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JNCI Journal of the National Cancer Institute 1999 91(10):833-838;
© 1999 by Oxford University Press
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Journal of the National Cancer Institute, Vol. 91, No. 10, 833-838, May 19, 1999
© 1999 Oxford University Press

COMMENTARY

A Tangled Web: Factors Likely to Affect the Efficacy of Screening Mammography

Cornelia J. Baines, Rachel Dayan

Affiliations of authors: C. J. Baines (Department Public Health Sciences), R. Dayan (Department of Pediatrics), University of Toronto, Canada.

Corresponding author: Cornelia J. Baines, M.D., 12 Queen's Park Cres. W., Toronto, ON M5S 1A8, Canada (e-mail: cornelia.baines@utoronto.ca).


   INTRODUCTION
 
Given the direct and indirect costs of mammographic breast cancer screening in North America (1,2), any evidence leading to the improved efficacy of screening mammography should be welcome. The importance of high technical standards to achieve mammographic accuracy has been recognized (3). Improved accuracy should lead to improved efficacy, namely, further reductions in mortality from breast cancer.

The efficacy of breast screening is most contested in women who are 40-49 years old (4), many of whom are premenopausal. In this group, a 16% reduction in breast cancer mortality has been observed 7-10 years after the initiation of screening (5), about half of that observed in women who are 50-69 years old. Although mammographic sensitivity is indisputably lower (less accurate) in younger women, one expert has asserted (6) that "Nothing magical happens at age 50. There is no significant . . . [Full Text of this Article]


   BREAST TISSUE CHANGES DURING THE MENSTRUAL CYCLE
 
Physical Changes

Histologic Changes

Changes Detected by Magnetic Resonance Imaging


   FEATURES OF THE POSTMENOPAUSAL BREAST
 

   FACTORS AFFECTING MAMMOGRAPHIC DENSITY
 
Menstrual Cycle

Reproductive History, Age, and Body Build

Diet

Hormone Replacement Therapy


   FACTORS AFFECTING MAMMOGRAPHIC ACCURACY
 
Menstrual Cycle Phase

Mammographic Density


   CONCLUSION
 

   REFERENCES
 

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