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Mammograms, 40-Year-Olds: It’s In The Risks

May 2, 2012
Written by: , Filed in: Breast Imaging
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Those debating whether women in their 40s should receive routine mammograms tend to take absolutist positions: all 40-something women should be screened, or none of them should.

Two studies published Tuesday in Annals of Internal Medicine say instead that some women in their 40s should be screened—those with extremely dense breasts and those with a mother, sister, or daughter who has had breast cancer. Said one author of both studies:

They’re twice as likely to develop breast cancer as the average woman, and that higher risk of developing breast cancer tips the balance to having more benefit to the harms.

That’s the summation of Jeanne Mandelblatt, MD, an oncologist at Georgetown University, as quoted by Rob Stein of NPR News.

One of the studies did a meta-analysis of 66 previous studies. It concluded that having extremely dense breasts or first-degree relatives with breast cancer was associated with at least a doubled risk of breast cancer. Having a prior breast biopsy, second-degree relatives with breast cancer, or heterogeneously dense breasts was associated with an increase in risk of one and a half to two times. Use of oral contraceptives, not having given birth, and being 30 or older when giving birth for the first time were associated with an increased risk of up to one and a half times.

The second study, a comparative modeling study, tried to determine what level of increased risk would make the harm-benefit ratio of routine mammograms for women in their 40s the same as it is for women 50 through 74. Turns out the magic number is two. Hence the conclusion that extremely dense breasts or a first-degree relative with breast cancer bumps the risk-reward balance for women in their 40s to that of average women in their 50s. That, in Dr. Mandelblatt’s words, is “the tipping point.”

Karla Kerlikowske, MD, of the University of California, San Francisco, who also worked on both studies, summed up their recommendations: “If’ you’re a 40-year-old who’s at high risk of breast cancer, then undergoing mammography every two years makes sense for that person. If you’re a 40-year-old person who’s at very low risk, waiting till you’re 50 is reasonable.”

Not everyone agrees with that, of course. But the studies do add some nuance to the mammography debate. Not that nuance is necessarily what a lot of people are looking for.

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