- Question from DorisS: If current guidelines recommend mammography screening begin at age 40, then how can younger women be diagnosed? Our health care system doesn't seem to have a way to screen for breast cancer in women younger than 40.
- Answers —Lynn Schuchter, M.D.: The issue about screening and what makes an effective screening test and who should be screened really has to do with large trials that try to show that screening has altered mortality rates from a cancer. Screening guidelines are really sort of our public health recommendations. Because breast cancer is more common in older women, and because mammograms are a better test in older women because their breasts are less dense, the studies show screening is more effective in older women. So this is complicated because we do see breast cancer in younger women but as we begin to screen younger and younger women, we run into the problem that tests like mammograms are not going to be very useful. We end up having a lot more false positives as one possibility. So we try to make screening guidelines based on hard evidence that the test is useful and that it detects the cancer at an early stage, and that results in better overall survival rates. If there is reason to think a younger woman is at higher risk for breast cancer based on previous abnormal biopsy or family history, it may be appropriate for her to start screening at an earlier age. Screening can be flexible so younger women can be screened. We just don't have evidence that screening younger women with mammograms is a useful thing to do. Tonight we've heard from lots of young women with breast cancer and in some of those situations mammogram was probably helpful and in others it was not. So we're looking at lots of avenues in research — better ways of identifying who is at risk for developing breast cancer so this type of research is crucial as we try to discover why younger women are developing breast cancer. There is a tremendous amount of research going on right now. It is critically important, and hopefully we will get better tools to diagnose all women and hopefully develop better methods for younger women.
- Jennifer Armstrong, M.D.: In summary, the salient issue is not then why mammograms are not recommended for women under 40 (mammograms are not as effective screening tools in younger women); the key issue is can we develop more effective screening tools for younger women, keeping in mind Dr. Schuchter's key points that screening tools are particularly difficult to develop when the risk of disease is low (and the risk of developing breast cancer is low in most young women).
On Wednesday, April 19, 2006, our Ask-the-Expert Online Conference was called Young Women and Breast Cancer. Lynn Schuchter, M.D. and moderator Jennifer Armstrong, M.D. answered your questions about the special concerns of young women who have been diagnosed with breast cancer.
The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.
A production of LiveWorld, Inc.
Copyright 2008. All rights reserved.
Lynn Schuchter, M.D. is a medical oncologist specializing in breast cancer and melanoma at the University of Pennsylvania Cancer Center in Philadelphia, Pa.
Jennifer Armstrong, M.D. is a breast cancer oncologist at Paoli Hematology-Oncology Associates in Paoli, Pa., with a special interest in physicians' communication skills.
