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RE: Selecting the right patients.
Mammography should be offered starting at age 40. This is the sweet spot, where the incidence of breast cancer increases, and the risk of radiation decreases. Half of fatal cancers are diagnosed by age 49.
Breast cancer incidence increases with age. Although less common in the decade 40-49 than subsequent decades, the growth rate is faster in in this age group given the presence of endogenous estrogens in younger women. Recent observational studies show 44-60% mortality reduction in screened women starting at age 40, far higher than shown in the randomized trials done from the 1960s to early 1990s. The risk of overdiagnosis in these younger women is vanishingly small, since they are less likely than older women, to have co-morbidities. Screening should continue as long as a woman is in good health, with a life-expectancy of at least 5-10 years.RE: Rescreening at the right interval.
The most lives are saved by annual screening starting at 40. Sadly, this is not the case in Canada. Each provincial program chooses the age at which to start and the screening interval. The choices are made based on financial resources and the understanding, or misunderstanding, of the harms and benefits of screening.
RE: Ensuring high-quality tests.
Happily, this is not an issue in Canada. All the provincial screening mammography programs have excellent quality control, and monitor performance metrics of the radiologist...
Show MoreCompeting Interests: None declared.