by Dr. Yiola Markou, M.D.
Population screening for breast cancer with mammography, and in some women, ultrasound screening, has been shown to reduce mortality from this disease. Most European countries provide these screenings for free as part of Europe's strategy to reduce cancer deaths by 2030. There are several concerns about the use of screening, as with any scientific issue.
Before delving into the international data, it should be noted that decisions and recommendations in medicine should never be based on personal opinions or beliefs, but on scientific data derived from epidemiological, statistical, and health studies, whether randomized or not, which are analyzed so that the result follows the Hippocratic "Beneficence or no harm" principle, which states that the doctor has a duty and obligation to act for the benefit of the patient and avoid causing harm!
Today, most European countries have age limits ranging from 44-45 to 74. Mammographic screening appears to save lives at these ages. Even in the United States, starting at 40 is not widely accepted by all scientific societies.
Mammography is not a test that always detects cancer. Even when combined with ultrasound, it may not detect all cancers. Lowering the age limit reduces the diagnostic value of both tests and, unfortunately, increases the possibility of false negative or false positive results, resulting in unnecessary biopsies, which have a financial cost but, more importantly, a huge psychological cost for patients.
Women with a family history of cancer, or gene carrier patients, should begin screening before the age of 40, and usually, 10 years before the youngest case in the family was diagnosed with cancer.
Ultrasound alone should not be used to screen very young women because it is not scientifically supported. In fact, ultrasound alone should not be used for screening. The use of ultrasound in very young women is justified only if there is a palpable finding.
Breast cancer is uncommon at very young ages. According to the cancer registry, only 36 cancers were recorded in women under 30 years of age in Cyprus over the last ten years in a population of 71,000 women under 30. Breast cancer is extremely rare in people under the age of 25. Surprisingly, only one woman under the age of 30 has died from breast cancer in the last ten years. Think about all the pointless tests that would be done on this population to diagnose this illness!
Should screening, however, be discontinued for women over the age of 74? Breast cancer is very common in older women, but they rarely get aggressive subtypes. Women should continue screening after the age of 74 if they are able. More personalized recruitment of all women is the way screening will progress in the future.
*Dr. Yiola Markou works as a pathologist at the Bank of Cyprus Oncology Centre.
[This Op-Ed piece was translated from its Greek original]