Radiation risk associated with mammography screening examinations for women younger than 50 years of age

The target group of the German mammography screening program, conducted according to the European guidelines is clearly defined all women aged 50-69 years without evidence of breast cancer are invited to screening mammography every two years. In the present study the question was raised whether breast cancer screening mammography every two years. In the present study the question was raised whether breast cancer screening by means of mammography is - from the point of view of radiation hygiene -justified also for women under 50 years of age. Based on current radio-epidemiological breast cancer studies, the excess lifetime risk (ELR) to incur or die from breast cancer of a 40,45 and 50 year old woman was assessed. Different risk models were used to estimate the radiation risk e.g. models given for the "Life Span Study" of the atomic bomb survivors and the risk model given in the recent Biological Effects of Ionizing Radiation (BEIR) VII report. The benefit risk ratio was defined as the ratio of the number of "saved lives" due to screening to the number of deaths due to " radiation induced breast cancer:. All estimations were based on the assumption that screening is taking place up to the age of 69 years with screening examinations being performed annually up to the age of 50 and every two years from the age of 50 onwards. The glandular dose per two-view mammography investigation was assumed to bt 4 mGy. The benefit due to mammography screening was assumed to be 25% for all age groups. Assuming screening from the age of 40 or 45 years, the ELR of breast cancer is on average about 3.5 0r 2 times as high compared to the ELR associated with screening starting from the age of 50 years. In comparision to the benefit risk ratio which results for women participating in a mammography screening from the age of 50 years the benefit risk ratio for women starting with screening already from the age of 40 04 45 years is reduced by a factor of 3 or 2. With the present data - with regard to both the benefit and the radiaton risk - it appears not to be justified to expose women from the age of 40 years to the additional radiation exposure associated with a mammography screenign.