Screening Mammography in Young Women
Mandy D. Petrie
Pima Medical Institute

Screening Mammography in Young Women
Turning forty may be a difficult time in a woman’s lifespan. Not only is a woman thinking about leaving the younger life of the thirties behind; she is thinking about turning the dreaded 40 and her first mammogram. The American Cancer Society has recommended that a woman should start her yearly screenings at the age of 40 even if the woman does not have a family history of cancer. The mammogram guidelines have changed several times since the implementation of mammography. A screening mammogram under the age of 50 does not reduce mortality rates, produces an increase in false-positive diagnoses, and forces unnecessary procedures.
Breast cancer is the second leading cause of the woman’s death next to lung cancer. In 1992, the American Cancer Society updated the mammogram guidelines recommending that at the age of 40 women should start their yearly screening mammograms. In more recent years, randomized controlled trials have proven that the change of guidelines has not reduced the mortality rate. A trial performed in Canada has “recently published 25 year results of the Canadian randomized screening mammogram trial for women 40-59 years show no difference in mortality despite a 22 percent higher diagnoses rate”(Annual mammography, 2014, p. 5). The trials have proven that the mortality rate has not been improved, but the false-positive rate has increased.
The diagnosis rate for false-positive mammograms has significantly increased in later years. A false-positive is an abnormal mammogram that will call for a woman to have additional testing. The cause of the rise of false-positive diagnoses is because younger women have breasts that are more dense, making it difficult to detect tumors on mammograms. Wolfe (1997) states that “a woman who has yearly mammograms between the ages of 40 and 49 has about a 30% chance of having one that’s false-positive.” The downside of false-positive consequences is that it calls for the need for additional testing as well as it may cause woman's anxiety, depression or may induce one to lay their life on hold. Along with the side effects of a false-positive result comes the stress of extra testing. Since a false-positive result is inconclusive, women will have to endure the wait of a different diagnostic test to determine whether or not they have cancer. The figure below shows that those tests have increased by 30% for women in their 40’s getting screening mammograms. A 2011 analysis of mammograms found that “mammogram screening only extended the life of one out of every 2000 women while it led to unnecessary test and treatments in 10 of those women” (Do you, 2012, p. 7). Several tests may be needed to determine the diagnosis and will be costly and time consuming for the patient. Those tests can range anywhere from a diagnostic mammogram, ultrasound, stereotatic biopsy, or the most invasive of all procedures, a surgical resection.
A common found cancer in mammography is ductal carcinoma in situ (DCIS). DCIS is a noninvasive cancer that builds up in the lining of the ducts. “Epidemiologic data suggest that screening has substantially contributed to an increase in the detection of early-stage disease that may have little chance of progressing or becoming lethal over the course of a person’s lifetime” (Esserman, Ozanne, van't Veer, 2013, p. 190). DCIS is a cancer whose etiology is unclear and represents 20-25% of malignancy detected in screening mammography. The most common cure for DCIS is a mastectomy; a massive, disfiguring procedure that may be unnecessary due to a patients fear of the word “carcinoma.”
DCIS has been more common because it is only detected on a mammogram. A rise in DCIS diagnoses is because 60% of screening mammograms are women between the ages of 40 and 50. In the years of late, physicians have steered away from clinical breast exams and have