Breast Cancer Screening for Women in Their 40s: Moving from Controversy about Data to Helping Individual Women

We should move beyond a discussion of the quality of the evidence for breast cancer screening for women in their 40s. Instead, we should learn to live with smaller absolute benefits and higher risks than those we had originally hoped for. In the face of continuing controversy about the evidence, our priority now should be to help women make informed decisions.

Three articles in this issue (1–3) can help us make the transition from controversy to action. The first is a succinct clinical practice guideline from the American College of Physicians (ACP) that advises clinicians on how to approach breast cancer screening decisions when seeing individual patients in their 40s (1). The practice guideline was guided by a systematic literature review in this issue of the benefits and potential harms of screening (2). Unlike previous reviews that generally emphasize data on benefits of screening from only randomized trials, the review, by Armstrong and colleagues (2), also examined data from 117 observational studies and summarizes extensive data on the potential harms of screening, such as overdiagnosis and radiation exposure. Their review also discusses how to assess benefit and risk on an individual basis, which will be particularly relevant to women younger than the age of 50 years. To our knowledge, a second systematic review article in the issue, by Brewer and colleagues (3), is the first to specifically examine the long-term consequences of false-positive mammograms in such detail.

Although these reviews are extensive, they do not include the recently published Cochrane Collaboration review (4) or the much-anticipated Age randomized trial (5). The Age trial is particularly relevant because it was designed to determine whether screening women in their 40s is associated with a reduction in breast cancer mortality. Unfortunately, 2 developments prevented the trial from having sufficient …