Mammogram Advice a Health Threat

The recent announcement by the U.S. Preventive Services Task Force, a national panel of medical officials tasked with reviewing clinical data and making recommendations about preventive care, has generated considerable confusion about the role of mammography and threatens to undo years of beneficial public and physician education and behavior adaptation.

Since the news broke about the recommendation last month, our team of breast cancer specialists has been inundated by questions, concerns and comments from women.
Until 1990, the breast cancer death rate in the United States had remained unchanged for 50 years. With the introduction of screening mammography, there was an abrupt and sustained decrease in the breast cancer death rate by 30 percent over the past 20years. The new USPSTF guidelines threaten to reverse the significant progress that has been made over the past two decades.

The task force recommends against routine screening mammography for women ages 40-49. However, there is ample scientific evidence that women in their forties can expect an equivalent decrease in breast cancer mortality due to screening mammography as compared to women 50 and older. Population studies in Sweden have shown a 40 percent decrease in breast cancer mortality in women ages 40-49 who underwent screening.

The incidence of breast cancer rises steadily with age, but there is no dramatic increase at age 50. The probability of being diagnosed with breast cancer among women in their forties is 1.44 percent as compared with 2.63 percent among women in their fifties. Meanwhile it has been estimated that 40 percent of the years of life saved by screening can be attributed to women diagnosed under the age of 50.

The task force advises only those women in their forties who are at high risk to undergo screening. However, it should be emphasized that only 10 percent to 25 percent of breast cancers occur in women at high risk. The majority of breast cancers arise in women with no special risk factors.

Yearly screening may be especially important for younger women because they tend to have faster growing cancers. Lengthening the screening interval to two years will diminish the survival benefit for all women and ultimately contribute to more treatment related toxicity because more cancers will be diagnosed at a later stage.
Physical exam, whether practiced by a woman herself or her doctor, will always be complementary to any breast-imaging technique.

Women should remember to bring any changes to their doctor's attention regardless of how soon after a negative mammogram they occur. We can each cite many personal instances where a woman's self exam led her to a doctor for follow up, sometimes with life-saving consequences.

In conclusion, the breast specialists at the Center for Cancer Prevention and Treatment at St. Joseph Hospital do not support the revised screening mammography guidelines recently issued by the Task Force and strongly urge women 40 and older to continue annual screening mammography. Better yet, talk to your own doctor about your risk factors and make a decision together about your breast health. It could save your life.