|
Should Mammography be offered as a screening tool to women aged 40-49?
The
current UK practice is to offer mammographic screening to women age 50-
74. The age of 50 was
originally chosen as a surrogate for the menopause, but with modern
technology and specialist centres, mammography should be offered from age
40. A meta-analysis of 8 Randomised Controlled Trial from
patients between 1963 and '82, published in 1997 showed an 18% reduction
in mortality from mammographic screening in women age 40- 49. With the advent of digital mammography, highly trained and
experienced radiologists and radiographers, and other diagnostic tools
such as MRI and stereotactic/USS guided core biopsies, this figure should
be higher in modern times. Provisional
reports from the UK study predict a mortality improvement of 10-11% in
women who have mammographic screening from age 40, and this figure will
improve with continued follow-up. It
has been shown that mammographically diagnosed breast cancers have
improved oncological characteristics and are appropriate for more
conservative surgical procedures and less adjuvant toxic therapy.
Claims that risks outweigh benefits in mammographic screening in
younger women have not been substantiated in this age group. We
believe that the evidence suggests that women age 40- 49 have a
significant reduction in mortality from screening and that they should be
offered 12-18 monthly mammograms in specialist centres using the latest
radiographic technology. If
these women are fully informed then they should be given the choice to
join a mammographic screening programme from the age of 40. Bibliographic
reference:
Sophie Helme, Kefah Mokbel Breast Unit, St George's Hospital, Tooting, London, UK
|