SATURDAY, Sept. 22, 2001 (HealthDayNews) -- Mammograms have long been considered the gold standard for detecting breast cancer in women. In fact, several studies since the 1970s support the belief that the screenings could potentially cut breast-cancer deaths by 30 percent.
Now a recently released study shows that mammograms are dramatically more effective than previously thought: They can cut breast cancer mortality by 63 percent.
"Women should understand that if they have regular mammography screenings, they will reduce their risk of dying from breast cancer by about two-thirds," says Robert A. Smith, director of cancer screening at the American Cancer Society.
For its study, the cancer society analyzed previous Swedish research on mammograms. The Swedish research focused on 6,807 women between 20 and 69 years old who were diagnosed with breast cancer during a 29-year period in the counties of Dalarma and Ostergotland. Of these women, 1,863 died from the disease.
The researchers examined mortality rates during three time periods: 1968 to 1977, before mammograms were available; 1978 to 1987, when mammograms were offered to half the women in a large study in both counties; and 1988 to 1996, when all women older than 40 were sent invitations for free mammograms every two years.
By the 1988-96 period, breast cancer deaths had plummeted by 63 percent among those women who had mammograms.
Smith says he "hopes that the data will refute some recent studies that are questioning the very proven benefits of mammograms."
One of the problems with those recent studies was that "patients who refused mammograms were still counted as screened patients," explains Dr. Ward Parsons, medical director of the University of Texas Southwestern Center for Breast Care.
The new study is more accurate because it shows the true benefit for women who actually participate in breast-cancer screening, adds Dr. Etta D. Pisano, professor of radiology at the University of North Carolina School of Medicine.
Unlike the Swedish counties, the United States has no system to provide invitations for breast-cancer screenings because the health-care system here is decentralized, not really a system at all, says the cancer society's Smith. However, larger health-maintenance organizations have started to implement similar reminder programs, he says.
All states except Utah now require insurers and HMOs to cover the cost of mammograms, and programs like Medicare and Medicaid also pay for the expense, Smith adds.
Although the new study should settle the question of a mammogram's value, there's still some debate over the age at which a woman should get her first one. This, predictably, has confused many women, Smith says.
But, he adds, "the American Cancer Society has not changed its recommended guidelines since 1997."
Those guidelines state that:
Women 40 and older should have a screening mammogram every year.
- Women between the ages of 20 and 39 should have a manual breast examination by a health professional every three years. After age 40, women should have a manual breast exam as well as a screening mammogram every year.
During these examinations, "if a health professional detects a mass, a radiologist can perform a diagnostic mammogram and catch a problem before it becomes a significant threat," Smith says.
- Women 20 or older should perform a breast self-exam every month. By doing so, they get to know how their breasts normally feel and can better detect potential problems, such as a lump.
Doctors add that women under 40 should consider mammograms if they have certain risk factors. If there's a family history of breast cancer, women should begin a more rigorous screening schedule -- which should start about 10 years earlier than the earliest family case of breast cancer, says Dr. Lee B. Riley, medical director of the cancer center at St. Luke's Hospital in Bethlehem, Pa.
For example, he says, "If a mother has breast cancer at age 45, then I recommend the daughters have a mammogram screening starting at age 35."
Adds Smith, "The key to utilizing a mammogram to its fullest potential is by getting a high-quality screening performed by a competent clinician, with a consistent rate of participation at the recommended intervals."
What to Do: To learn more about mammograms, read the National Cancer Institute's mammogram primer. The American Cancer Society explains what to expect when you get a mammogram. To obtain National Cancer Institute fact sheets and other publications about breast cancer, click here.
