Breast Cancer Awareness
Breast Cancer Q & A of the Day: Why aren’t mammograms recommended for women under age 40?
It is commonly believed that breast cancer rates have been increasing among young women, but that is not the case. Among women during 1998–2002, those aged 20 to 24 had the lowest incidence rate, 1.3 cases per 100,000. During this same time period, 95 percent of new breast cancer cases and 97 percent of breast cancer deaths occurred in women aged 40 and older. (For more statistics, see Breast Cancer Facts and Figures 2005-2006.)
This does not mean that there aren't a greater number of young women with breast cancer; there are. But that's due to changes in the US population. Not only has the population grown, but in the late 1980s and 1990s the number of women in the population between the ages of 25 and 40 increased over what it had been previously. (This was due to trends in birth rates 25 to 40 years ago.)
To better understand the difference between incidence rate and numbers of women with a disease, imagine two islands. One has a population of 200,000 women between the ages of 25 and 40. The second has a population of 400,000 women between the ages of 25 and 40. If both islands have a breast cancer rate of 2 percent, you would find 4,000 young women with breast cancer on the first island and 8,000 young women with breast cancer on the second island. The incidence rate is the same on both islands, but the absolute number of women with breast cancer is higher on the second island because the population is larger to begin with.
This does not mean that young women don't get breast cancer. The American Cancer Society estimated that 1,600 new cases of ductal carcinoma in situ (DCIS) and 9,510 cases of invasive breast cancer would be diagnosed in women under the age of 40 in 2005. These women under 40 represented 3 percent of the estimated 58,490 women diagnosed with DCIS and 4.5 percent of the estimated 211,240 women expected to be diagnosed with invasive breast cancer in 2005.
The reason mammograms are not recommended for breast cancer screening for women under age 40 is not that we don't want to pay for it but rather that mammography is not a good screening tool in women under 40. This has to do with age and how our breasts change during our lifetimes.
After menopause, women's fatty breasts look gray on mammography, and cancer—which is white on mammography—shows up much better against this background. In premenopausal women, breast tissue tends to be dense and glandular, and this dense tissue appears white on a mammogram, just like cancer. This makes looking for cancer on a young woman's mammogram like looking for a polar bear in the snow. It just is not accurate. It is not that we want to deprive young women of their God-given right to be radiated. It's just that the benefits in this age group are not worth it.
This does not mean women under 40 should not pay attention to their breasts; they should. It is important that all women have an annual breast exam by their physician, and that they point out to and discuss with their physician any lump they have found, any pain they feel, or any other signs or symptoms that concern them. If a young woman does find a lump, she should have a mammogram and an ultrasound. That's because even though mammograms aren't a good screening tool in young women, they can still help in a breast cancer diagnosis once other signs or symptoms have been noticed.
Because mammography is not effective in young women, and breast self-exam, as the research has shown, is not the lifesaving tool we had hoped it would be, we desperately need a test that will work in young women. My hope is that ductal lavage will ultimately lead in this direction.
Learn more about Young Women and Breast Cancer at the Dr. Susan Love Research Foundation website here.
This post is courtesy of the Dr. Susan Love Research Foundation, dedicated to eradicating breast cancer and improving the quality of women's health through innovative research, education and advocacy.
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