Breast cancer scan: Is 40 the right age or 50?
Reported November 19, 2009
NEW DELHI: So what’s the right age for an Indian woman to start getting screened for breast cancer — 40 or 50? Opinion is divided just like it is in the US right now.
The United States Preventive Services Task Force (USPSTF) recommended on Monday that regular breast cancer screening of women should start at the age of 50 as opposed to 40, which is the suggested age right now in the US.
Publishing them in the journal “Annals of Internal Medicine”, USPSTF recommended against routine screening mammography in women aged 40 to 49 years and start biennial screening mammography for women aged 50 to 74 years. It also said that current evidence is insufficient to assess the benefits of screening mammography in women 75 years or older.
Dr Diana Petitti, vice-chairperson of the task force, said, “The guidelines were aimed at reducing the harm from overscreening. A test can trigger unnecessary biopsies that can create extreme anxiety. And mammograms can find cancers that grow so slowly that they never would be noticed in a woman’s lifetime.”
According to USPSTF’s report, one life is saved for every 1,900 women aged 40-49 screened for breast cancer, compared to one life for every 1,300 in the 50-59 year age group.
However, just like in the US, the recommendations have started a storm in India too. Some experts say India should stick to 40.
Dr Sidharth Sahni, surgical oncology (breast) expert at Artemis Health Institute, said, “Women in India have started to get diagnosed with breast cancer at an early age 42 to 44 years. So to start screening at 50 will be futile. We should stick to 40 and screen women every year from then on. No damage is recorded from radiation if taken after 10 months.”
Dr Ramesh Sarin, surgical oncologist at Indraprastha Apollo Hospital, added, “Getting a mammography once every year is a must for women at 50. However, Indian women get diagnosed with breast cancer a decade before their western counterparts. So I feel women should get a mammogram done once every two years after 40. Early mammography has been shown to greatly reduce mortality among women suffering from breast cancer.”
Other experts had a different view.
Dr Vinod Raina, head of medical oncology at AIIMS, said women in high risk groups like those with denser breast tissue and strong family history of breast cancer should get themselves screened from 40 years of age.
“However for general screening, Indian women should undergo a mammography once every two years after they reach 50. This is because the incidence of breast cancer in India (30 per 100,000 women) is much lesser than in US (100 per 100,000 women) where the problem is acute. Also most women suffering from breast cancer are identified after 50 because the yield of the mammography machine is better then. Mammography in India is also expensive, around Rs 1,500 per test,” Dr Raina said.
Dr Bhavana Sirohi, head of medical oncology at Max Hospital, said the screening should actually start from age 45. “Indian women attain menopause five years before the women in the West making the former more susceptible to breast cancer. That’s why women in India should be screened from age 45.”
But what experts were unanimous about was that India should start a mass breast cancer-screening plan like the West under the country’s National Cancer Programme.
Screening mammography rate in India is abysmally low. WHO’s latest World Health Statistics (WHS) said less than 5% women, aged 50-69 years, underwent screening by mammography in India between 2000-2003.
WHO says there is significant evidence to show that mammography screening among women in this age group reduces mortality from breast cancer by 15%-25%. Among women, breast cancer is the most common cause of cancer mortality, accounting for 16% of cancer deaths globally. Less than a quarter of women globally undergo breast cancer screening. In India, breast cancer is the most common form of cancer in women. One in 26 women in India are expected to be diagnosed with breast cancer in their lifetime, WHO says.
Experts say 50% of breast cancer cases are detected very late in India.
Source : The Times of India
