Lower-risk women need fewer mammograms: study

NEW YORK (Reuters Life!) - Less-frequent mammograms for women at low risk for breast cancer can be a cost-effective way of saving lives, according to a study that challenges current screening guidelines.

Women with no family history of the cancer, no previous biopsy from a cancer scare and breasts that are not very dense might get a similar benefit from mammograms every three to four years, instead of every two, said a report published in Annals of Internal Medicine.

The U.S. Preventive Services Task Force, an expert panel with federal support, advises women to have a mammogram every two years, but lead researcher John Schouseboe said the new study provides a more personalized set of mammogram guidelines than what is currently available.

"The benefits of mammography are going to depend a lot on what your underlying risk is, and the current guidelines look only at age," Schousboe, a doctor at Park Nicollet Health Services in Minneapolis, told Reuters Health.

Current recommendations say women aged 50 to 74 should have a mammogram every two years, unless the woman and her doctor feel there is reason to make an exception.

The team used data from two national surveys, which tracked the frequency of mammograms and the breast cancer rates of more than a million women, to form hypothetical scenarios.

In one, they were not screened, while in another they got mammograms every two years. In a third scenario they received a mammogram every three to four years.

All scenarios assumed that at age 40, every woman received a mammogram to reveal her breast density.

For women in their 40s with less dense breasts and no other risk factors, the study found that screening at any interval, whether biennially or every three to four years, was not cost effective.

It would cost $228,000 to save a life for a year if low-risk women in their 40s were screened every three to four years, compared to no screening.

The study also found that to save one life among women in their 40s, 8,000 would need to be screened, and 17 out of every 100 of them would experience a false cancer scare -- leading to additional testing, which exposes them to more radiation.

"I think that, other things being equal, it's reasonable for a patient and their doctor at that point to say, 'we're going to put off the next mammogram until age 50,'" said Schousboe.

But women with more dense breasts who have a close relative with breast cancer or have had a past breast biopsy would benefit from screening every three to four years in their 40s.

For women in their 50s to 70s, the study found, it was cost-effective for those with low-density breasts and no other risk factors to be screened every three to four years.

For women over 50 with denser breasts, a biannual screening became cost effective. If they had another risk factor, a mammogram every two years would be appropriate, the report said.

The study, funded by pharmaceutical firm Eli Lilly, the Da Costa Family Foundation for Research in Breast Cancer Prevention of the California Pacific Medical Center, and the National Cancer Institute, does not apply to women who have a high genetic risk of breast cancer.

It also did not test the scenarios in a real-life situation, with the analyses based on simulations of screening policies.

Some experts said that while the concept was "exciting," there were obstacles to refining the guidelines.

"Communicating risk-based screening will be very difficult and will require education of women and physicians," said Jeanne Mandelblatt of Georgetown University Medical Center in Washington D.C., who was not involved in the study. SOURCE: http://bit.ly/kW0ReF

(Reporting by Kerry Grens at Reuters Health; editing by Elaine Lies)

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