A failure analysis of more than 7,000 breast-cancer deaths published online by the journal Cancer has found that 71 percent of the confirmed breast cancer deaths occurred in the 20 percent of the study population that did not receive regular mammograms. In addition, the women who died tended to be younger. Half of the breast cancer deaths occurred in women under the age of 50, while only 13 percent were in women ages 70 or older.
Because the influential U.S. Preventive Services Task Force in 2009 issued a controversial recommendation that women without other risk factors could wait until 50 to start breast cancer screening, the ACR and Society of Breast Imaging (SBI) issued a statement underlining the study’s findings about the need for greater use of annual mammography in women ages 40-49.
“These findings should quiet those who argue that women age 40 to 49 do not need regular mammography screening. In fact, these women need annual screening – as do all women 40 and older. This is the message physicians should be promoting,” said Barbara S. Monsees, MD, FACR, chair of the ACR Breast Imaging Commission, in the statement
The study by Harvard Medical School researchers examined the records of 7,301 patients with invasive breast cancer diagnosed between 1990 and 1999 at Partners HealthCare hospitals and followed them through 2007, analyzing demographics, mammography use, surgical and pathology reports and recurrence and death dates to discover correlations.
A failure analysis is different than other studies that have examined the relative value of breast cancer screening because this type of analysis looks specifically at cases where the patient died in order to find clues to what might improve survival rates in the future.
In the study, the median age for women who died of breast cancer was 49. For those dying of any other cause, the median age at diagnosis was 72. Therefore, screening women under 50 annually might save more lives because while breast cancer is rarer in younger women, when it occurs, it is often faster growing and, as the study showed, more deadly.
Because of greater use of screening and better treatments, breast cancer mortality has been on steady decline (about 2 percent per year) in the last two decades, according to the ACR. “With more prevalent screening, especially in younger women, the study suggests that breast cancer mortality could decrease to much less than 10 percent overall in the next ten years, and perhaps to as low as 5 percent overall by 2030,” the ACR stated.