Screening Mammography Still Crucial Despite History of Breast Cancer

The following is a guest post written by Edward A. Sickles, M.D., Professor Emeritus.

As the co-author of a recent study published in the Journal of the American Medical Association, I want to emphasize one of the conclusions of the study, which was buried in recent news reports.

The study examined outcomes of women with a personal history of breast cancer (PHBC) compared to women without PHBC. Not surprisingly, the study showed that both groups of women benefit substantially from screening mammography. Another finding was that after a diagnosis of breast cancer it becomes somewhat more difficult for mammography to find a second cancer if one had previously existed.

The most important conclusion of the study, however, was that although there are slight differences between the two groups, both women with and without PHBC should be managed in the same way. That is, they both should have screening mammography every year, which is what we do at the UCSF. For women without PHBC yearly screening should start at age 40.

At UCSF we routinely recommend screening mammography for women who had a previous breast cancer because they are at higher risk and should therefore be more vigilant, regardless of age, so long as they remain healthy.

Although there are no official guidelines for women who have a history of breast cancer, the assumption is if it’s good to screen women who are at lower risk for breast cancer, who haven’t already had one, then it certainly makes sense to screen women who are at higher risk, who have had one. Our study reinforces that.

As noted above, the study concludes that although mammography is somewhat less accurate among women with PHBC (principally because there are more false-positives), mammography still is the only screening test proved to reduce breast cancer deaths, and women should continue to have regular screenings. So as not to create unreasonable expectations, women with PHBC should be informed that mammography is less accurate in their case.