Screening Mammography for Most Women Recommended Every Two Years

The study compared three possible mammography-screening approaches with a model of current US screening practices.

The study’s findings were published on February 4, 2014, in the journal Annals of Internal Medicine. The study’s investigators recommend adoption of guidelines developed in 2009 by the US Preventive Services Task Force (USPSTF; Rockville, MD, USA). Under those guidelines, in addition to biennial screening for women aged 50 to 74, women aged 40 to 49 would be screened according to other risk factors, and women 75 and older would be screened depending on the presence or absence of other diseases.

The study was led by Laura J. Esserman, MD, MBA, a professor of surgery and radiology from the University of California, San Francisco (UCSF; USA), and an internationally known leader in the field of breast cancer. “The USPSTF guidelines are based on the best scientific evidence to date,” said Dr. Esserman, director of the Carol Franc Buck Breast Care Center at the UCSF Helen Diller Family Comprehensive Cancer Care Center. “What we need now is a better way to assess breast cancer risk and implement a more risk-based approach to screening. We have demonstrated that the resources for doing this are already in the system. We should redirect them to learning, enabling change, and improving outcomes.”

Approximately 70% of women in the United States, according to the investigators’ estimate, were screened for breast cancer in 2010, at a cost of USD 7.8 billion. Some women are screened yearly, some biennially, and some are screened on a sporadic basis.

The scientists compared this current outlook of breast cancer screening with three simulated models: annual screening of 85% of women aged 40 to 84, in accordance with recommendations from the American Cancer Society and many other policymaking organizations, at a yearly estimated cost of USD 10.1 billion; biennial screening of 85% of women aged 50 to 70, comparable to guidelines used in many European countries, at a yearly estimated cost of USD 2.6 billion; and screening in accordance with USPSTF recommendations, which the authors estimate would cost USD 3.5 billion per year at a screening rate of 85%.

“Over the last decade, in study after study, it has become very clear that—apart from limited, specific high risk groups—biennial screening is as effective as annual screening mammography,” said Dr. Esserman. “At the same time, annual screening is associated with a greater likelihood of false-positive results, which have an adverse impact on women’s well-being and quality of life. From the viewpoint of women’s health, the USPSTF screening recommendations make sense. “We can go one step further and learn who is at risk for what kind of breast cancer, and over time, further tailor screening by adjusting the age to start and frequency as well as include recommendations for prevention.”

Lead author Cristina O'Donoghue, MD, currently at the University of Illinois at Chicago (IL, USA), but with UCSF at the time of the study, noted that the billions of dollars saved from avoiding less-effective mammography screening could be used to improve women’s health. “We could increase women’s participation in screening, improve routine assessment of breast cancer risk and referral services for women at high risk, offer better genetic counseling for women with a family history of breast cancer and work on improving the quality of screening, with an emphasis on higher-quality mammography read by specialized mammographers,” said Dr. O'Donoghue. “These would be only some of the potential benefits of using our healthcare resources more intelligently.”

Related Links:
University of California, San Francisco
US Preventive Services Task Force