Concerns about recommending routine screening mammograms for women aged 40-49 years

Benign-appearing mammographic abnormalities in women aged 40-49

The ongoing debate was addressed concerning the appropriateness of mammographic screening for women aged 40-49 years, with particular emphasis on those patients with benign-appearing mammographic abnormalities (BMA), and whether findings differed from those of successive age decades. A review was conducted of 2,482 patients presenting for surgical consultation with a mammographic abnormality as a chief complaint, with particular emphasis on the 1,632 patients with BMA and more specifically those aged 40-49 years. Surgical interventions and risk factors for breast cancer were evaluated. Although 16% of 393 patients with BMAs biopsied were proven to have breast cancer, only 2.7% of all patients with BMAs were found to have breast cancer as a result of biopsy or short-term follow-up. Women aged 40-49 years represented 48% of patients with BMAs, and only 1.5% of these patients had breast cancer. The finding of breast cancer in the BMA population was progressive by decade of age, as would be expected, and in a cut-point analysis of those biopsied, age 60 best divided patients into high- and low-risk groups. Women aged 40-49 years with BMAs should not be excluded from mammographic screening, as they represented part of a continuum when successive decades were compared. Efforts should be directed at minimizing patient and physician anxieties as well as diagnostic interventions related to a BMAs.

Screening mammography in women aged 40-49 years

Screening mammography in women aged 40-49 years reduces breast cancer mortality by 16%-18%, and is recommended by various national organizations. However, one must be aware of the recognized limitations of the approach. The actual benefit appears to be small (absolute risk reduction, 0.07%; the number of women who need to be screened to prevent 1 woman from dying of breast cancer, about 1,500-2,500), and there are associated risks and costs with this approach. The medical and scientific communities, in partnership with advocacy groups, must continue to work to improve our breast diagnostic capabilities, especially in younger women. Since this is an emotional and controversial issue, each woman will need to consider, with the aid of her primary caregiver, whether the risks of screening outweigh its potential benefits, and make an informed decision regarding screening.