Breast Screen Petition 40- 49:

The controversy of whether to provide mammographic screening to women in their 40s should be at an end. There is no doubt a significant mortality reduction can be achieved in screening this age group. Choosing the age of 50 has no biological significance and at best was chosen as a surrogate for menopause.

To quote Dr Kopans, Harvard, USA  1998:

“Medicine is under great pressure to reduce the cost of health care. Nevertheless, science should not be corrupted to avoid difficult social debates. If health planners do not believe it is worth paying for an intervention, such as screening women in their forties, they should state this openly for public debate. Inappropriate data analysis, to suggest that there is no benefit from screening, should not be used to avoid complex societal issues.  By the most rigorous scientific analysis there is clear proof that screening using mammography, beginning by the age of 40 can save lives and that this should be done on an annual basis. Women should also know that the primary reason to go to a longer time between screens is to save money.”

The analysis of data from many trials support the benefit in mortality reduction of screening from age 40. References and more complete information is available if required.

Unfortunately many of the breast cancers I see in women in their 40s are detected when a woman presents with a lump or other symptoms. This is often more “advanced” breast cancer  with a worse outcome.  Many of these cancer could have been detected by mammographic screening.

My own radiology practice has specialised in women’s imaging for five years. We do not provide services to Breast Screen Aotearoa and our practice is in large part related to screening in the younger age group, together with providing diagnostic services to the symptomatic population of all ages.

For the purposes of this submission I completed a statistical survey of the age distribution of detected cancer in our practice over the last five years. Our experience parallels that of the literature in as much as 1/3 rd of the breast cancers occur under the age of 50, 1/3 rd in the screen age group of 50-65 and 1/3 rd in the 65 plus age group. Specifically, 11% occurred below the age of 40, 23% in the 40 – 49 age group, 30% in the 50 – 65 age group and 35% in the over 65 age group.

While high risk women in their 40s can access publically funded mammography it should be available to all women in this age group.

Providing annual screening mammography to all women 40 – 49 is strongly supported.

Dr Deborah Andrews



TAURANGA – 9.2.04