Are we moving backwards with the new mammogram guidelines?
The US Preventive Services Task Force (USPSTF) issued their update to the 2002 screening mammogram recommendations. The Task Force no longer recommends routine mammogram screening for women ages 40-49. Further, they now recommend every-other-year mammogram screening for women ages 50-74, down from yearly screening. Finally, they recommend no routine screening after age 75. I feel that it is my responsibility to respond to the USPSTF recommendations because I disagree with them, and I think they are taking a step backward in our fight against breast cancer.
Importantly, the former recommendation for annual mammograms for women in their 40s is based on evidence that mammograms save lives. Women in their 40s tend to have more aggressive tumors, so regular screening is required to detect breast cancer while it is still small and curable. Dr. Otis Brawley of the American Cancer Society was quoted in an CNN article as saying “With its new recommendations, the [task force] is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them.” In the same article, Dr. Therese Bevers of the University of Texas M.D. Anderson Cancer Center stated, “You have to screen more women. It’s the value we put on zero women dying.” Well said. Our goal should indeed be zero women dying.
Another interesting response came from the American Congress of Obstetricians and Gynecologists (ACOG). ACOG calculated that with mammogram screening in the 40-49 year age group there would be “approximately 6,800 fewer deaths than expected” over a 10-year period based on current relative risk data (For the full article visit www.acog.org). That is 680 lives per year saved! 680 daughters, mothers, and sisters saved – well worth it!
Some additional arguments provided by the UPSTF for not recommending screening in the 40-49 year age group are that women may experience false positive results, anxiety, and pain. I know that I am not alone in thinking I would rather endure the former than miss cancer while it is still curable. I will recover from any anxiety, but I may not recover from missed cancer.
Radiation harm from mammogram was another argument provided by the UPSTF. However, the average radiation dose from a mammogram is 0.7mSv (millisievert), which is only about 1/3 the average yearly natural background radiation exposure for each of us in the U.S. (2mSv). So ten years of annual screening equates to about an extra 3 years of additional exposure on earth. This does not seem a compelling enough reason to not perform screening mammograms.
The biennial screening recommendation for women ages 50-74 also raises concerns. Like women in their 40s, women in their 50s tend to have more aggressive, faster growing cancers. These are the exact kinds of tumors that would benefit from yearly screening as an additional year of undetected growth can change prognosis significantly for the worse.
While the relative proportion of aggressive, fast growing tumors over slower growing tumors may decrease as women reach their 60s and 70s, both types of tumors benefit from the earlier detection offered by yearly screening.
And lastly, no routine screening after age 75? Are we disposable after that? Women in this age group have so much to offer their families, their communities and our society. The risk for developing breast cancer is highest in this age group and with life expectancy significantly above the 75-year mark, eliminating routine screening altogether exposes this population to years and, for many, even decades of unchecked tumor growth. People who have so much to offer will unnecessarily lose their lives with strict adherence to the new recommendations.
Despite the new recommendations, I think the optimal approach to detecting breast cancer involves regular, yearly screening starting at age 40. Depending on how extensively the new recommendations are accepted and practiced, you may need to have a discussion with your health care provider about the benefits of yearly screening and the risks associated with the new recommendations.
Get your screening mammograms, choose moderation over excess and most importantly, enjoy your life!
Dr. Marla Anderson is a board certified practicing general surgeon. She is Chief of the Department of General Surgery at a major hospital in San Rafael, California. Dr. Anderson attended medical school at Northwestern University Medical School and completed her general surgery residency at Northwestern Memorial Hospital in Chicago. Dr. Anderson holds a special place in her heart for her patients, as well as all women, diagnosed with and undergoing treatment for breast cancer.
