Screening mammography under age 50.

Abstract

MAMMOGRAPHY IS A SCREENING procedure that has decreased the risk of death from breast cancerby25%to30%,asshownin7randomized studies (TABLE 1). It can detect breast cancer or carcinoma in situ at 5 to10mmindiameter.Mostphysicians cannotreliablydetectlesionssmallerthan 10mmonphysicalexamination,andpatientsgenerallyseekmedicalattentionfor lesions that are 25 mm or larger. Of women with known breast cancer who undergo mammography, 80% to 90% have a positive test result. A negative mammogram result does not preclude clinical breast cancer and should not dissuade physicians from biopsy of a palpable abnormality. The remainder of this article discusses screening mammography only. No controversy exists over diagnostic mammography in any woman or man with a suspicious breast examination finding whether older or younger than 50 years. The most common malpractice suit against primary care physicians is failure to diagnose cancer, and, of these, failure to diagnose breast cancer is most common. A substantially higher proportion of these lawsuits involve women younger than 50 years than what is expected based on their relative incidence of breast cancer.