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NEWS & VIEWS |
A recent study suggests women 50 and older may be able to wait as long as two years between mammograms.
Researchers from the Fred Hutchinson Cancer Research Center in Seattle examined the records of 7,840 women diagnosed with invasive breast cancer or ductal carcinoma in situ to determine whether a longer interval between exams would cause breast tumors to be found at a later stage.
In women over 50, going two years between mammograms didn’t seem to make a difference. These older women were no more likely to be diagnosed with advanced cancer than women who got mammograms every year (OR = 0.97 for women 50-59, OR = 0.99 for women 60-69, OR = 0.88 for women 70 and older), the researchers report in the Journal of the National Cancer Institute (2004;96:1832–1839).
But for women in their 40s, the two-year interval did lead to greater risk of later-stage tumors being detected (OR = 1.35).
The findings should be taken into account when major health groups revise their guidelines for breast cancer screening, said lead researcher Emily White, PhD.
The ACS already recommends that women in their 40s get a mammogram every year to look for breast cancer.
"We have known for many years that breast cancer grows faster in younger women compared with older women," said Robert Smith, PhD, Director of Cancer Screening for ACS. "Based on that evidence, the ACS modified its guidelines in 1997 to recommend annual screening to women in their 40s."
"For women under 50, having screening every year compensates for the problem that they have faster growing tumors," White said. "But it doesn’t compensate for the fact that they have denser breasts and it’s harder to read the mammogram."
The ACS also advises women aged 50 and older to get a mammogram every year. Does White’s study mean that advice is no longer valid?
Not necessarily, said Smith. One reason the ACS urges older women to get screened every year is because there are so many factors at play—age, individual risk, individual characteristics, and the quality of screening where women are being seen—that a more cautious approach is still needed at this time. Breast density, family history of breast cancer, or use of hormone therapy all might make a difference in how fast a tumor grows and how easy it is to find.
Although there are studies suggesting it’s safe to wait two years between mammograms, "we cannot say exactly at what [age] women could start screening at a wider interval," Smith said. While the age of 50 may be easy to remember, it may not be the best cutoff point.
White’s study will be one of many taken into consideration when it’s time to review the screening guidelines, he said, which occurs no less frequently than every five years, and even more frequently if new findings suggest the need for an interim update. At that time it may also be possible to find other studies that help define age groups or other factors that could safely allow women to wait longer between mammograms. The guidelines were last updated in 2003.
A potential advantage to screening older women less often, White said, would be the money saved. "You don’t want to spend health care dollars on things that don’t bring a benefit," she said.
Smith agreed that looking at the costs to society is important, but questioned how much money could really be saved.
"If women over age 50 could be screened every two years with the same benefit as annual screening, then the cost savings could be considerable," he said, "if we [currently] had high rates of adherence to recommended screening guidelines."
The problem is, most women don’t follow the current guidelines. Right now, women are more likely to get screened every 18 to 36 months, Smith said. That means the cost savings from moving to a two-year schedule might not be as large as expected, although it could still be considerable because so many women get screened.
Even a two-year mammography interval can have an impact on breast cancer mortality, though. Writing in BMJ (2005;330:220–223), Danish researchers report that breast cancer mortality dropped by 25% in Copenhagen after the city introduced biannual screening for women 50 and older. The screened women were compared with women in other regions of the country where organized screening was not available.
Today, some health insurers pay for annual mammograms, and some pay only for mammograms every two years, Smith said. Medicare pays for women 40 and older in the program to have a mammogram every year.
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