Why Breast Cancer Risks are Higher for Younger Women

Why Breast Cancer Risks are Higher for Younger Women

And so the mammography debate goes on. A new study from the journal Cancer was just released, refuting guidelines by the U.S. Preventive Services Task Force (USPTF) to defer mammography until age 50.

You may remember when the USPTF first introduced its guideline change in 2009, and the intense difference of opinion it sparked between our renowned scientists and institutions.

What are the facts?

  • We know that mammography saves lives through early diagnosis of breast cancer, particularly in women ages 50-74.
  • Breast cancer is the leading cause of death in women ages 40-59 in the US.

Why the debate?
The age at which women should begin to get mammograms and with what frequency is at the heart of the controversy. The USPTF advocates starting at age 50 and screening every 2 years. Other institutions, particularly the American Cancer Society, recommends that screening start at age 45 and be done annually (then every other year after age 55).

The problem is, the cancers that arise in the 30s-40s are often the most aggressive forms. In the newest study, of the 7,000 women with breast cancer, 609 died from the disease. Of those that died, 65 percent had never had a screening, and the median age of diagnoses for fatal cancers was 49 years, while that of nonfatal cancers was 72 years.

Breast cancer that develops early is more likely to be fatal—so we should screen more, right? That was the conclusion of the study in Cancer—and the source of the ongoing debate. The problem is that annual mammograms can miss many of them. So even if you’re annually screening women at the age of 40, you can still miss the majority of deadly cancers, as these can change from being a simple cell to metastatic cancer within months, before the next annual screening. Would you catch SOME with early diagnosis? Yes. But, you’d also cause many women to have more extra imaging, testing and even biopsies. Some studies show that for every 1,000 women receiving a mammogram between the ages of 40-49, 80 will require additional imaging, another 10 will need biopsies, and one life will be saved. However, other scientists argue that the benefit is much greater than this, and say that delaying mammography to age 50 may miss 15 percent of cancers that would be diagnosed if screening had started at 40.

What’s the bottom line?
Breast cancer is much less common for women in their 30s and 40s, but more dangerous. In the end, the decision has to be individual—one made by informed women, in discussion with their physicians.

Medically reviewed in July 2018.

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