Protection of mammography screening against death from breast cancer in women aged 40–64 years

Abstract

This study assessed the efficacy of community-based screening mammography in protecting against breast cancer death, asking whether age differences in efficacy persisted in the 1990s. In a case–control study with follow-up, odds ratios (OR) were used to estimate the relative mortality rates from invasive breast cancer among women with at least one screening mammogram in the two years prior to a baseline reference date compared to non-screened women, adjusting for potential confounding. The multicenter population-based study included 553 black and white women diagnosed during 1994–1998 who died in the following five years, and 4016 controls without breast cancer. Efficacy for reducing the rate of breast cancer death within five years after diagnosis was greater at ages 50–64 years (OR = 0.47, 95% confidence interval (CI) 0.35–0.63) than at ages 40–49 (OR = 0.89, 95% CI 0.65–1.23), and greater among postmenopausal (OR = 0.45, 95% CI 0.33–0.62) than premenopausal women (OR = 0.74, 95% CI 0.53–1.04). Estimates of efficacy were conservative, as shown by sensitivity analyses addressing whether cancer was discovered by a screening mammogram, age at which screening was received, the length of the screening observation window, and years of follow-up after diagnosis. Despite the persistence of age differences in efficacy of mammography screening, with greater observed benefit for women aged 50–64 years, these findings support current screening recommendations for women 40–64 years old.