As more younger women are diagnosed and the profile of older women at risk is refined, experts are saying that breast cancer screening can be better targeted. A large study has shown that a stratified approach to screening worked as well in detecting tumors as universal yearly screening. Another study found that the number of younger women getting breast cancer suggests more should be getting regular screening.
Current guidelines are that all women of average risk have a mammogram every year, starting at 40 and lasting until age 74.
“There’s no downside to screening besides the fact that it is expensive,” Stamatia Destounis, MD, told Inside Precision Medicine. But that’s a huge hurdle. “We need to get to a point where supplemental screening is covered,” she added. Destounis is a radiologist at Elizabeth Wende Breast Care in Rochester and led the research on screening in younger women.
A large national trial of about 46,000 women, 40 to 74 years old, recently found that a stratified approach to screening worked as well in detecting tumors as universal yearly screening. In fact, this approach lowered the chance that cancers would not be found until they were at a more advanced stage. The study appeared in JAMA online this month, and the lead author was Laura J. Esserman, MD.
Destounis’s group presented data on 1,799 breast cancers in 1,290 women in the 18 to 49 age group at the annual meeting of the Radiological Society of North America (RSNA). Their analysis of records covered seven outpatient centers in the New York region and found that 20-24% of all breast cancers diagnosed over an 11-year span occurred in women between 18 and 49 years old. Each year, the number of cases ranged from 145 to 196.
The number of diagnosed cancers in younger women remained consistently high throughout their study period. Even when fewer young women were seen overall, the absolute number of cancers did not decline.
“That means this problem is not going away,” she said. “It is here to stay and needs to be addressed on a larger scale. Research such as this supports earlier and tailored screening to allow for earlier detection and better treatment outcomes.
Destounis added that the study reinforces the fact that breast cancer in younger women is not uncommon anymore and cases in this group are often more serious.
“Most of these cancers were invasive, meaning they could spread beyond the breast, and many were aggressive types—especially in women under 40,” Destounis said. “Some were ‘triple-negative,’ a form of breast cancer that is harder to treat because it doesn’t respond to common hormone-based therapies.”
Growing national data sets have been pointing toward an uptick in breast cancer among younger women, which has encouraged experts to reconsider recommended screening ages and how patients are evaluated for risk.
For women considered average risk, the U.S. Preventive Services Task Force recommends mammography every other year beginning at age 40 and continuing until age 74. The American Cancer Society recommends yearly mammograms starting at age 45, with screening optional for those aged 40 to 44. Women who are classified as high risk may be advised to receive a breast MRI and a mammogram each year beginning around age 30, but there are still no established guidelines for women younger than that.
