Lancet Oncology: How old is breast cancer screening? The 23-year follow-up data led to discussion.

Mammography target (X-ray) is an important means of breast cancer screening, and the positive significance of screening for early diagnosis and treatment and improving survival rate has been supported by a lot of research.
, however, the question that remains debatable is: Which age group is best suited to start breast cancer screening? On the one hand, young women's breasts tend to be more dense, which can affect the sensitivity of the target, and second, young women are less likely to develop and die overall, but at the same time, there is evidence that young women may develop faster and have a worse prognosticity once they develop breast cancer.
screening for breast cancer groups (organized programs for women of appropriate age), there is currently no recommended age in China, the international recommendation of 40 to 50 years old, different guidelines are not completely consistent.
International Agency for Research on Cancer (IARC) breast cancer screening guidelines confirm the role of targeting women over 50 years of age, and for women aged 40 to 49, there is limited evidence.
12 August local time, the final results of a 23-year follow-up to 160,000 people in the UK Breast Cancer Age Trial were published in The Lancet-Oncology.
that early screening age to 40 may reduce mortality and not increase overdiagnosis.
has led to a lot of discussion since the study was published, and the impact on clinical practice may not be that simple.
The randomised controlled trial began in 1990 and in 1990-1997, more than 160,000 British women aged 39-41 were invited to a different group: from the time they joined the study, they were screened annually, or as recommended by the NHS National Screening Scheme, until they were 50 years old.
23-year follow-up results, published last week, showed that breast cancer mortality could be significantly reduced by 25 percent in the 10 years before the study, when women were screened annually between the ages of 40 and 49.
the difference in breast cancer mortality between the two groups was no longer significant as follow-up time increased.
Lead researcher Professor Stephen Duffy, of Queen Mary University of London, said: "This study confirms that the benefits of screening women under the age of 50 are mainly reflected in the first decade;
results also suggest that screening between the ages of 40 and 49 did not lead to an increase in overdiagnosis compared to starting screening at age 50.
the study period, there was no significant difference in the overall incidence of breast cancer between the two groups of women, including the incidence of immersive breast cancer.
the intervention group reported more in-place cancers between the ages of 40 and 49, but the gap narrowed and there was no difference between the two groups at the end of the 23-year follow-up.
the worst-case scenario is moderate overdiagnosis, where breast cancer is 'overdiagnosed', even if not found between the ages of 40 and 49, and is diagnosed in screening starting at age 50," the team said.
based on the data, the team believes that lowering the screening age threshold from 50 to 40 may help reduce breast cancer mortality.
, however, in the paper's discussion, the team also noted that breast cancer treatment is no longer the same as it was in the 1990s, when trials began.
On the one hand, advances in therapy may reduce the benefits of screening, and on the other hand, more cutting-edge screening devices may be more conducive to early detection, while recent results still support the huge survival benefits of early diagnosis and treatment.
, it is still necessary to assess the impact of the latest breast cancer screening techniques and treatment options on women under the age of 50.
, an honorary professor at the University of Toronto, thought more about the results in a commentary published simultaneously in The Lancet-Oncology.
She argues that although this is a well-designed trial, it does not really address the "breast cancer starting age is 40 or 50" controversy, because the trial did not set a blank control group, although screening in the 40s has early survival benefits, but over time the gap between the two groups of breast cancer mortality rates is not obvious, so the benefits of starting screening at different ages are not convincing.
also need to be noted that in younger women, some breast cancers that can be found through physical examination may also be negative.
, an honorary professor at the Open University in the UK, commented on the absolute benefits, which have yet to be assessed.
, despite the large number of people covered by the trial, it is less common for women to die of breast cancer before the age of 50, which may affect the accuracy of mortality estimates.
, several experts still attach great importance to the risk of overdiagnosis in their reviews.
In Dr. Anthony Miller's view, because overdiagnosis usually increases with age, in this trial, it is possible that both groups of women were overdiagnosed after the age of 50, and that the test was not designed to detect statistical differences.
Professor Kevin McConway points out that overdiagnosis is one of the most important risks of target screening, and that for every woman who saves a woman's life from age 50, three women are diagnosed with non-fatal cancer.
Even if screening begins at age 40 or 50, being overdiagnosed sooner or later and overdiagnosing earlier means that women may have to endure treatment and psychological burdens for longer, as the trial papers say.
, professor of cancer genetics at the University of London, cautions that "screening methods may be more sensitive today, which in turn may lead to more false positive diagnoses."
" effective screening does reduce mortality.
key is to find the right people, starting age and check-up methods.
about the age of breast cancer screening, the newly published results may also leave more questions than the exact answer.
more research and evidence to continue to optimize screening strategies and help more women stay away from the "killer" of breast cancer.
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