Wednesday, July 6, 2011

Is Personalizing Mammogram Screening the Way to Go?

Updated 3/2017-- all links (except to my own posts) removed as many no longer active. 

I read the LA Times article by Shari Roan, Study urges more individual mammogram guidelines, with interest.  As Roan notes, guidelines to date have mainly focused on a woman’s age and not her other risks factors.
The American Cancer Society recommends that healthy women undergo screening mammograms every one to two years beginning at age 40 regardless of risk factors. In 2009, the U.S. Preventive Services Task Force recommended a different schedule which urged the inclusion of an individual’s personal risks:  screening for women ages 40 to 49 should be based on individual risk factors and women ages 50 to 74 should be screened every two years.
Monday, a paper was published in the Annals of Internal Medicine (full reference below) which argues for a more personalized approach to screening mammograms.
The study by Dr. Steven R. Cummings, senior author and senior researcher at the California Pacific Medical Center Research Institute, and colleagues was based on a computer model comparing the lifetime costs and health benefits for women who got mammograms every year, every two years, every three to four years or never.
The researchers concluded that “Annual mammography was not cost-effective for any group, regardless of age or breast density.”
They also note that “Mammography is expensive if the disutility of false-positive mammography results and the costs of detecting nonprogressive and nonlethal invasive cancer are considered.”
I find it interesting that the major limitation of the paper noted by it’s authors is that the results are not applicable to carriers of BRCA1 or BRCA2 mutations.   This is a group of women who has a major risk factor for developing breast cancer, yet “personalization” of screening mammograms might not work for them.  Why not?  Might not personalization for this group involve more frequent rather than fewer mammograms?
I personally like the idea of individualizing the screening schedule, rather than one-size fits all.  It is why I have embraced the U.S. Preventive Services Task Force recommendations. 

Related posts:
New Breast Cancer Screening Guidelines (November 17, 2009)
Screening Mammogram Recommendations (January 7, 2010)
The New Mammogram Guidelines - What You Need to Know (December 27, 2009; TBTAM)
Dr. Marya Zilberberg’s, Healthcare, etc, post:  Why medical testing is never a simple decision (December 15, 2010)

1.  Personalizing Mammography by Breast Density and Other Risk Factors for Breast Cancer: Analysis of Health Benefits and Cost-Effectiveness; John T. Schousboe, Karla Kerlikowske, Andrew Loh, and Steven R. Cummings; Ann Intern Med July 5, 2011 155:10-20
2.  To Screen or Not to Screen Women in Their 40s for Breast Cancer: Is Personalized Risk-Based Screening the Answer? (Editorial); Jeanne S. Mandelblatt, Natasha Stout, and Amy Trentham-Dietz; Ann Intern Med July 5, 2011 155:58-60

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