title: Risk-based recommendations for mammographic screening for women in their forties.
abstract: OBJECTIVE
  To develop risk-based recommendations for mammographic screening for women in their 40s that take into account the woman's age, race, and specific risk factors.
  
  
  METHODS
  We assumed that regular mammographic screening is justified for a 50-year-old woman, even one with no risk factors, and that a younger woman with an expected 1-year breast cancer incidence rate as great or greater than that of a 50-year-old woman with no risk factors would benefit sufficiently to justify regular screening. Recommendations under this criterion were based on age- and race-specific breast cancer incidence rates from the National Cancer Institute's (NCI's) Surveillance, Epidemiology, and End Results (SEER) Program; assessments of risk factors from the Breast Cancer Detection and Demonstration Project (BCDDP); and reports in the literature.
  
  
  RESULTS
  Two methods, the exact-age procedure (EAP) and the grouped-age procedure (GAP), were developed. The less precise GAP only requires following a flow diagram. The proportion of white women recommended for screening by the EAP ranges from 10% for 40-year-old women to 95% for 49-year-old women, and the corresponding percentages for black women are 16% and 95%. The assumptions that underlie the guidelines are discussed critically.
  
  
  CONCLUSIONS
  For women or physicians who prefer an individualized approach in deciding whether to initiate regular mammographic screening in the age range of 40 to 49 years, the present report offers recommendations based on individualized risk-factor data and clearly stated assumptions that have an empiric basis. These recommendations can be used to facilitate the counseling process.
authors.affiliation: National Cancer Institute, Division of Cancer Epidemiology and Genetics, Rockville, MD 20892, USA. gailm@epndce.nci.nih.gov
authors.forename: M
authors.initials: M
authors.lastname: Gail
authors.forename: B
authors.initials: B
authors.lastname: Rimer
mesh_terms: D000328:Adult; D000367:Age Factors; D001943:Breast Neoplasms / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008327:Mammography / Q000009:adverse effects / Q000592:standards*; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D012307:Risk Factors