California Forum

Revised guidelines recommend later screening for breast cancer

Michelle Barry was diagnosed with breast cancer when she was 41, working full time and raising three children. Four years later, she has rebounded.
Michelle Barry was diagnosed with breast cancer when she was 41, working full time and raising three children. Four years later, she has rebounded. rpench@sacbee.com

A breast cancer diagnosis is devastating at any age, but for women in their 20s and 30s, the disease and its treatment can create additional challenges.

Growing number of women in 20s, 30s confront disease” (Insight, Oct. 17) was a poignant reminder that cancer can strike at any age, and that women and their health care providers should remain vigilant.

However, the story’s implication that screening mammograms for all women beginning at age 35 would address the problem, as suggested by former breast cancer surgeon Ernie Bodai, is outdated and misguided.

The nation’s two largest organizations that make cancer screening recommendations – the American Cancer Society and the U.S. Preventative Services Task Force – revised their guidelines last year based on extensive research.

The Cancer Society recommends that healthy women with no strong family history of breast cancer start screening at 45, and suggests that women 40-44 make an individual choice. The task force advises that women begin screening at 50, and that women 40-49 make a personal choice. No society recommends screening or even a “baseline screen” for women under 40 unless they are at very high risk due to rare factors.

The changes reflect evidence that younger women are less likely to benefit from screening. Mammography does not work as well in young women because they have dense breast tissue, which masks lesions. And cancer is very rare in young women, but when it occurs, it often grows fast, making it less likely that routine screening will detect it. Younger women are also more likely to experience false alarms that can result in unnecessary biopsies. And up to 30 percent of screen-detected breast cancers would never have harmed the woman in her lifetime, yet treatment of these cancers can have significant health consequences.

It is understandable that a breast surgeon who treated young women would feel strongly that every woman should have regular screening, including those under 45. But there is no one-size-fits-all, and women 40-49 should decide for themselves about screening.

Diana Miglioretti is the dean’s professor in biostatistics at UC Davis, member of the UC Davis Comprehensive Cancer Center and author of numerous scholarly articles on screening mammography. Contact her at dmiglioretti@ucdavis.edu.

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