International Herald Tribune Editorial - Breast cancer screening

International Herald Tribune Editorial - Breast cancer screening
Copyright by The International Herald Tribune
Published: April 9, 2007


The often confusing issue of screening for breast cancer just got more confusing. First, a major medical group disputed the need for regular mammograms for all women ages 40 to 49, as is currently recommended. Then a widely used computer system that was supposed to make mammograms more accurate was judged to make them less accurate.

And guidelines just issued by the American Cancer Society recommend annual MRI scans - in addition to mammograms - for all women at high risk of developing breast cancer, starting at age 30.

Nothing in the new material shakes the long-standing recommendation that all women age 50 or older should get regular mammograms. Women in their 40s, however, will need to weigh the pros and cons carefully.

Most expert groups believe they should get mammograms every year or two. But guidelines issued by the American College of Physicians take a more discriminating approach.

The guidelines acknowledge that regular mammograms for women in their 40s can reduce the risk of dying from breast cancer by a modest amount. But a very high percentage of the women screened, the college warns, will get false positive results that lead to unnecessary biopsies.

The latest verdicts on two advanced technologies were mixed. One new study found that MRI scans could find tumors that mammograms had missed in a small percentage of women. The downside is that the costly scans are so sensitive they pick up lots of suspicious but harmless growths.

Another study found that a costly computerized system to help read mammograms was no better at finding cancer than traditional mammography and led to many more false alarms. The computerized systems are used in some 30 percent of all mammography centers, where they are driving up costs for no clear benefit. Government and private insurers may need to reconsider whether the systems are worth covering.