Mammography for older women?

Those participating in the recent controversies as to whether mammography screening every 2 years is adequate in women over the age of 50 years, engendered by the latest (2009) recommendations of the US Preventive Services Task Force on breast screening, have overlooked several issues [1]. One is that the Swedish Two-County trial, the screening trial most often cited as showing a major impact of mammography screening on breast cancer mortality, did not use annual mammography in women over the age of 50 years, but instead used mammography every 33 months [2]. As a result, in Europe, the majority of the breast screening programs only offer mammography every 2 or 3 years. Indeed, in the UK, when discussions were ongoing about whether to screen annually rather than every 3 years, a trial was commissioned to specifically evaluate the issue. The result was a clear indication that it would not be cost effective to move from 3-yearly to annual screening [3]. Therefore, in the UK, the basic screening policy is still to offer mammography every 3 years to women aged 50–69 years. Part of the reason for the fixation on annual screening in the USA has been the tradition to offer women annual Pap smears to check for the precursors of cancer of the cervix, a policy that has now been shown to be unnecessary and wasteful in terms of resources [4].

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