To Screen or Not to Screen Women in Their 40s for Breast Cancer: Is Personalized Risk-Based Screening the Answer?
Authors: Jeanne S. Mandelblatt, Natasha Stout, Amy Trentham-Dietz
Journal: Annals of Internal Medicine (2011)

Editorials5 July 2011To Screen or Not to Screen Women in Their 40s for Breast Cancer: Is Personalized Risk-Based Screening the Answer?Jeanne S. Mandelblatt, MD, MPH, Natasha Stout, PhD, and Amy Trentham-Dietz, PhDJeanne S. Mandelblatt, MD, MPHFrom Lombardi Comprehensive Cancer Center, Washington, DC 20057; Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02215; and University of Wisconsin Carbone Cancer Center, Madison, WI 53792., Natasha Stout, PhDFrom Lombardi Comprehensive Cancer Center, Washington, DC 20057; Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02215; and University of Wisconsin Carbone Cancer Center, Madison, WI 53792., and Amy Trentham-Dietz, PhDFrom Lombardi Comprehensive Cancer Center, Washington, DC 20057; Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02215; and University of Wisconsin Carbone Cancer Center, Madison, WI 53792.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-155-1-201107050-00008 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail After decades of research and numerous consensus panels, guidelines on the use of screening mammography to detect breast cancer among women aged 40 to 49 years (1, 2) continue to generate controversy in the scientific community (3) and confusion in the public sector (4–6). The most recent update to screening mammography guidelines by the U.S. Preventive Services Task Force (2) was based on a synthesis of the clinical trial evidence about the balance of benefits and harms of screening for average-risk women and did not consider costs. They concluded that "there is moderate certainty that the net benefit [in terms ...References1. Qaseem A, Snow V, Sherif K, Aronson M, Weiss KB, Owens DK; Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Screening mammography for women 40 to 49 years of age: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2007;146:511-5. [PMID: 17404353] LinkGoogle Scholar2. U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151:716-26, W-236. [PMID: 19920272] MedlineGoogle Scholar3. Hendrick RE, Helvie MA. United States Preventive Services Task Force screening mammography recommendations: science ignored. AJR Am J Roentgenol. 2011;196:W112-6. [PMID: 21257850] CrossrefMedlineGoogle Scholar4. Kolata G. Panel urges mammograms at 50, not 40. New York Times. 16 November 2009. Accessed at www.nytimes.com/2009/11/17/health/17cancer.html on 25 May 2011. Google Scholar5. Sargenti S, Dresdale A. Celeb survivors protest breast cancer screening guidelines. ABC News. 18 November 2009. Accessed at abcnews.go.com/Health/OnCallPlusBreastCancerNews/celeb-survivors-rail-breast-cancer-screening-guidelines-olivia/story?id=9128759 on 25 May 2011. Google Scholar6. Taranto J. Death panels already? Wall Street Journal. 17 November 2009. Accessed at online.wsj.com/article/SB10001424052748704782304574541833250894194.html on 25 May 2011. Google Scholar7. Schousboe JT, Kerlikowske K, Loh A, Cummings SR. Personalizing mammography by breast density and other risk factors for breast cancer: analysis of health benefits and cost-effectiveness. Ann Intern Med. 2011;155:10-20. [PMID: 21257850] LinkGoogle Scholar8. Gail M, Rimer B. Risk-based recommendations for mammographic screening for women in their forties. J Clin Oncol. 