The Mammogram Wars

You’ve probably read some of the debate over when women should begin having mammograms and how often. 

We recommend that ALL WOMEN begin having annual mammograms at age 40 and continue through their senior years. For some women, we may suggest an earlier age or additional screening depending on individual risk factors. We follow the recommendation of our professional organization, the American College of Obstetricians and Gynecologists, as well as the American Cancer Society.

There is no disagreement that mammograms save lives

The controversy developed when the U.S. Preventive Health Task Force (USPTF) in 2009 stated that most women should not begin mammograms until age 50 and should be screened only every two years. The USPTF is a group appointed and funded by the federal government whose purpose is to advise healthcare policy-makers and individuals about the risks and benefits of preventive care. They based their conclusion on the concern that screening outside of these guidelines did not save enough lives to justify its potential harms. Here is an excerpt from the USPTF’s statement:

The harms resulting from screening for breast cancer include psychological harms, unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results. Furthermore, one must also consider the harms associated with treatment of cancer that would not become clinically apparent during a woman’s lifetime (overdiagnosis), as well as the harms of unnecessary earlier treatment of breast cancer that would have become clinically apparent but would not have shortened a woman’s life. Radiation exposure (from radiologic tests), although a minor concern, is also a consideration.

Women, healthcare providers, and advocacy groups were alarmed

Many expressed concern that the recommendation would lead government insurers to deny payment for mammograms outside of these guidelines and that private insurers might follow. They worried that USPTF’s statement scaling back the value of mammograms as a life-saving tool might dissuade women being screened.

The USPTF does not deny that mammograms save lives of women in their 40s. Recent studies have strengthened evidence that mammograms do save lives in the younger age group. For example, a study published just last month in the journal Cancer reported that among a group of over 7301 women followed from 1990 to 1999, “Overall, 29% of cancer deaths were screened, whereas 71% were unscreened.” But the USPTF report argues that over 1900 forty-something women have to be screened to save a single life. And, among the rest, many will undergo extra tests, anxiety, and perhaps biopsies without finding a cancer.

Your physicians here believe that only you can make the decision about whether the chance that yours is that one life is worth extra inconvenience, anxiety, and possible medical procedures. We agree with those who say women are quite capable of understanding the evidence, managing their anxiety and dealing with inconvenience associated with this important health issue. We have the responsibility to provide you with information.

Mammography is not a perfect screening tool since it cannot always distinguish a cancer from a non-cancerous lump, and more importantly—it will not detect all cancers. But unless the best available scientific information changes, we will continue to recommend annual mammograms beginning at age 40. We will try to make your mammogram as convenient and comfortable as possible. In our diagnostic center, we provide FDA-certified digital mammography and can usually schedule it at the same time as your annual exam. As always, we appreciate that you have chosen to place your trust in our care and recommendations.