Controversies in the Use and Periodicity of Mammography as a Screening Method for Breast Cancer - Revista Brasileira de Ginecologia e Obstetrícia
Mammography has been used as a preparatory method for breast cancer screening, considering different protocols for specific age groups, which suggest the periodicity of its undertaking. The exam is considered necessary, both by physicians and the public, in population strategies to reduce mortality caused by breast cancer. However, studies have questioned the benefit of the periodic mammographic screening. In Canada, an analysis of women between 40 and 59 years old submitted to an annual mammography test for 5 consecutive years showed that there was no significant reduction in mortality rates associated with breast cancer. In the United Kingdom, annual mammographic screening in women between 39 and 41 years old for 7 years resulted in a nonsignificant advantage. These studies indicate that mammographic screening does not seem to offer benefits to prevent breast cancer in low- or medium-risk women.
From an epidemiological perspective, screening assumes the use of mammography in healthy women to detect suspected cancer, which will subsequently be submitted to specific diagnostic tests to confirm the disease and guide the treatment. A better mammographic screening approach would effectively reduce death rates in women who undergo this type of exam. Any case of cancer detected through screening should be treated and followed-up over a long period of time for professionals to verify its impact on mortality rates. When mortality rates associated with breast cancer are compared, it is necessary to separate the cases which were detected, treated and followed-up in screening programs from those in which the diagnosis was performed without screening mammography, according to the disease stage indicated by the diagnosis.
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Mammography has been used as a preparatory method for breast cancer screening, considering different protocols for specific age groups, which suggest the periodicity of its undertaking. The exam is considered necessary, both by physicians and the public, in population strategies to reduce mortality caused by breast cancer. However, studies have questioned the benefit of the periodic mammographic screening. In Canada, an analysis of women between 40 and 59 years old submitted to an annual mammography test for 5 consecutive years showed that there was no significant reduction in mortality rates associated with breast cancer. In the United Kingdom, annual mammographic screening in women between 39 and 41 years old for 7 years resulted in a nonsignificant advantage. These studies indicate that mammographic screening does not seem to offer benefits to prevent breast cancer in low- or medium-risk women.
From an epidemiological perspective, screening assumes the use of mammography in healthy women to detect suspected cancer, which will subsequently be submitted to specific diagnostic tests to confirm the disease and guide the treatment. A better mammographic screening approach would effectively reduce death rates in women who undergo this type of exam. Any case of cancer detected through screening should be treated and followed-up over a long period of time for professionals to verify its impact on mortality rates. When mortality rates associated with breast cancer are compared, it is necessary to separate the cases which were detected, treated and followed-up in screening programs from those in which the diagnosis was performed without screening mammography, according to the disease stage indicated by the diagnosis.
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