Every Woman Age 40 and Over Needs an Annual Screening Mammogram

by Amanda J. Ferrell, M.D.
Director - Breast Imaging - Baptist Health
Radiology Consultants of Little Rock, PA

The U.S. Preventive Services Task Force (USPSTF) recently withdrew its support for screening mammography for women 40-49 and for women over 75, and recommended that women ages 50-74 be screened every two years instead of annually.  In addition, they recommended against Clinical Breast Examination and Breast Self-Examination.

 

Those of us involved in the diagnosis of breast cancer here in Arkansas for the past 25 years disagree with these new guidelines.  Under the current screening guidelines, we have seen significant improvement in the quality of life of our breast cancer patients, and a 30% drop in breast cancer deaths in women of all ages.  Here are some of the real problems I have with the USPSTF recommendations:

 

*  The 16-member USPSTF had not one expert on breast cancer screening, diagnosis, or treatment on its panel.  This fact is truly difficult to fathom: it was impossible for the panel members to have fully understood the real impact that mammography has on women's lives, since no one had any expertise or practical experience in these matters.

 

*   In our own practice at Radiology Consultants of Little Rock, PA, we have diagnosed 892 breast cancers since 2007.  175 (20%) were in women under 50.  Had our patients under 50 followed the USPSTF recommendations and not obtained mammograms, not performed breast self examinations, and not undergone clinical breast examinations, then most of their breast cancers would have gone undiagnosed in the early stages.  As it is, over 90% of those women under 50 in whom we have diagnosed breast cancer over the past 20 years have had no recurrence of their cancer, and are doing well.  The same numbers are true for those women in our practice who are over 50.

 

*   Screening mammography is the most carefully studied test in medical history, with seven of the eight randomized trials involving over half a million women world-wide showing between a 30% and 44% decrease in breast cancer deaths in the women undergoing screening mammography.  In addition, non-randomized screening studies on millions more women have shown up to a 63% decrease in breast cancer deaths.  These numbers are well-documented in the medical literature, and yet were strangely ignored by USPSTF in their research before issuing their recommendations.

 

*  The USPSTF claimed that there had been only a 15% reduction in breast cancer deaths in women 40-49.  The actual decrease based on the same randomized trials mentioned above was between 23% and 44% for women in this age group.  Even if there had been only a 15% reduction in deaths in this age group, as USPSTF had underestimated, this would still translate into thousands of young lives saved. 

 

*  The USPSTF also recommended that for women 40 to 49, they should speak with their physicians about whether or not to have a mammogram, based on their being at high or low risk for getting breast cancer.  What the USPSTF failed to understand was that 80% of all breast cancers occur in women with no identifiable risk factors whatsoever.  Therefore, 80% of the breast cancers in women 40-49 (those in women who would be denied mammograms because they would be considered "low risk") would go undetected at their earliest and most curable stage.   

 

*  The USPSTF claimed the "harms" of false-positive results, pain, and anxiety were somehow worse than allowing a woman with breast cancer to go undiagnosed at an early stage, with no scientific basis for such claims.  What an incredible insult it is to women that the USPSTF should decide what is "best" for them, based on what was essentially the personal opinion of USPSTF.  In fact, when I ask my patients about the issue of anxiety, the vast majority state that screening mammograms actually relieve their anxiety that they might have breast cancer.  For most, it is a "good news" exam.

  

We all know that there is no perfect test in medicine, and that mammography is no exception.  However, it is by far the best weapon we have in the war against breast cancer, and it is a proven one.  It is my sincere hope that women and their physicians will continue to follow the recommendations of the American Cancer Society:

 

SCREENING MAMMOGRAM EVERY YEAR, BEGINNING AT AGE 40.

 

When I became a physician, I took an oath to serve my patients and save lives. I steadfastly refuse to betray that oath.