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The news was startling: The decade-old advice that every woman needs to get an annual mammogram starting at age 40 is obsolete, a respected medical society announced in April. These tests might be unnecessarily risky, they claimed -- at least for many women age 40 to 49. The bombshell came in new guidelines from the 120,000-member American College of Physicians (ACP), the nation's second-largest physicians group.
Only women at high risk for breast cancer should automatically receive annual mammograms in their 40s, according to the ACP. Other fortysomethings should have their physicians assess their risk of breast cancer and inform them of the "potential benefits and harms of screening mammography" before deciding whether to do it.
Harms? What harms? We consulted Etta D. Pisano, MD, Kenan professor of radiology and biomedical engineering at the University of North Carolina School of Medicine. Dr. Pisano won a 2006 Ladies' Home Journal Health Breakthrough Award for her work assessing digital mammograms.
Q: What's your reaction to this?
Dr. Pisano: I am exceedingly unhappy with the ACP reopening this issue. I thought the medical community had finally reached a consensus that mammography saves lives for women over 40.
Q: Why do you think the ACP came to this conclusion?
A: They note that more than 98 percent of women will not develop breast cancer between ages 40 and 50. But the ACP also acknowledges that a screening mammography every one to two years results in a 15 percent decrease in breast-cancer mortality. I feel doctors should be patients' advocates. But by focusing on the "burden" of breast cancer in women this age being "low for a population-based screening program," the ACP seems to be concluding that saving lives is not as important as the costs. You definitely find less breast cancer in younger women, but when you do find it, it's often more aggressive -- and young women have years of life ahead of them.
Q: Let's talk about the two most serious risks cited: first, that screening finds "cancer that would not have become clinically evident [i.e., big enough to find] during the patient's lifetime," resulting in unnecessary treatments.
A: The ACP's discussion of this risk focuses on ductal carcinoma in situ (DCIS), cancer of the lining of the milk ducts. Some DCIS may never develop into full-blown cancer, but some will progress. Being screened gives women and their doctors the ability to decide what to do; some women might just have an excision and not opt for radiation or chemo.
Q: The other risk is a positive result that turns out to be false -- but not before the patient has further procedures to rule out cancer.
A: A false positive is traumatic, but it's resolved in a month. And is it really as bad as losing your life because you weren't screened?
Note: The American Cancer Society still recommends yearly mammograms for every woman, starting at age 40.
Originally published in Ladies' Home Journal, July 2007.