Older Women Seem to Do Fine with Biennial Mammogram,
Regardless of Breast Density
Younger women - 40 to 49 - with high density should
stick with annual exams says new study considering harm and benefits of
various screening frequencies and considering age, breast density and
March 15, 2013 It appears to be okay for older
women those ages 50 to 74 to have mammograms every two years because
a new study finds regardless of breast density or hormone therapy it
does not increase the risk of presenting with advanced breast cancer and
does substantially reduce the cumulative risk of a false-positive
mammography result and biopsy recommendation. Women aged 40 to 49 years
with extremely dense breasts, however, should consider annual screening.
This study compared the benefits and harms of the
frequency of screening mammography to age, breast density and
postmenopausal use of hormone therapy (HT). It suggests that woman ages
50 to 74 years who undergo screenings once every two years have a
similar risk of advanced-stage disease and a lower cumulative risk of
false-positive results than those who get mammograms every year,
according to a report published Online First by JAMA Internal Medicine,
a JAMA Network publication.
In 2009, the U.S. Preventive Services Task Force
issues guidelines that biennial mammography, rather than the previously
recommended mammography every one to two years, be performed for women
ages 50 to 74, but the updated guidelines did not consider the influence
of breast cancer risk factors beyond age, according to the study
Karla Kerlikowske, M.D., of the University of
California, San Francisco, and colleagues sought to determine whether
the benefits, such as early detection, and the harms, such as a
false-positive mammography result or biopsy recommendation, differ among
women undergoing screening mammography according to age, breast density
and postmenopausal HT use.
Researchers analyzed data collected from January
1994 to December 2008 from mammography facilities in community practice
that participate in the Breast Cancer Surveillance Consortium (BCSC)
mammography registries. Data were collected from 11,474 women with
breast cancer and 922,624 without breast cancer.
The authors found that biennial vs. annual
mammography for women ages 50 to 74 was not associated with an increased
risk of advanced-stage or large-size tumors regardless of a womens
breast density or HT use. However, the results indicate that among women
ages 40 to 49 years with extremely dense breasts, biennial mammography
vs. annual was associated with an increased risk of advanced-stage
cancer (odds ratio 1.89) and large tumors (odds ratio 2.39).
Study results also show that the cumulative
probability of a false-positive mammography result was high among women
undergoing annual mammography with extremely dense breasts who were
either ages 40 to 49 years (65.5 percent) or used estrogen plus
progestogen (65.8 percent) and was lower among women ages 50 to 74 years
who underwent biennial or triennial mammography with scattered
fibroglandular densities or fatty breasts.
In conclusion, women aged 50 to 74 years,
regardless of breast density or HT use, can undergo biennial rather than
annual mammography because biennial screening does not increase the risk
of presenting with advanced disease but does substantially reduce the
cumulative risk of a false-positive mammography result and biopsy
recommendation, the authors write in their conclusion.
Women aged 40 to 49 years with extremely dense
breasts who choose to undergo mammography should consider annual
screening to decrease the risk of advanced-stage disease but should be
informed that annual screening leads to a high cumulative probability of
a false-positive mammography result because of the additional screening
This study was supported by the Breast Cancer Surveillance Consortium cooperative
agreement funded by the National Cancer Institute.
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