New findings that run counter to federal recommendations indicate that women should be encouraged to initiate regular mammographic screening before age 50 years.

Blake Cady, MD, professor of surgery (emeritus) at Harvard Medical School in Boston, Massachusetts, and colleagues explained in the journal Cancer that individual trials and meta-analyses demonstrate varying rates of mortality reduction from mammographic screening, leading to questions about the value of such testing and whether treatment advances have diminished the importance of early detection. To explore their hypothesis that most deaths from breast cancer occurred in unscreened women, the investigators used a technique known as failure analysis, which looks backward from death to identify correlations at diagnosis.

Cady’s group gathered data from diagnoses of invasive breast cancers made between 1990 and 1999 and followed through 2007. Invasive breast cancer failure analysis defined 7,301 patients between 1990 and 1999, with 609 documented deaths from breast cancer and 905 deaths from other causes. The majority of breast cancer deaths (71%) occurred among unscreened women.

Median age at diagnosis was 49 years for fatal cancers and 72 years for deaths not from breast cancer. Half (50%) of all breast cancer deaths occurred in women younger than 50 years, with 13% occurring in women 70 years and older. ONA