Breast health

What — no annual mammogram screening? New recommendations for women

Women have been taught that we should get annual mammograms and check our breasts once a month — an idea so ingrained that the notion of doing less seems almost as though we’re being deprived of something wonderful. But the “good” accomplished by mammography screening has been carefully evaluated recently and found to be limited for the overall population of women. Yes, for individual cases mammography has been useful — and we all know someone whose cancer was found on a mammogram — but the study found that the great majority of women gained no benefit from yearly mammograms, and some even had serious problems from mammography. Other recent studies have pointed to overdiagnosis and the emotional toll of false-positives as drawbacks to annual mammograms.

A recent report in the Annals of Internal Medicine summarizes the new recommendations, made by the US Preventive Services Task Force (USPSTF) after careful analysis of all published research on screening for breast cancer. The USPSTF now recommends that unless women have specific risk factors, they should start mammography screening at age 50 and obtain a mammogram every two years, rather than yearly. The Task Force also says that women can stop getting mammograms at age 74. But the final decisions about mammogram timing should be left to a woman and her doctor, and made with respect to her personal medical history. Teaching of breast self-exam is no longer advised. And these recommendations are all based on evidence-based scientific research!

Here’s why the change: new statistical data from computerized models and a number of well-designed, carefully conducted studies, each with over 10 years of follow-up, showed that mammogram screening exams would prevent only 1 death in nearly 2000 women aged 40-49, while there would be 99 false-positive results per 1000 screening exams. The hazards from radiation exposure from extra images are also part of the added harm to this age group. Likewise, the studies and statistical analyses showed no difference in survival among women 50-69 years of age who were screened every 1 to 2 years. These new recommendations are actually in line with the protocols followed by European countries for the last 10 years — and Europe does not have higher rates of death from breast cancer than the US!

Help! What is a woman supposed to do now — simply sit tight, drumming her fingers until she gets breast cancer? On the one hand, you wonder if the baby is being thrown out with the bathwater with respect to mammograms. On the other hand, it appears we’ve been sold a bill of goods with significant drawbacks. Either way, we should be in an uproar! Is this more bad news like reports about the stock market, the real estate crash, and unemployment numbers?

Truthfully, I don’t believe that’s the case. I would instead look upon the new recommendations as an opportunity — a new turn in the road for women and researchers. The advancement of medicine and science is a constant work-in-progress. I don’t believe researchers set out to maliciously torture women by squishing their breasts between two cold plates, then exposing them to radiation! The experts really did think this technology would help us detect cancers earlier and save lives — and initial studies showed it did just that. And as healthcare practitioners, we all bought into the early detection hypothesis. It seemed valid — but we now know that there are more than five types of breast cancer. Some types act in ways that make finding them early helpful, while others do not. And we’re even discovering that some forms of cancer might be better off left undetected!

We were, in a sense, swept up by the business side of medicine that took over, with certain groups promoting mammography. The medical media has done a superb job of enforcing the need for self-exams and annual mammograms. And who among us could have spoken up against these guidelines? No one wants to get breast cancer, and the mammogram came to be seen as a way to prevent getting the disease — which it certainly is not. During this time, women were chastised for not performing monthly breast self-exams or for missing their mammograms. Doctors could either be sued for not sending their patients for their mammograms or shunned by their peers for not advocating and touting their advantages. But suddenly it seems this was all a case of the cart overtaking the horse — a cart that kept on rolling without strong evidence to support it.

Dixie’s perspective — a new approach for breast cancer screening, detection, and prevention

As a breast health specialist, I think it’s good that we slow down the “cart” of the mammography industry. This is a chance to stop, reflect, and look around for new ideas! It may feel scary for us all, not having the security blanket of an annual mammogram. But the reality is that the approach we were using as a security net was not protective for many women. Now this generation of well-educated women will have to look hard at this information, talk it over with our friends and healthcare providers, and make our own decisions.

At least we now have some genuine data, rather than making decisions based on wishful thinking or emotional hubris. Instead, this is a call to action for researchers to develop new tests for breast cancer screening and risk detection. I also believe we need to reestablish and refocus our efforts to find the cause or causes of breast cancer, and prevent it altogether. Check out the Army of Women for more information. Hey, I used to joke about it, but maybe I will get to be the curator of a mammogram museum when I retire!

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References & further reading on mammography recommendations

 

Original Publication Date: 11/18/2009
Last Modified: 02/16/2010
Principal Author: Dixie Mills, MD, FACS