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Advocate Analysis: Study on screening mammography in women under 40

May 14, 2010

This study confirms what my breast surgeon told me over four years ago -- that finding a tumor in a mammogram of a woman under the age of 40 was like "looking for a snowball in a blizzard." In other words, it is very difficult and not reliable. This study looked at a large group of women under the age of 40 who had had a first mammogram, to examine the accuracy and reliability of mammograms in women under the age of 40. The study looked at two types of mammograms performed in younger women, screening mammograms and diagnostic mammograms. Screening mammograms are those performed as a matter of routine, to look for breast cancer in the absence of any specific symptoms. While screening mammograms are no longer recommended by the American Cancer Society in women under the age of 40, they are still performed. This study found that in screening mammograms, cancer was detected only 1.6 times out of 1,000 and the sensitivity (probability of a positive test given that cancer was detected within a year) and positive predictive value (probability of cancer detection within a year after a positive test) of mammograms was poor. In addition, women under the age of 40 were more likely to be recalled for further testing or imaging, exposing them to additional radiation, and have false-positive results causing needless anxiety. However, diagnostic mammograms were found to be more accurate and reliable than screening mammograms in women under 40. Diagnostic mammograms are those performed because a woman has found a symptom in her breast (such as a lump) which could indicate a cancer. For diagnostic mammograms, the sensitivity and positive predictive value were higher as were the number of actual cancers discovered, 14.3 per 1000.

The take home message in this study is that screening mammograms in women under 40 are not reliable, do not detect many cancers, and may even be harmful to the patient. Serious consideration should be given before a woman under 40, without symptoms of breast cancer, has a mammogram. Diagnostic mammograms, however, are more likely to find a cancer and should continue to be used when women of any age find a lump or other breast abnormality that could be cancer.

And by the way, while my surgeon did not see anything on my mammogram that definitively showed a tumor, less than a week after visiting my surgeon I was diagnosed with breast cancer at the age of 37.

-Michelle Esser, Quality Care Project LEAD® 2007, Project LEAD® 2008

Comments

VickyTM

Date: May 23, 2010

Michelle does a good job of distinguishing between diagnostic and screening mammograms. Many women think that because mammography isn't recommended as a screening tool for women under 40 that they can't get one if they have a problem - which is obviously not true - though other tests may be better a detecting a breast cancer.

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Date: May 15, 2012

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