Back in 2009, the U.S. Preventive Services Task Force came out with breast cancer screening guidelines that flew in the face of “the norm”: for best protection against breast cancer death, women should begin having yearly mammograms at age 40. The USPSTF recommended no screening mammograms for healthy women under age 50; and mammograms every 2 years from age 50 to 74. Now, new data seems to indicate that regular mammograms, beginning at age 40, do in fact lower a woman’s risk of death from breast cancer.
Four years ago, the USPSTF’s controversial new guidelines around screening mammography generated a firestorm of protest. Everyone from individual breast cancer survivors, to the American Cancer Society (ACS), to Kathleen Sebelius, U.S. Secretary of Health and Human Services (the agency that funded the USPSTF’s work), questioned the guidelines.
How could early detection NOT save lives?
As it turned out, the USPSTF didn’t question the fact that some women’s lives are saved by early detection of their cancer via mammography. The argument behind the new guidelines, however, was that the expense of having so many women screened outweighed the benefit. And by expense, the USPSTF meant emotional as well as financial, claiming that a huge number of healthy women each year receive unnecessary callbacks, undergo follow-up ultrasounds, and even have biopsies – all as a result of “over-screening.”
The USPSTF eventually backed off its original call for women under 50 to stop having yearly mammograms. Instead, the task force recommended that starting at age 40, women discuss with their doctor whether or not to have a mammogram, weighing the risk of false positives and unnecessary follow-up tests against the possibility of actually discovering a tumor.
Now, a new study published Sept. 9 in the journal Cancer shows that it may be more important than ever for women between the ages of 40 and 50 to have regular mammograms.
The study followed over 7,000 women diagnosed with breast cancer in a number of Boston hospitals between 1990-1999. Of the 609 women who died, 71% hadn’t had regular mammograms. Fully half of the women who died were under age 50, while only 13% were over 69. (Rettner, 2013)
Based on the data, the study authors concluded that more women under age 50 should receive regular screening; while fewer women over age 60 should be screened on a regular basis.
Some experts disagree with the study’s conclusions, as well as how it was carried out. Dr. H. Gilbert Welch, of the Dartmouth Institute for Health Policy and Clinical Practice, has long decried the “over-diagnosis and over-treatment” caused by regular screening mammograms.
Dr. Welch takes issue with the study’s setup, called “failure analysis.” This type of study starts with a group of subjects at a predetermined end-point (in this case, their death), and backtracks to see the path those subjects took to reach that point. A randomized trial, on the other hand, identifies a group of subjects and a timeframe, and tracks what happens to them during the duration of the study.
Others, though, agree with the study’s conclusions. Robert Smith, the ACS’s director of screening, notes that “The message here is that mammography is a good part of your prevention plan.” And Dr. Barbara Monsees, chairwoman of the American College of Radiology Breast Imaging Commission, concludes “Screening doesn’t reduce the risk of getting breast cancer, but it does reduce the risk of dying from it.” (Doheny, 2012).
Should you have a yearly mammogram beginning at age 40? It’s up to you. For more help with this decision, see our post, “You’re 40 Years Old; Should You Have a Mammogram?”
Doheny, K. (2013, September 09). Most breast cancer deaths occur in younger, unscreened women: Study. Retrieved from http://consumer.healthday.com/cancer-information-5/breast-cancer-news-94/most-breast-cancer-deaths-occur-in-younger-unscreened-women-study-679937.html
Rettner, R. (2013, September 09). Breast cancer screening: New study suggests benefit of early mammograms. Retrieved from http://www.livescience.com/39491-breast-cancer-screening-early-mammograms.html
Published On: October 27, 2013