Should women under 50 be screened for breast cancer?

Abstract

Despite some controversy in recent years, the majority of experts agree on the evidence for effectiveness of breast screening by mammography for women aged 50 years and above, but for those under 50 years, the picture is much less clear. However, the issue remains of importance both to policy makers and to individual women; although the incidence of breast cancer is lower at younger ages, the life years lost due to cancers diagnosed below 50 years amount to a third of all those lost due to the disease. This article summarises the current position in different countries, and reviews the most recent evidence on effectiveness of screening women below 50 years from randomised trials. It has not been conducted as a systematic review or meta-analysis, of which a number have been performed. It also addresses the range of potential disadvantages of screening with particular reference to this age group.

Making policy decisions about population screening for breast cancer: The role of citizens’ deliberation

“…We deliberately chose experts with a range of viewpoints-including the Ministry of Health and two who had already made their views (for and against screening in this age group) known. Fortunately they all used comparable information about harms from trials and extrapolations from existing programmes [18][19][20], so the main differences between their presentations rested on the estimated probability of a survival benefit (likely but very small; likely; and uncertain, respectively).…”

Epigenetic Biomarkers of Breast Cancer Risk: Across the Breast Cancer Prevention Continuum

“…Regular mammographic screening has greatly improved breast cancer mortality among women ages 40–74 [78, 79]; however, mammography has limited sensitivity and specificity particularly in women with dense breasts [80, 81] and in younger women [82, 83]. Moreover, breast cancer is a complex disease that is difficult to detect in early stages by a single-marker approach.…”

A Rapid-Response Economic Evaluation of the UK NHS Cancer Reform Strategy Breast Cancer Screening Program Extension via a Plausible Bounds Approach

“…Nevertheless the age group of interest is older than that reported in the trial and is likely to include significantly more menopausal women. Because mammography is known to have a lower positive predictive value in younger women [8], the trial results can be seen as a lower bound for the model parameters given in Table 2. Conversely, the NHSBSP provides data from an older cohort, which will therefore have a higher percentage of menopausal women than the age group of interest, thus providing an upper bound.…”

“…Nevertheless, the anxiety induced in the short term is likely to be marked, and any such evaluation would be strengthened greatly by including it. In younger women, breast cancer prevalence is lower, and mammography has a lower positive predictive value [8]. This will increase the impact of anxiety from false positives on the cost‐effectiveness of screening for this age group.…”