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Mammography is not what is needed in developing countries

March 10, 2011

Lower income countries are feeling the pressure to implement mammography screening programs as in the United States and other industrialized countries. However, as discussed in an article published in this month's Lancet Oncology, such a program may not be the most beneficial way for these countries to use their resources to reduce breast cancer mortality.  The incidence of breast cancer is lower in these countries, therefore substantially more women would need to be screened to find a case of breast cancer. Additionally, there is a higher proportion of young women in the population of lower income countries, which results in an earlier average age of breast cancer diagnosis.  Because of this, it has been suggested that any future screening program begin at a younger age than in the US.  However, we know from our program in the US that mammography is less effective in younger women due to a higher prevalence of faster growing, more aggressive tumors in these women and the fact that younger women are more likely to have dense breasts.  As the author said, "For any population, the harm-to-benefit ratio [of mammography] depends on incidence, since there are more women who are exposed to the harm but receive no medical benefit when incidence is lower."  For this reason, it is likely that the benefits would not outweigh the harms in lower income countries. Furthermore, organized screening of asymptomatic women is likely impractical and not cost-effective for these health care systems.  As the author concludes, their limited resources "might be better used to raise awareness and encourage more women with palpable breast lumps to seek and receive treatment in a timely manner."