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Study suggests biennial mammograms best after 50

Monday March 18, 2013
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Women ages 50 to 74 who undergo biennial screenings have a similar risk of advanced-stage disease and a lower cumulative risk of false-positive results than those who get mammograms annually, according to a study.

In 2009, the U.S. Preventive Services Task Force issued guidelines that biennial mammography, rather than the previously recommended mammography every one to two years, be performed for women ages 50 to 74. But the updated guidelines did not consider the influence of breast cancer risk factors beyond age, according to background information in the study, which was published March 18 on the website of JAMA Internal Medicine (formerly the Archives of Internal Medicine).

Karla Kerlikowske, MD, of the University of California, San Francisco, and colleagues sought to determine whether the benefits, such as early detection, and the harms, such as a false-positive mammography result or biopsy recommendation, differ among women undergoing screening mammography according to age, breast density and postmenopausal hormone therapy use.

The researchers analyzed data collected from January 1994 to December 2008 from mammography facilities in community practices that participate in the Breast Cancer Surveillance Consortium mammography registries. Data were collected from 11,474 women with breast cancer and 922,624 without breast cancer.

The authors found that biennial versus annual mammography for women ages 50 to 74 was not associated with an increased risk of advanced-stage or large-size tumors regardless of a women’s breast density or HT use. However, the researchers calculated that among women ages 40 to 49 with extremely dense breasts, biennial mammography versus annual was associated with an 89% increased risk of advanced-stage cancer and more than twice the risk of large tumors.

The results also showed that the cumulative probability of a false-positive mammography result was high among women undergoing annual mammography with extremely dense breasts who were either ages 40 to 49 (65.5%) or used estrogen plus progestogen (65.8%) and was lower among women ages 50 to 74 who underwent biennial or triennial mammography with scattered fibroglandular densities or fatty breasts.

In conclusion, the authors wrote, women ages 50 to 74, "regardless of breast density or HT use, can undergo biennial rather than annual mammography because biennial screening does not increase the risk of presenting with advanced disease but does substantially reduce the cumulative risk of a false-positive mammography result and biopsy recommendation."

Women ages 40 to 59 with extremely dense breasts who choose to undergo mammography "should consider annual screening to decrease the risk of advanced-stage disease but should be informed that annual screening leads to a high cumulative probability of a false-positive mammography result because of the additional screening examinations."

The study abstract is available at http://archinte.jamanetwork.com/article.aspx?articleid=1669103.


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