Screening mammography in women less than age 50 years.
OBJECTIVE
For women aged 40-49 years, to describe the benefits and harms of performing screening mammography, accuracy of digital mammography, and new evidence on the effectiveness of risk-based screening.


RESULTS
New data support a 15% reduction in breast cancer mortality for women aged 40-49 years after 10 years of screening; however, the absolute benefit is small and not outweighed by important harms. Digital mammography is more sensitive, but less specific than film mammography in women aged 40-49 years. Risk-based screening that identifies and screens women aged 40-49 years with breast cancer risk similar to an average-risk woman aged 50-59 years results in similar benefits and harms of screening these high-risk women as screening average-risk 50-year-old women.


CONCLUSIONS
Practitioners should discuss with women aged 40-49 years the benefits and harms of undergoing screening mammography before offering them screening. If women elect to undergo screening mammography, they should undergo biennial screening with digital mammography. Targeting screening for those women aged 40-49 years with risk factors that substantially increase the risk of breast cancer, such as high breast density, family history of breast cancer, and history of benign breast biopsy, could maximize the benefits and minimizes the harms of screening this age group.
Department of Medicine, University of California, San Francisco, California, USA. Karla.Kerlikowske@ucsf.edu
Karla
K
Kerlikowske
D000328:Adult; D000367:Age Factors; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000517:prevention & control; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000517:prevention & control; D055088:Early Detection of Cancer; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008327:Mammography; D008403:Mass Screening; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D012680:Sensitivity and Specificity