Unlike their Norwegian counterparts, Swedish investigators failed to report mortality rates, making interpretation of the data difficult. Nor did they detail the health costs of mammograms among women in their 40s.
Note: For more on the debate over screening mammography, see Dr. Kaunitz’s earlier commentary on the subject, “I’ve been rethinking my zeal for breast cancer screening,” in the December 2009 issue of OBG Management, and Dr. Robert L. Barbieri’s distinctive viewpoint, “Access to screening mammography: Priceless,” in the January 2010 issue at obgmanagement.com.
WHAT THIS EVIDENCE MEANS FOR PRACTICE
For the foreseeable future, most clinicians will continue to recommend regular screening for women 50 to 69 years old, and most women will continue to choose to have mammograms. In my practice, however, I plan to spend less time nagging women who are reluctant to get mammograms. I now feel more comfortable recommending screening consistent with the US Preventive Services Task Force guidelines from late 2009.
As for women 40 to 49 years old, I plan to continue following USPSTF guidelines. However, I will also continue to order screens for women in their 40s who are at increased risk of breast cancer due to family history or other reasons and for those who prefer to be screened despite awareness of the high rate of false-positive findings.
—ANDREW M. KAUNITZ, MD
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