The breast cancer screening debate that started in 2009 when the United States Preventive Services Task Force (USPSTF) recommended that women should start receiving regular mammograms at age 50 instead of 40 has started up again thanks to a new Harvard University study that suggests testing younger women may saves lives.
Researchers followed 600 women who had been diagnosed between 1990 and 1999 and tracked them until 2007. They found that half of the women who died were under age 50, and 71 percent of them never received a mammogram until their diagnosis.
“The biological nature of breast cancer in young women is more aggressive, while breast cancer in older women tends to be more indolent," lead author Blake Cady, professor emeritus of surgery at Harvard Medical School, told Science Recorder. "This suggests that less frequent screening in older women, but more frequent screening in younger women, may be more biologically based, practical, and cost effective."
But no reason to panic if you skipped your mammogram this year. Because the study used a technique that is called "failure analysis" (that is, the researchers looked backward from death to discover correlations at the time of diagnosis rather than looking forward at the start of the study), coupled with the fact that the women in the study were diagnosed before the 2009 recommendations, it doesn't necessarily provide a clear answer on whether mammograms at an earlier age reduce the risk of death from breast cancer.
In fact, this study highlights a problem: We haven't actually managed to reduce breast cancer deaths even with advanced screening, says Laura Esserman, M.D., M.B.A., professor of surgery and radiology at University of California, San Franciso, and director of the UCSF Carol Frank Buc Breast Cancer Center. "This study doesn't add anything to the screening debate; however, we do know that younger women tend to develop 'killer' cancers more often. In that case, the study highlights that we haven't managed to fix the problem of aggressive biology with screening."
In 2009, the USPSTF recommended that women shouldn't start getting regular mammograms until age 50 because they don't save enough lives to justify the expense associated with the worry, anxiety false positvies, and unnecessary biopsies that often accompany them. While many experts and cancer organizations such as the American Cancer Society encourage regular screening from an earlier age, the grim truth is that there's no guarantee that early screening is saving younger women from cancer.
"Screening works best for more slow-growing cancers," Esserman says. "For fast-growing cancers, unfortunately, no one is going to say, 'Oh, you were screened, so this is no problem.' For more aggressive cancers, we know that we cannot count on early detection alone to prevent death."
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Talk about mixed messages! But when it comes to heading off cancer, the most important thing you can do is make the most of the factors you can control, such as diet, fitness routine, and alcohol consumption, as well as talking to your doctor about any concerns you might have. "Make sure you're getting enough vitamin D," Esserman adds, "and if you're overweight, getting your BMI in the normal range can also be beneficial."
All that said, some women can benefit from early screening. For example, 55 to 85 percent of women with the BRCA1 gene mutation will go on to develop breast or ovarian cancer, studies suggest, so women who are at a higher risk of developing cancer are encouraged to begin screening earlier than the average woman.
Bottom line? Maintaining a healthy diet and knowing your body and family history may be the three best weapons in your arsenal against breast cancer.
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