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Extending the Age Range in Mammography Screening: A Benefit-Risk Assessment from a Radiation Protection Perspective
Theresa Hunger1, Elke Anna Nekolla1, Eva Wanka-Pail1
1Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Neuherberg, Germany.
Rofo : Fortschritte Auf Dem Gebiete Der Rontgenstrahlen Und Der Nuklearmedizin
|August 28, 2025
Summary
Extending mammography screening programs (MSP) to women aged 45-75 is beneficial, reducing breast cancer mortality. While older women experience more overdiagnoses and younger women face higher radiation risks, the overall benefits outweigh these concerns.
Area of Science:
- Radiology and Radiation Oncology
- Public Health and Epidemiology
- Oncology
Background:
- Mammography screening programs (MSP) in Germany and Europe are established for women aged 50-69.
- Evidence suggests potential benefits and harms for women outside this age range.
Purpose of the Study:
- To assess the benefit-risk balance of mammography screening for women younger than 50 and older than 70.
- To evaluate the impact of extending age limits for MSP from a radiation protection perspective.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Estimation of radiation-associated lifetime attributable risks (LAR) using a modified BEIR Committee model.
- Analysis of breast cancer mortality and overdiagnosis rates.
Main Results:
- Screening reduced breast cancer mortality by 28% in women aged 70+ and 18% in women aged 39-49.
- Overdiagnosis proportion was estimated at 19% for older women, higher than for younger women.
- Extending screening to age 75 had minimal impact on the benefit-risk ratio.
Conclusions:
- Extending MSP age limits to 45-75 years is justified, as benefits substantially outweigh radiation risks.
- Mammography screening can reduce breast cancer mortality in women aged 45-49 and 70-75.
- Germany approved extending MSP to women aged 70-75 in February 2024.
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