associate professor of clinical medicine and of clinical public health, and Judith S. Jacobson call into question whether mammograms are justified for any woman under age 50, even those at risk. In a research review, the authors found no evidence that mammograms are more effective in reducing mortality for high risk women under 50 than for other women in this age group.

Women with a family history (generally one or more first-degree relatives) of breast cancer constitute 6 percent to 12 percent of women under the age of 50. The authors write that "these women are mammographically screened not because there is any evidence that screening reduces their risk of dying from breast cancer, but only because they are at higher risk than other women for developing breast cancer."

While the authors found mammography to be effective in detecting and predicting tumors in women with a family history of breast cancer, they continue to doubt that such screening is beneficial in women in their 40s.

"The purpose of screening is to reduce mortality," the authors write. "If screening does not reduce mortality, it has no benefit that can justify even a small cost or risk."

Regular mammograms may be prescribed for young women who are found to carry the recently discovered BRCA1 gene, but the authors warn "screening may still not reduce mortality among these women, and it is important that they and their doctors understand its limitations."

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