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Younger Women Do Benefit from Mammography

Screening finds cancers in earlier stages among women in their 40s, research shows

FRIDAY, Jan. 3, 2003 (HealthDayNews) -- Middle-age women who have regular mammograms are 56 percent more likely to have a breast cancer detected at earlier stages than women who don't undergo screening.

While there is controversy about the efficacy of mammograms for women in their 40s, a University of Colorado study has found that among more than 200 women diagnosed with breast cancer, those who had regular screening prior to their diagnosis were more likely to have the cancers found earlier, says study author Dr. Sandra Buseman, now a preventive medicine doctor for the Albany, N.Y., County Health Department.

There is debate about whether or not women with no family history of breast cancer should have regular mammograms in their 40s, Buseman says, because the breast tissue is denser, making detection trickier.

"It has been controversial. There is the risk of over-diagnosing, finding false-positives that lead to unnecessary biopsies and anxiety," Buseman adds. Conversely, a misreading of the dense tissue could mean missing a cancer.

"But this study supports the idea that screening is beneficial," she adds. "Those who had undergone regular mammography screening prior to being diagnosed with breast cancer showed the better outcome of being diagnosed at an early stage."

Earlier detection of breast cancer is associated with a better long-term prognosis and more treatment options, which is important for women in this age group because breast cancer is the leading cause of death for women in their 40's, and that age group accounts for 25 percent of all breast cancer deaths, according to the researchers.

"This is a good, very positive study that shows that screening matters," says Dr. Jay Brooks, chief of hematology and oncology at the Oschner Clinic Foundation in Baton Rouge, La. "Mammograms have a dramatic impact on the death rate."

Brooks says that the incidence of breast cancer rises sharply as women move through their 40s, from approximately 70 cases per 100,000 women at age 40 to about 130 cases per 100,000 at age 49, so that screening during this time can be very important despite concerns about the efficacy of mammograms.

"As they move through the decade, a woman's body is changing from a reproductive phase to a peri-menopausal and menopausal life, and one change is that breasts become less dense, which makes it better for mammography," he says.

In the study, Buseman investigated 247 women from a Denver, Colorado health maintenance organization (HMO) who had been diagnosed with breast cancer between the ages of 42 and 49. Data was collected on demography, family history, prior mammogram history, and cancer stage. For the purposes of the study, "early" cancer detection was defined as cancers found in stage 0 or 1, and "late" cancer detection was defined as stages II through IV.

Stage 0 and I breast cancers, according to the National Cancer Institute, are cancers that smaller than two centimeters (about 3/4s of an inch) and have not spread to the lymph nodes. Stages II and higher refer to cancers that are larger than 2 cm and may have spread to other parts of the body, making the cancer more difficult to treat.

The women were divided in two groups, 142 who had not had mammograms during the prior two years, and 105 who had undergone screenings at least once in the previous two years.

Among the women who had had mammograms, 39 percent had late-stage breast cancer, compared to 52 percent of the unscreened women. This was statistically translated into a finding that screened patients were 44 percent less likely than unscreened patients to be diagnosed at a later stage of cancer.

A further finding of the study was the benefit of mammography in detecting breast cancer. The test alone was responsible for diagnosing cancer in 55 percent of the asymptomatic screened patients and 61 percent of the asymptomatic unscreened patients. Asymptomatic, in breast cancer, means that no breast lump was found or that there was no discharge from the nipple, both of which are symptoms of the disease.

"A mammogram isn't a perfect test, but is really the best we have now," says Buseman, "and it is a beneficial tool for women who go on to have breast cancer."

What To Do

More recommendations for mammograms for women beginning at age 40 come from the the U.S. Preventive Services Task Force.

For in-depth information about breast cancer, you can visit The National Cancer Institute.

SOURCES: Sandra Buseman, M.D., M.S.P.H., physician specialist, Albany County Health Department, N.Y.; Jay Brooks, M.D., chief of Hematology and Oncology, Oschner Clinic Foundation, Baton Rouge, La.; Jan. 15, 2003, Cancer
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