Breast cancer

29 December 2018

For some women, mammograms may need to begin at 30

Experts are looking to see if younger women with certain risk factors may benefit from earlier onset screening mammography.

Women at increased risk for breast cancer should start receiving mammograms earlier than recommended, even as young as age 30, a new study contends.

Young women who have dense breasts or a family history of breast cancer appear to benefit from regular mammograms as much as women in their 40s do, researchers reported.

The findings support new breast cancer screening recommendations issued by the American College of Radiology this year, said lead researcher Dr Cindy Lee, an assistant professor of radiology at NYU Langone Health in New York City.

"Every woman by age 30 should have a risk assessment with their primary care physician or ob-gyn to see if they are at increased breast cancer risk," Dr Lee said. "If there is family history, then maybe they should consider a baseline mammogram to determine their breast density."

Just not enough evidence

Breast cancer screening guidelines now call for women to start regular mammograms later in life.

The US Preventive Services Task Force recommends mammograms every other year for women aged 50 to 74, while the American Cancer Society recommends annual mammograms from 45 to 54 and at least every other year from 55 onward.

But Dr Lee said no one has really examined the benefits of starting breast cancer screening in a woman's 30s.

"So far, everyone is talking about screening women above the age of 40, but we're looking at a decade earlier because there's just not enough evidence out there," Dr Lee said. "We're looking to see if younger women with certain risk factors may benefit from earlier onset screening mammography."

For this study, Dr Lee and her colleagues analysed data from more than 5.7 million screening mammograms performed on more than 2.6 million women between 2008 and 2015. The mammograms took place at 150 facilities in 31 states in the United States.

The researchers looked at women aged 30 to 39 with three specific risk factors – dense breasts, prior diagnosis of breast cancer, or breast cancer in a first-degree relative (mother, sister or daughter).

Preliminary research

The investigators compared the results of mammography in these women against mammograms given to women aged 40 to 49 without those risk factors.

Breast cancer was detected about as often in younger women with these risk factors as in women in their 40s, the researchers found.

They also determined that women in their 30s with breast cancer risk factors have to come back to the doctor for further testing and biopsy about as often as older women undergoing regular screening.

"Women with at least one of these three risk factors likely benefit from screening mammogram beginning at age 30, instead of age 40," Dr Lee said.

The findings were to be presented Wednesday at the Radiological Society of North America annual meeting, in Chicago. Such research is considered preliminary until published in a peer-reviewed journal.

A breast cancer risk assessment and possible initiation of mammograms at age 30 doesn't necessarily run counter to current screening guidelines, said Robert Smith, vice president of cancer screening for the American Cancer Society.

Regular surveillance

"The ACS guidelines for women at higher risk already recommend breast cancer screening before age 40 if a woman is a carrier of a known or suspected mutation on a breast cancer susceptibility gene, or if she was exposed to radiation treatment for childhood cancer," Smith said.

"Likewise, women and their doctors can make individual decisions. So if a woman has a family history in a first-degree relative diagnosed before the age of 50, it is not unreasonable for her to seek advice about whether she should begin screening before age 50," he said.

The US Preventive Services Task Force recommendation on breast cancer screening also includes some flexibility, saying that the decision to start regular mammography before age 50 "should be an individual one and take patient context into account".

Smith added that mammograms for women who've already had breast cancer shouldn't really be regarded as screening.

"If a woman has prior history of breast cancer, her regular exams are dictated by that experience," Smith said. "Any woman diagnosed with breast cancer will undergo regular surveillance breast imaging from that point forward."

Image credit: iStock


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Breast cancer expert

Dr Gudgeon qualified in Birmingham, England, in 1968. She has more than 40 years experience in oncology, and in 1994 she founded her practice, Cape Breast Care, where she treats benign and malignant breast cancers. Dr Boeddinghaus obtained her qualification at UCT Medical School in 1994 and her MRCP in London in 1998. She has worked extensively in the field of oncology and has a special interest in the hormonal management of breast cancer. She now works with Dr Gudgeon at Cape Breast Care. Read more.

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