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Plea To Lower Age For Mammography Screening In The UK (p 246)

July 16, 2003

Two leading UK cancer experts are calling for the entry age for mammographic screening for breast cancer to be reduced from 50 to 47 years for women in the UK. Their rationale is detailed in a correspondence letter in this week's issue of THE LANCET.

Screening mammography became widely available from the UK National Health Service in the late 1980s. Women aged 50-64 years are invited for screening every three years. Considerable debate surrounds the ideal age for women to enter screening programmes; an ongoing trial due to report at the end of 2004 could recommend lowering the entry age to women in their 40s.

Peter Sasieni and Jack Cuzick (both leading scientists at Cancer Research UK) believe there is sufficient evidence now to lower the entry age for screening ahead of the ongoing research.

Peter Sasieni comments: "At age 40 years, the annual rate of breast cancer is 79 per 100 000 women, but rises substantially to 148 per 100 000 women at age 47 years and 152 per 100 000 women at age 48 years. Between age 48 and 54 years, the rates of breast cancer plateau before again increasing more slowly reaching 221 per 100 000 women by age 64 years. Thus, the incidence rate of breast cancer at age 48-49 years is as great as that at age 50-54 years, and the number of life-years that could be saved is potentially greater among these younger women."

Jack Cuzick adds: "Although it is justifiable not to screen women in their early 40s without additional evidence, the case for offering screening to women aged 47 years is as strong as the case for offering screening to women aged 50 years. Starting mammographic screening at age 47 years, rather than at age 48 years, allows for a 1 year lead-time for screen-detected cancers. We propose that it is time to begin screening at age 47 years in all women, with screening every 3 years thereafter."

Lancet