Clearing the Confusion on Mammography Recommendations

Our phones at WDI ring frequently with women asking questions about when to start and stop mammography, and how often to get screened. I hope this ends the confusion.

Why are there conflicting recommendations? Groups like the The U.S. Preventive Services Task Force (USPSTF) make policy for the masses, not individuals. Yet, medicine is moving rapidly towards more individualized diagnosis and treatment.

I recommend women of average risk to begin mammography at age 40 and have an exam annually. Women at high risk, especially with a family history, should begin earlier! This is the recommendation of the American Cancer Society, the American college of Radiology (ACR) and the Society of Breast Imaging (SBI). Women should continue mammography into their 70s and beyond, as long as their health is good enough for treatment if cancer is found.

Mammography saves lives by detecting breast cancer early, when there is a better chance it can be treated successfully. If you are age 40 or older, and have not had your annual mammogram, please consider making your appointment soon.

Medical professionals who understand breast cancer diagnosis and treatment reject the recommendation of the The U.S. Preventive Services Task Force (USPSTF) that women get screened every other year (bi-annual screening) starting at age 50. Bi-annual screening will result in many cancers found later, when they are harder to treat. Debra Monticciolo, chair of the ACR Breast Imaging Commission, said that following these recommendations "...would result in lethal consequences for thousands of women each year."

Here are a few important statistics from The American College of Radiology:

  • 1 in 6 breast cancers occur in women aged 40 - 49.

  • 30% of cancers would be missed if women aged 50+ had a mammogram every other year.

  • Mammography has contributed to a 40% reduction in breast cancer mortality since 1990.

Dr. Elizabeth Morris, Breast Imaging Chief at Memorial Sloan Kettering (MSK) explains the issue well:

"MSK places the greatest emphasis on what's been shown to save the highest possible number of lives: annual mammograms beginning at age 40. Groups most focused on minimizing biopsies and repeat scans, on the other hand, recommend that women start annual mammograms at age 50 and continue every other year - as do groups that place the greatest value on keeping costs down."

The USPTF also recommends that women stop mammography after age 75 because they do not benefit. But a 2014 study on mammography for women age 75 and older published in the journal Radiology came to a very different conclusion:

  • 97% of women with mammography-detected cancer were alive 5 years after diagnosis.

  • 87% of women with patient-or doctor-detected cancer were alive 5 years after diagnosis.

The report quotes one of the researchers, Dr. Judith Malmgren, Affiliate Assistant Professor at the University of Washington's School of Public Health and Community Medicine, who said:

"Longer life expectancy for women increases the importance of early detection. A 75-year-old woman today has a 13 year life expectancy. You only need 5 years of life expectancy to make mammography screening worthwhile."

I have a patient whose cancer was detected by mammography and treated with radiation when she was 80 years old. Today she is 96. In those 16 years she watched her grandchildren grow up and was able to walk down the aisle (with a walker) at their weddings. Now she is a great-grandmother. Would you say that's a good reason to continue mammography?

Be your own advocate. Get a breast cancer risk assessment. Follow through with the screening you need and the frequency you need. You are an individual, not a statistic. And you should be treated that way.

Warm regards,

Lisa R. Weinstock, M.D.

Director, Women's Digital Imaging

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