1998;16:3105-14. [PMID: 9738582] CrossrefMedlineGoogle Scholar9. Mandelblatt JS, Cronin KA, Bailey S, Berry DA, de Koning HJ, Draisma G, et al; Breast Cancer Working Group of the Cancer Intervention and Surveillance Modeling Network. Effects of mammography screening under different screening schedules: model estimates of potential benefits and harms. Ann Intern Med. 2009;151:738-47. [PMID: 19920274] LinkGoogle Scholar10. Boyd NF, Martin LJ, Bronskill M, Yaffe MJ, Duric N, Minkin S. Breast tissue composition and susceptibility to breast cancer. J Natl Cancer Inst. 2010;102:1224-37. [PMID: 20616353] CrossrefMedlineGoogle Scholar11. Aiello EJ, Buist DS, White E, Porter PL. Association between mammographic breast density and breast cancer tumor characteristics. Cancer Epidemiol Biomarkers Prev. 2005;14:662-8. [PMID: 15767347] CrossrefMedlineGoogle Scholar12. Ma H, Luo J, Press MF, Wang Y, Bernstein L, Ursin G. Is there a difference in the association between percent mammographic density and subtypes of breast cancer? Luminal A and triple-negative breast cancer. Cancer Epidemiol Biomarkers Prev. 2009;18:479-85. [PMID: 19190139] CrossrefMedlineGoogle Scholar13. Ziv E, Tice J, Smith-Bindman R, Shepherd J, Cummings S, Kerlikowske K. Mammographic density and estrogen receptor status of breast cancer. Cancer Epidemiol Biomarkers Prev. 2004;13:2090-5. [PMID: 15598766] MedlineGoogle Scholar14. Conroy SM, Pagano I, Kolonel LN, Maskarinec G. Mammographic density and hormone receptor expression in breast cancer: The Multiethnic Cohort Study. Cancer Epidemiol. 2011;:. [PMID: 21247819] CrossrefMedlineGoogle Scholar15. Martin LJ, Boyd NF. Mammographic density. Potential mechanisms of breast cancer risk associated with mammographic density: hypotheses based on epidemiological evidence. Breast Cancer Res. 2008;10:201. [PMID: 18226174] CrossrefMedlineGoogle Scholar16. Chiu SY, Duffy S, Yen AM, Tabár L, Smith RA, Chen HH. Effect of baseline breast density on breast cancer incidence, stage, mortality, and screening parameters: 25-year follow-up of a Swedish mammographic screening. Cancer Epidemiol Biomarkers Prev. 2010;19:1219-28. [PMID: 20406961] CrossrefMedlineGoogle Scholar17. Kerlikowske K, Ichikawa L, Miglioretti DL, Buist DS, Vacek PM, Smith-Bindman R, et al; National Institutes of Health Breast Cancer Surveillance Consortium. Longitudinal measurement of clinical mammographic breast density to improve estimation of breast cancer risk. J Natl Cancer Inst. 2007;99:386-95. [PMID: 17341730] CrossrefMedlineGoogle Scholar18. U.S. Food and Drug Administration. Mammography Quality and Standards Act National Statistics. Silver Spring, MD: U.S. Food and Drug Administration; 2011. Accessed at www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/FacilityScorecard/ucm113858.htm on 25 May 2011. Google Scholar19. Pisano ED, Gatsonis C, Hendrick E, Yaffe M, Baum JK, Acharyya S, et al; Digital Mammographic Imaging Screening Trial (DMIST) Investigators Group. Diagnostic performance of digital versus film mammography for breast-cancer screening. N Engl J Med. 2005;353:1773-83. [PMID: 16169887] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Jeanne S. Mandelblatt, MD, MPH; Natasha Stout, PhD; Amy Trentham-Dietz, PhDAffiliations: From Lombardi Comprehensive Cancer Center, Washington, DC 20057; Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02215; and University of Wisconsin Carbone Cancer Center, Madison, WI 53792.Grant Support: By grants U01 CA00905, UO1CA088283, U01CA152958, KO5CA096940 (Dr. Mandelblatt), R01 CA067264 (Dr. Trentham-Dietz), U01CA086076-10S1, and RC2 CA148577 from the National Institutes of Health and grant 118223-MRSG-10-002-01-CPHPS from the American Cancer Society (Dr. Stout).Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-1100.Corresponding Author: Jeanne S. Mandelblatt, MD, MPH, Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street Northwest, Suite 4100, Washington, DC 20057; e-mail, mandelbj@georgetown.edu.Current Author Addresses: Dr. Mandelblatt: Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street Northwest, Suite 4100, Washington, DC 20057.Dr. Stout: Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215.Dr. Trentham-Dietz: University of Wisconsin Carbone Cancer Center, 610 Walnut Street, WARF Building, Room 307, Madison, WI 53726. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPersonalizing Mammography by Breast Density and Other Risk Factors for Breast Cancer: Analysis of Health Benefits and Cost-Effectiveness John T. Schousboe , Karla Kerlikowske , Andrew Loh , and Steven R. 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