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From OncoLog, May 2014, Vol. 59, No. 5

Screening Mammography for Breast Cancer Saves Lives
MD Anderson recommends most women begin screening mammography at age 40

Graphic: House CallYou may have seen conflicting reports about breast cancer screening over the past few months. Even among doctors, opinions vary about what the benefits of screening with breast mammography (x-rays) are and which women should be screened. Experts at The University of Texas MD Anderson Cancer Center continue to recommend screening mammography because it prevents cancer-related deaths.

Benefits of mammography screening

Mammography has been used in breast cancer screening for decades and evaluated in numerous clinical studies in various groups of patients. An overall analysis by the U.S. Preventive Services Task Force of multiple studies found that screening mammography reduced the risk of breast cancer–related death by 15%–20%.

“Screening mammography is the most studied cancer screening test available,” said Therese Bevers, M.D., a professor in the Department of Clinical Cancer Prevention, “and it’s clear that fewer women will die from breast cancer if more women are screened.”

Risks from mammography

A common misconception about mammography is that the radiation dose poses a threat. Dr. Bevers said that although a person’s lifetime radiation dose from all imaging is a concern, the radiation received during screening mammography is equivalent to that received during a round-trip transatlantic flight.
Photo: Woman undergoing mammography
“It’s important to keep concerns about the radiation dose in perspective,” Dr. Bevers said. “Screening mammography uses the lowest radiation dose of any kind of x-ray examination.”

Another major concern is that mammography can produce false-positive results, that is, the mammogram may show a lesion that looks like cancer but isn’t. False-positive results can cause anxiety and lead to unnecessary testing.

When mammography reveals a suspicious-looking lesion, the patient may have to return to the clinic for further testing, which could include additional mammography, ultrasonography, or even a needle biopsy to rule out breast cancer. While these tests pose very little threat to the patient’s health, they can be uncomfortable, inconvenient, and expensive.

Another concern is overtreatment, which occurs when patients receive treatment that was unnecessary. For example, it is possible for a false-positive finding to result in treatment for a precancerous lesion that might never develop into cancer or harm the patient if left alone. However, Dr. Bevers said that overtreatment is much less common in breast cancer than in some other cancers, such as prostate cancer.

The 2009 analysis by the U.S. Preventive Services Task Force found that although screening mammography reduced the risk of breast cancer–related death among women 40–49 years old, the rate of false-positive findings was higher for this group of women than for other age groups. However, Dr. Bevers said, “Forty percent of the years of life lost to breast cancer death are from women in their 40s. While we have to consider the possible harms, most women understand that a reduced chance of dying from breast cancer outweighs the risk of a follow-up test for a false-positive finding.”

Who should be screened?

Dr. Bevers said that a risk assessment is the first step in breast cancer screening. Women can determine their risk level for breast cancer by having a discussion with their health care providers. Among the risk factors for breast cancer are age, family history of breast cancer, genetic mutations such as those to the BRCA1 or BRCA2 genes, and personal history of precancerous lesions.

MD Anderson recommends that women 20–39 years old at average risk for breast cancer undergo clinical breast examinations without mammography every 1–3 years. Women 40 years or older at average risk for breast cancer should undergo annual clinical breast examinations and mammography.

Women with a higher risk for breast cancer may begin screening mammography at a younger age, undergo more frequent screening, or be screened with additional tests such as magnetic resonance imaging (MRI).

“While we may add tests such as MRI, at this time nothing replaces screening mammography,” Dr. Bevers said. “Mammography is the only test that has been shown to reduce a woman’s chance of dying from breast cancer.”

— B. Tutt

For more information, ask your physician, visit www.mdanderson.org, call askMDAnderson at 877-632-6789, or call the Cancer Prevention Center at 713-745-8040 or 800-438-6434.

Other articles in OncoLog, May 2014 issue:

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