Mammograms should not be done on a one-size fits all basis, but instead should be personalized based on a woman’s age, the density of her breasts, her family history of breast cancer and other factors including her own values. That’s the conclusion of a new study in the July 5 issue of the Annals of Internal Medicine. The study challenges current guidelines from groups such as the American Cancer Society and the U.S. Preventive Services Task Force that make recommendations based on age alone. The American Cancer Society recommends annual screening starting at age 40 with no upper age limit, while the U.S. Preventive Services Task Force recommends biennial screening for women between the ages of 50 and 74. While mammography screening indisputably decreases deaths from breast cancer, there is disagreement as to when women should begin mammography and how often they should get it: every two years starting at 50 or every year starting at 40? “Our analysis suggests that women with a first-degree relative with breast cancer or with a history of a breast biopsy should have an initial screening mammography at age 40,” said [a] ...co-author [of the study]....“For women age 40 to 49 with high breast density, and with either a first-degree relative with breast cancer or a prior breast biopsy, the benefits versus harm for performing mammography every two years is similar to screening an average-risk woman in her 50s. This amounts to about 20 percent of women in their 40s. For women age 40 to 49 without these risk factors, it is reasonable to wait until age 50 to start mammography screening.”....“What our study shows is that other factors, particularly breast density, are just as important, if not more so, in helping a woman decide what is most appropriate for her. We show that mammography should be personalized. The best interval for you depends on your age, breast density, and other risk factors for breast cancer.”
I believe that all quality medicine and certainly diagnostic screening is based on general rules. Clearly and as noted above, there are differences between the American Cancer Society and the U.S. Preventive Services Task Force recommendations on the frequency of mammography screening. These differences need to be reconciled. However and for patients with special risk factors such as a family history of breast cancer, mammography needs to be scheduled more frequently. My preference is not to refer to such modifications of the general screening guidelines as personalized but rather as individualized changes. This is to say that the decision takes into consideration the individual characteristics and needs of the patient.
I have posted previous notes about the need for periodic mammograms including the frequency of routine screening based on age (see: Shift to Digital Mammography Results in Increased Patient Recalls ; Confusion Caused by Conflating "False Positive" and "Overdiagnosis" in Breast Cancer ). Now comes news of research suggesting that mammogram screening should be personalized (see: Mammogram scheduling should be personalized, not based on age alone: study ). The article caught my attention because of the use of the term personalized. Here is an excerpt from the article:
Mammograms should not be done on a one-size fits all basis, but instead should be personalized based on a woman’s age, the density of her breasts, her family history of breast cancer and other factors including her own values. That’s the conclusion of a new study in the July 5 issue of the Annals of Internal Medicine. The study challenges current guidelines from groups such as the American Cancer Society and the U.S. Preventive Services Task Force that make recommendations based on age alone. The American Cancer Society recommends annual screening starting at age 40 with no upper age limit, while the U.S. Preventive Services Task Force recommends biennial screening for women between the ages of 50 and 74. While mammography screening indisputably decreases deaths from breast cancer, there is disagreement as to when women should begin mammography and how often they should get it: every two years starting at 50 or every year starting at 40? “Our analysis suggests that women with a first-degree relative with breast cancer or with a history of a breast biopsy should have an initial screening mammography at age 40,” said [a] ...co-author [of the study]....“For women age 40 to 49 with high breast density, and with either a first-degree relative with breast cancer or a prior breast biopsy, the benefits versus harm for performing mammography every two years is similar to screening an average-risk woman in her 50s. This amounts to about 20 percent of women in their 40s. For women age 40 to 49 without these risk factors, it is reasonable to wait until age 50 to start mammography screening.”....“What our study shows is that other factors, particularly breast density, are just as important, if not more so, in helping a woman decide what is most appropriate for her. We show that mammography should be personalized. The best interval for you depends on your age, breast density, and other risk factors for breast cancer.”I can find no fault with the results of this study. However, I do have a problem with the use of the term personalized by the study author. I have posted previous notes about personalized medicine (see: Term "Personalized Medicine" More About Business than Healthcare Delivery ; Further Consideration of the Definition for Personalized Medicine ; A "New" Twist on Personalized Medicine: Genetically Targeted Therapy ). My problem with this word is that it has become more of a marketing term than a scientific one. Its use is often prompted by the warm and fuzzy connotation that is often associated with it and implies patient choice rather than need. A medical consumer reading this article may be thinking: physicians are finally taking my personal choices into consideration rather than primarily the scientific facts.
I believe that all quality medicine and certainly diagnostic screening is based on general rules. Clearly and as noted above, there are differences between the American Cancer Society and the U.S. Preventive Services Task Force recommendations on the frequency of mammography screening. These differences need to be reconciled. However and for patients with special risk factors such as a family history of breast cancer, mammography needs to be scheduled more frequently. My preference is not to refer to such modifications of the general screening guidelines as personalized but rather as individualized changes. This is to say that the decision takes into consideration the individual characteristics and needs of the patient.