November 18, 2009 at 5:20 pm , by Julia Kagan
UPDATE December 2, 2009
The mammogram debate continues. If we screen only “high risk” women, we’ll miss 75-90% of those get breast cancer, says Daniel B. Kopans, M.D., professor of radiology at Harvard Medical School and director of breast imaging at Massachusetts General Hospital, at a Radiology Society Of North America press conference.
Earlier this week, the distinguished U.S. Preventive Services Task Force (USPSTF) announced its new breast cancer screening guidelines, reversing many of its 2002 recommendations. In a move that has already become a point of controversy, USPSTF now recommends that women start getting mammograms later in life and less frequently. But after years of preaching “prevention, prevention, prevention,” what should we do now?
1. USPSTF advises women to start getting routine mammograms at age 50—not 40—until age 74. However, those between ages of 40-49 who are at high risk for breast cancer should talk to their doctor whether to begin regular screenings sooner.
2. USPSTF suggests getting a routine mammogram every two years, instead of every year—again, women in high-risk groups may need a greater frequency.
3. USPSTF recommends that doctors should not teach women how to do breast self-exams.
The reasoning: USPSTF found that among women ages 40-49, mammograms save one cancer death per every 1,904 people screened for 10 years. Among those ages 50-74, this number increases to 1 in every 1,339 women, and to 1 in every 337 women ages 60-69.
Based on these findings, the USPSTF concludes that for women ages 40-49, the risk of overtreatment (unnecessary biopsies, stress) from a mammogram outweighs its benefits. There is also data showing breast self–exams don’t find cancers in a more treatable stage or decrease deaths (read a Q&A with Susan M. Love, M.D. about this topic from our October 2009 issue after the jump, below).
The controversy: Not everyone agrees with USPSTF’s interpretation. “The panel acknowledges that screening mammography for women in their 40s saves lives, but considers it too costly in dollars per woman saved and in false positives. This seems inappropriate to me and would be to most women in their 40s, I think,” says Etta D. Pisano, M.D., Kenan Professor of Radiology and Biomedical Engineering and Director of the UNC Biomedical Research Imaging Center at UNC School of Medicine in Chapel Hill, North Carolina. “I do think the data support less frequent screening for older women,” she adds—but whether that should “start at 50 or later when women have fatty breasts…would be important to study.”
Moreover, the American Cancer Society still recommends women get an annual mammograms starting at 40. And so does Susan G. Komen for the Cure. And in terms of limiting mammograms from age 40 to 50 to just those with identified high risk factors: It turns out, according to Komen, that most women diagnosed with breast cancer in the U.S. do not have any risk factors aside from being female and getting older, and breast cancer that occurs in younger women is often more aggressive than breast cancer in women in their 50s or older.
The bottom line: Right now you still get to choose which recommendation you want to follow. And for women who hate mammograms, this is medical confirmation that you can have them much less often. But if you want to keep being tested according to the old standards, be prepared that insurance companies and Medicare may look at whether they should reduce the number of mammograms they are willing to cover.