What Is the Ideal Age for Screening Mammography?

The conflict over the recommended age for a screening mammogram continues with a new study whose authors conclude that an annual screening starting at age 40 has the greatest impact on reducing mortality.

The study used mean values from 6 Cancer Intervention and Surveillance Modeling Network (CISNET) models to compare 3 recommendations from major healthcare organizations:

• Annual screening at ages 40 to 84 years
• Screening annually at ages 45 to 54 years, then biennially at ages 55 to 79 years
• Biennial screening at ages 50 to 74 years

Per their analysis, the highest reduction in mortality was observed in the cohort that started annual screening at age 40 and continued until age 84 years (mean reduction, 39.6%). The second-highest mortality reduction was observed in the hybrid group (mean reduction 30.8%)—this group initiated their annual screening at age 45 and continued until age 54, followed by biennial screening from 55 to 79. The group that followed the biennial screening recommendation between 50 to 74 years had the lowest reduction in mortality (23.2%).

The analysis showed that for a single-year cohort of women aged 40 years, an annual screening mammogram initiated at age 40 would prevent 29,369 deaths. This compared with 22,829 lives saved for the hybrid screening and 15,599 lives for the biennial screening ages 50 to 74 years (based on 2016 CISNET estimates).

“Our findings are important and novel because this is the first time the 3 most widely discussed recommendations for screening mammography have been compared head to head,” senior author Elizabeth Kagan Arleo, MD, of Weill Cornell Medicine, said in a statement. “Our research would be put to good use if, because of our findings, women chose to start annual screening mammography starting at age 40. Over the long term, this would be significant because fewer women would die from breast cancer.”

Arleo would like women and their physicians to use the findings of this analysis to guide screening choices, with respect to initiation and frequency of screening.

Otis Brawley, MD, FACP, chief medical officer of the American Cancer Society, wrote in an accompanying editorial highlighted the importance on an individual’s value judgement.

“Our goal should be to provide truthful, balanced information so that women can make informed choices about when to start screening for breast cancer. A woman who is making a decision about screening is more interested in her personal chances of benefit and risk of harm and is less interested in the benefits to the population,” he wrote.

His editorial also pointed out the limitations of a mammogram and emphasized the importance of a better test for women that would avoid false positives and be more sensitive.

Reference

Arleo EK, Hendrick R, Helvie MA, and Sickles EA. Comparison of recommendations for screening mammography using CISNET models [published online August 21, 2017]. Cancer. 2017. doi: 10.1002/cncr.30842.