A CONTRIBUTION TO THE CONTROVERSIAL ASSESSMENT OF SCREENING MAMMOGRAPHY IN ASYMPTOMATIC WOMEN BETWEEN 40 AND 50 YEARS OF AGE

The results of screening studies conducted in the United States and in Europe in females between the ages of 40 and 50 are analysed. It is s hown, that the results of this study on mortality reduction are less f avourable, the poorer the technique of mammography (forgoing of genera l two-view mammography) and the longer the time interval between two m ammography screenings. Arguments are presented, that are brought forwa rd when declining to perform general mammography screening in this age group. The author's own results, obtained in the Hamburg mammography screening study, which included from 1971 to 1986 also premenopausal w omen, show, that the survival rates of patients below 50 years of age with mammographically detected carcinomas of the breast do not differ from those in patients older than 50 years, according to a relevant ag e group classification. The advances in the technique of mammography i n recent years are analysed on the basis of the author's own patient m aterial. It is evident, that the positive predictive value has been do ubled, especially in the age group between 40 and 50. An analysis of t he distribution of diagnosed noninvasive carcinomas compared with the invasive carcinomas reveals, that particularly this age group has the highest percentage of identification of prognostically favourable carc inoma stages. Further analyses show, why the randomised European mammo graphy studies could not yield a significant mortality rate improvemen t. A prerequisite for the inclusion of mammography screening in the le gally prescribed early detection of carcinoma examinations, however, a re the quality controls, whose realisation, in our health system, will have to be confirmed by the German mammography study.