The recent evidence on the harms of routine mammography has initiated considerable debate among medical experts as to what is the best approach for breast cancer screening – especially for women in their 40’s. It demands a closer look at how primary care physicians are making screening decisions for their patients. Rather than follow a basic protocol for screening based on age, it may be more appropriate to make informed decisions based on individual risk and patient preference to develop a personalized approach to mammography screening.
Medical experts generally agree that women with the following factors have a greater risk of developing breast cancer: first-degree relative with breast cancer history, BRCA gene mutations, past history or current smoker, obesity, nulliparity (not bearing offspring) and past or current use of hormone therapy.
A recent systematic review and meta-analysis was initiated to identify which risk factors for breast cancer are specific to women in their 40’s and to what extent, that in turn could assist in making individualized informed screening decisions (Risk Factors for Breast Cancer For Women Aged 40-49 Years, Annals of Internal Medicine, May 2012).
The researchers concluded that extremely dense breasts and first-degree relatives with breast cancer (mom or sister) each doubled the risk for breast cancer in women aged 40 to 49 years. Prior breast biopsy, second-degree relatives with breast cancer, or heterogeneously dense breasts (dissimilar density in one breast relative to the other) were each associated with a 1.5- to 2.0-fold increased risk. Current use of oral contraceptives, nulliparity, and age 30 years or older at first birth were associated with a 1.0- to 1.5-fold increased risk.
Although the study did not consider the effects of multiple risk factors (further research to study the combined effects of these factors on overall risk is warranted), identification of these individual risk factors may be useful for personalized mammography screening. Making screening decisions based on a woman’s individual cancer risk has the potential to save more lives than current conventional practice. Risk-based screening can refocus efforts onto the women who are most likely to benefit from screening, while minimizing associated harms in those who are not as likely to benefit from mammography screening. It is also important to respect the preferences of individual women. Joint decision making with the patient will ultimately help lead to better outcomes.
Just as there is not a “one-size-fits-all” undergarment to support women’s breasts, we are learning that neither is there a screening protocol that suits all women when it comes to breast cancer screening.Leave a reply