The question, ”At what age should women begin getting regular mammograms?,” has been one of the most contentious in science and medicine .In 1993 , the International Workshop on Screening for Breast Cancer13 created considerable controversy when it concluded that for women aged 40 to 49 years ,randomized controlled trials consistently demonstrated no benefit from screening in the first 5 to 7 years after entry and a marginal benefit after that . The issue became even more inflamed after a 1997 National Institute of Health Consensus Conference on Breast Cancer Screening for Women Ages 40 to 49.39 The report, contrary to expectations, found insufficient data to recommend that women in their 40s get regular mammograms. Disagreement still exits over whether the modest reduction in mortality warrants a recommendation that all women in there 40s get regular mammograms. Disagree warrants a recommendation that all women in their 40s be screened .40 The argument turns primarily on the small population benefit archived and the fact that most of the benefit occurs when screened women are in their 50s. Only 1to2women’s lives would be extended per 1000 women of 40to 50 years of 10 years. However, in agreeing on a reduction in breast cancer mortality of 18%, the ACS and the NCI changed their screening recommendations, with the ACS now advising annual mammograms for women aged 40years and older. Annual screening for women in there 40s is based on the assumption of a shorter lead-time for younger women.
Controversy flared again in 2000, when Gotzsche and Olson published another metaanalysis of the world’s mammography trials and found most of the trials methodologically flawed. They concluded that mammography did not show a statistically significant benefit for women in any group.
Over the past several years, there has been a convergence of opinion across most medical organizations, including those that are grounded in evidence-based decision making, that mammography benefits women aged 40 years and older. Current controversies focus on the net benefits and optimal screening schedule. The benefit is modest. Because no trials have included sufficient numbers of older women to permit separate analyses by age, there are no good data on the upper limit of benefit. Most informed sources (e.g., ACS) not recommend regular screening for women aged 40 years and over, with some organizations recommending annual and some biennial screening.
The evidence suggests that a 5% to 20% additional benefit in mortality reduction can be achieved by adding a high-quality CBE. The US Preventive Services Task Force reviewed the data regarding CBE and concluded that they were insufficient to reach conclusions about efficacy or to issue population-based recommendations. No evidence has shown that BSE reduces mortality from breast cancer. Large trials conducted in China and Russia did not result in the hoped-for reduction of cancer mortality as a result of careful BSE instruction. In its 2002 report, the US Preventive Services Task Force concluded that the data also are insufficient to reach conclusions about BSE. Green and Taplin recommended that if women want to perform BSE, they are taught to do it correctly. Given the small windows of time physicians have to counsel and teach, time probably is best spent giving strong messages about the importance of mammography and performing a thorough CBE. Data from a large-scale service delivery program suggest that CBE may be most useful for women in their 40s where mammography may be somewhat less efficacious. Although the recommendations of different medical organizations vary, most encourage women to have a CBE yearly.
Controversy flared again in 2000, when Gotzsche and Olson published another metaanalysis of the world’s mammography trials and found most of the trials methodologically flawed. They concluded that mammography did not show a statistically significant benefit for women in any group.
Over the past several years, there has been a convergence of opinion across most medical organizations, including those that are grounded in evidence-based decision making, that mammography benefits women aged 40 years and older. Current controversies focus on the net benefits and optimal screening schedule. The benefit is modest. Because no trials have included sufficient numbers of older women to permit separate analyses by age, there are no good data on the upper limit of benefit. Most informed sources (e.g., ACS) not recommend regular screening for women aged 40 years and over, with some organizations recommending annual and some biennial screening.
The evidence suggests that a 5% to 20% additional benefit in mortality reduction can be achieved by adding a high-quality CBE. The US Preventive Services Task Force reviewed the data regarding CBE and concluded that they were insufficient to reach conclusions about efficacy or to issue population-based recommendations. No evidence has shown that BSE reduces mortality from breast cancer. Large trials conducted in China and Russia did not result in the hoped-for reduction of cancer mortality as a result of careful BSE instruction. In its 2002 report, the US Preventive Services Task Force concluded that the data also are insufficient to reach conclusions about BSE. Green and Taplin recommended that if women want to perform BSE, they are taught to do it correctly. Given the small windows of time physicians have to counsel and teach, time probably is best spent giving strong messages about the importance of mammography and performing a thorough CBE. Data from a large-scale service delivery program suggest that CBE may be most useful for women in their 40s where mammography may be somewhat less efficacious. Although the recommendations of different medical organizations vary, most encourage women to have a CBE yearly.
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