An overview of the breast cancer screening controversy.
Randomized controlled studies show that screening mammograms are as important for women aged 40-49 as for women 50 years old and above. It was the improper use of retrospective, unplanned, sub-group analysis to advise women and their physicians that caused the controversy over mammograms for women under 50. Furthermore, arbitrarily grouping women into two groups leads to the incorrect conclusion that the age of 50 is a significant break point when it is not. The data demonstrates that none of the parameters of screening change abruptly at age 50. The recall rates (an abnormal mammogram) and the rate at which biopsies are recommended are virtually the same, regardless of age. Breast cancer is not a trivial problem for women in their forties. More than 30% of the years of life lost to breast cancer are from women diagnosed while in their forties. Because of changing demographics, in 1995 and 1996, there were actually more women diagnosed with breast cancer in their forties than for women in their fifties. The data clearly show that screening women for breast cancer, on an annual basis, beginning by age 40, can reduce the death rate by approximately 24%. It is important to separate medical and scientific analyses from the economic considerations. "Society" may decide that it is too expensive to screen women for breast cancer, but women should be provided with the scientific and medical information so that they can participate in the discussion of whether screening is "worthwhile" and decide whether or not to avail themselves of its benefit. The economics should not be used to influence the scientific and medical analysis of benefit.
Massachusetts General Hospital, Department of Radiology, Ambulatory Care Center, Boston 02114, USA.
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Kopans
D000328:Adult; D017677:Age Distribution; D001943:Breast Neoplasms / Q000191:economics / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008327:Mammography / Q000009:adverse effects / Q000191:economics*; D008403:Mass Screening / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies