By Jacquelyn Paykel and William H. Wolberg
The controversy concerning the usefulness of screening mammography in younger-than-50 women continues. In general, two factors are consistently overlooked that should bear heavily on screening recommendations, particularly as they pertain to national policy. First, understanding why screening is more beneficial after as opposed to before age 50; second, assessing the societal cost of routine screening in younger women.
Pivotal to this discussion – and unavailable from any of the current studies – is the menopausal status of the patients being screened. Biological age is more important than is chronological age. At the time of menopause, the ovaries cease to produce estrogen. Lacking bodily estrogen, the breast glandular tissue involutes, and cancerous nodules become more apparent by mammogram. Therefore, screening is going to be as advantageous to a woman who is postmenopausal at age 48 as it is to a woman at age 55 or older. The reported screening studies have been conveniently designed based on the subjects’ date of birth (age), rather than on the appropriate standard which is the menopausal status of the subject. Furthermore, women who started to receive mammograms before age 50 continued to receive them after their fiftieth birthday. Not only was the menopausal status ignored, but any beneficial effect of screening before 50 could not be distinguished from that occurring after 50.
Some otherwise undetectable cancers are found by mammography in younger-than-50 women. Women in this age group who have been mammographically diagnosed become strong advocates for screening. However, the radiation given with mammograms undoubtedly causes some cancers particularly in younger women when the breast is under estrogen stimulation. What is unclear is whether mammograms result in curing more cancers than they cause in this age group. The available data indicate that there is a close trade off. [Read More…]