RISK-BASED RECOMMENDATIONS FOR MAMMOGRAPHIC SCREENING FOR WOMEN IN THEIR 40S

Purpose: To develop risk-based recommendations for mammographic screen ing for women in their 40s that take into account the woman's age, rac e, and specific risk factors. Methods: We assumed that regular mammogr aphic screening is justified for a 50-year-old woman, even one with no risk factors, and that a younger woman with an expected 1-year breast cancer incidence rate as great or greater than that of a 50-year-old woman with no risk factors would benefit sufficiently to justify regul ar screening. Recommendations under this criterion were based on age- and race-specific breast cancer incidence rates from the National Canc er Institute's (NCI's) Surveillance, Epidemiology, and End Results (SE ER) Program; assessments of risk factors from the Breast Cancer Detect ion and Demonstration Project (BCDDP); and reports in the literature. Results: Two methods, the exact-age procedure (EAP) and the grouped-ag e procedure (GAP), were developed. The less precise GAP only requires following a flow diagram. The proportion of white women recommended fo r screening by the EAP ranges from 10% for 40-year-old women to 95% fo r 49-year-old women, and the corresponding percentages for black women are 16% and 95%. The assumptions that underlie the guidelines are dis cussed critically. Conclusion: For women or physicians who prefer an i ndividualized approach in deciding whether to initiate regular mammogr aphic screening in the age range of 40 to 49 years, the present report offers recommendations based on individualized risk-factor data and c learly stated assumptions that have an empiric basis. These recommenda tions can be used to facilitate the counseling process. J Clin Oncol 1 6:3105-3114. (C) 1998 by American Society of Clinical Oncology.