Evidence of efficacy of mammographic screening for women in their forties

✍ Scribed by William D. Dupont

• Publisher: John Wiley and Sons
• Year: 1994
• Tongue: English
• Weight: 259 KB
• Volume: 74
• Category: Article
• ISSN: 0008-543X
• DOI: 10.1002/1097-0142(19940815)74:4<1204::aid-cncr2820740404>3.0.co;2-6

✦ Synopsis

The essence of the argument by Kopans et al.' in favor of mammographic screening for women in their forties can be summarized as follows:

1. Screening has been shown to save lives in women older than 50 years of age through randomized clinical trials.

2. Mammography can detect occult invasive cancers

in younger women which, if left undetected, would result in grim and early deaths. 3. It is unlikely that mammography will save a higher percentage of breast cancer deaths for women in their forties than for older women. Studies of women in their forties performed to date have insufficient power to show such a benefit and, therefore, do not prove that no benefit exists. 4. It may be possible to show the benefit of mammography for women in their forties with an enormous clinical trial. Such a trial would be expensive and may well be politically, clinically, and ethically unfeasible. 5. Regardless of whether such a trial is performed, points 1-3 justify screening all women older than age 40. Whether we accept this argument is critically dependent on the magnitude of the mortal risk reduction to younger women that will accrue from screening, on the strength of evidence supporting this reduction, and on the risks and costs associated with mammography. It may be helpful to consider the following in making this evaluation.

1. Magnitude of Mortal Risk Reduction for

Women Aged 50-69 Years.

There is consistent evidence' from the studies performed to date showing a reduction of approximately

From the Department of Preventive Medicine, Vanderbilt Uni-