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To Screen or Not to Screen? That is the Question
There’s been an ongoing debate about whether mammograms should be recommended for women in their 40s — in other words, whether the benefits outweigh the costs. The United States Preventive Services Task Force (USPSTF) recently said that routine screening was not necessary for women in their 40s, and thus began the controversy.
The American Cancer Society still recommends that women be screened after the age of 40. Now, two new studies with quite different findings throw some additional information into the pot, but whether they will help end the debate remains to be seen.
One study, published in the September 29, 2010 issue of Cancer finds that mammograms significantly reduced the mortality rate from breast cancer for 40-something women. The researchers at Umeå University in Sweden followed over one million women for 16 years. Some of the women had been invited to have mammograms by the counties in Sweden in which they lived. (Sweden requires women over between 50 and 69 to be screened, but individual counties may or may not "invite" their female residents to have mammogram screening.)
The authors found that among women who had been invited to have mammograms, the reduction in the death rate from breast cancer was 26%. As expected, the benefit was larger for women aged 45-49 than it was for women aged 40-44.
Another study, carried out in Norway and published in The New England Journal of Medicine’s September 23, 2010 issue, used a similar method to look at breast death rate among women between 50 and 69. Some of the women lived in counties that offered screening and some lived in counties that did not. The participants were followed for just over 2 years.
The team found that the death rate was reduced by about 10% in counties that offered screening, which was less than expected. The authors also calculate that "the screening program accounted for only one third of the total reduction in mortality among women who were invited to participate in the program"; according to the study, the other two-thirds were likely due to increased awareness and the ever-improving treatment options that are offered these days.
Women in U.S. may be confused by the recommendations of the various agencies, which are still currently at odds with one another. In addition to the issue of early detection, healthcare costs are also a factor: How much money is being spent to reduce the risk of how many women? As healthcare becomes a larger and larger part of everyone's budget, this, too, is an important factor.
What effect the two new studies will have on the USPTFS recommendations remains to be seen, but the first study surely adds fuel to the stance of the ACS. Time will tell whether breast cancer awareness societies will be able to agree on a recommendation.
October 13, 2010
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