The effect of screening across the age spectrum

Historically, the most hotly disputed issue in mammographic screening is whether to screen the age group 40–49. The most recently published combined analysis of the randomised trials of breast cancer screening at a range of ages between 40 and 74 gives a 24% reduction in breast cancer mortality in association with invitation to screening. The most recent combined analysis of the trial results for women aged 40–49 at randomisation shows a significant 18% reduction in association with invitation to screening. The effect in those who actually receive screening may be considerably greater. Evaluation of service screening programmes similarly suggests a mortality benefit in women aged 40–49. To achieve this benefit a greater commitment of financial and human resources is required. The decision to offer organised screening before age 50 will always vary, depending on the incidence in this age group, societal attitudes and competing calls on resources. However, breast cancer control in this age group is a major issue, because the proportion of deaths due to breast cancer is higher among younger women than among older women. The age at which to stop screening is a less researched question and a more difficult one. It is clear that there is a benefit of screening women up to age 70, but how long that benefit lasts if screening ceases at age 70, and what sort of non-intensive regimen might be offered to older women is not clear. Some tentative answers to these questions are proposed.