Should yearly mammograms start at 40?

Here in the UK, women aren’t usually invited to take regular mammograms until they reach the age of 50, and it’s been that way for years. However, a recent study from New York makes a solid case for women to start breast screening at a much earlier age.

According to the study, conducted by Weill Cornell Medicine and New York-Presbyterian, yearly mammograms for women between the ages of 40 and 80 could cut breast cancer deaths by 40% – which compares with a reduction of 23 to 31% with current screening recommendations that call for less frequent screening which start at an older age.

“Screening annually starting at age 40 is the best strategy to prevent an early breast cancer death,” said Dr Elizabeth Arleo, the leader of the study, which was published in the journal Cancer.

Why 50 in Britain?

Over two million women in the UK undergo mammograms, and the NHS Breast Screening Programme invites women to undergo a screening every three years from the age of 50. Why so late? Because the risk of breast cancer in women under that age is considered to be very low, and certainly too low for a public health service to spend money on in financially-strapped times – which is also why they tend not to issue an automatic invitation to women over 70.

This is not a new theory: an argument that annual, earlier mammograms save more lives has been going on across the Atlantic for a while. Groups such as the American Cancer Society and the US Preventive Services Task Force – a government-backed panel – acknowledge that screening beginning at age 40 will catch more breast cancers, but believe that screenings taken at this age also produce the most false positive results.

According to Dr Otis Brawley, Chief Medical Officer of the American Cancer Society, yearly mammograms starting at 40 would also lead to the most women being called back to doctors’ offices for false alarms and biopsies that turn out to be negative. In other words, for a 40-year-old woman who starts mammography now, the odds of having a false positive are ‘very high’ while the odds that the test will save your life ‘are very small’.

To screen or not to screen?

It’s only when women reach the age of 47 or 48 that the risk/benefit ratio begins to change, and the benefits of screening outweigh the risk of overdiagnosis, claims Dr Brawley. This is reflected in the suggestion by the American Cancer Society that yearly mammograms should start at the age of 45, moving to every other year by the time women reach the age of 55. The US Preventive Services Task Force, on the other hand, recommends that screening should occur every two years from the age of 50.

And it looks like the tide may be turning over here, with some parts of England running a trial where women aged 47 to 73 are being invited to commence or extend a breast screening programme.

At Thames Breast Clinic, we offer a one-stop breast diagnosis clinic for women who wish to go down the private route to seek diagnosis and reassurance.