US women not following mammogram guidelines: study

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US women not following mammogram guidelines: study

By Amy Norton

NEW YORK, Jan 07 (Reuters Health) - Many US women do not heed

recommendations for regular breast cancer screening with mammograms

starting at age 40--and the result is fewer cancers diagnosed in the

earliest stages, according to Boston researchers.

Their study of nearly 60,000 women who underwent mammograms in the 1990s

found that half waited until age 50 to have their first screening. Yet

one quarter of invasive breast tumors were detected in women in their

40s, according to a report in the January 1st issue of the journal

Cancer.

" Far too many women did not comply with the American Cancer Society

recommendation of prompt annual screening from the age of 40 years, "

report Dr. son and his colleagues at Massachusetts General

Hospital and Harvard Medical School in Boston.

Part of the reason is that some primary care doctors remain unconvinced

that mammography starting at age 40 saves lives, co-author Dr. B.

Kopans told Reuters Health.

A woman's primary doctor, he noted, is key in her decision to get

screened.

" If your doctor recommends it, " Kopans said, " you'll probably do it. "

The Massachusetts study was conducted before the recent widespread

coverage of a Danish study suggesting that mammography has made no dent

in breast cancer deaths. So Kopans said he does not believe confusing

media messages to women explain his team's findings.

" But who knows what will happen now? " he added, noting that media

coverage of the mammography issue can confuse not only women, but also

their primary care doctors.

That Danish study--the researchers' reanalysis of their own earlier,

widely criticized review of several mammography studies--was published

late last year. The investigators concluded that routine mammograms do

not save women's lives.

" That's basically nonsense, " Kopans said, arguing that " data clearly

show the benefit " of regular mammograms from age 40 on.

The American Cancer Society (ACS) has pointed out that, among other

evidence, three decades' worth of data from Sweden suggest that the

introduction of routine mammography in 1987 led to a 63% drop in breast

cancer deaths among women aged 40 to 69. The ACS currently advises women

to start getting mammograms when they turn 40.

In the current study, though, only 20% of women said they had undergone

the x-ray screening annually since age 40. Half received their first

mammograms at age 50. And many women failed to return for a second

screen within 2 years of their initial one.

Moreover, the researchers estimate that almost half of the invasive

tumors found during the study were detected as larger--and potentially

more lethal--masses because of delays in follow-up mammograms.

Since Massachusetts has one of the higher mammography rates in the US,

the study authors write, " these disappointing findings probably

underestimate the national failure to utilize breast cancer screening to

its fullest benefit. "

According to the US National Cancer Institute, a woman's odds of

developing breast cancer by the age of 40 are 1 in 235. By age 50, the

chances are 1 in 54.

SOURCE: Cancer 2002;94:37-43.