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Posted: Monday, November 28, 2016

Ending the Confusion About Mammograms

For years, the message was clear – women should begin getting annual mammograms at age 40. A few years ago, though, that message changed. Now, some experts say that women can wait until age 50 – a full decade longer – to start their annual mammogram routine. But other experts disagree with that notion, and it’s caused both heated controversy in the health care community and general confusion for the very group that needs things to be perfectly clear – that is, the women who will be receiving annual mammograms.

Fellowship-trained radiologist Dr. Kristen Carver from LeConte Radiology says she experiences this confusion first-hand. “As a breast imaging radiologist, I am acutely aware of the confusion many women have regarding screening mammography guidelines,” she said. “It's no wonder these women are scratching their heads. Over the past year, several trusted organizations on the front lines of diagnosing breast cancer have published varying and contradictory updates about breast cancer screenings, leaving many wondering whose advice they should follow. The four major players to consider are the American College of Radiology (ACR) partnering with the Society of Breast Imaging (SBI), the United States Preventative Task Force (USPTF) and the American Cancer Society (ACS). Every major American medical organization with expertise in breast cancer care, agrees that starting yearly screening mammograms at age 40 saves the most lives,” she explained. “They disagree, though, on what screening interval best balances the benefits and ‘risks’ of the test,” she added.

“All four organizations agree that there is minimal, if any, risk due to the low-dose radiation patients receive during the exam,” Carver continued. “According to USPTF and ACS, the ‘harm’ in mammography is found in the events that occur after a screening mammogram is performed, such as false-positive results or finding a nonaggressive cancer. These two organizations have cited such ‘harms’ as reasons to delay the age of a patient’s initial screening, and also to reduce the frequency of imaging. It should be noted, though, that the research behind the USPTF decision is the subject of significant skepticism due to use of outdated equipment, limited input from cancer experts, and major flaws in its design and implementation,” she explained.

Carver says anxiety also has played a major role in some of the confusion. “The USPTF and ACS reference anxiety related to being called back for additional imaging or needle biopsies as a ‘harm,’” she said. “The thing to remember is that anxiety is present in any medical field. This is even true in something as simple as routine blood work that elicits additional testing. If the potential for anxiety outweighs your concern of a timely breast cancer diagnosis, then following the ACS or USPTF guidelines which limit screening mammography may be for you. It is important for women to understand, though, that they are trading the chance to diagnose cancer at an early stage, when it is most easily treated, to escape short-term anxiety over additional imaging and biopsies,” she said. “Another reason the USPTF and the ACS tell women they don’t need yearly mammograms starting at age 40 is the ‘potential for overtreatment of cancers’ that may never kill you. The issue here is that each breast cancer behaves in different ways. It is true that some breast cancers may never spread, but others may grow rapidly. All are dangerous because imaging characteristics cannot predict future behavior of each cancer,” she explained. “Most importantly, there is no evidence to show that an invasive cancer has ever gone away or shrank without treatment,” she added.

“The USPTF and the ACS suggest we consider a woman’s underlying risk for breast cancer in deciding when to start screening,” Carver continued. “This reasoning is particularly devastating and flawed. The facts are that 75 percent of women diagnosed with breast cancer in their 40s have no special risk factors and fall in the average risk group. Screening only women with risk factors will miss the vast majority of women who will develop breast cancer,” she said. “The fact is that, by not getting annual mammograms starting at age 40, you increase your chances of dying from breast cancer and the likelihood that you will experience more-extensive treatment for any cancers found. Getting screened every year starting at 40 will save the most lives. In fact, one in six breast cancers occur in women ages 40-49. Annual screening starting at age 40 saves approximately 6,500 more women's lives each year than screening every other year starting at age 50. Early breast cancer detection enables less-extensive surgery and less-frequent or aggressive chemotherapy. Because of this, the Blount Memorial Breast Health Center continues to recommend that women get yearly mammograms starting at age 40. We follow guidelines set forth and maintained by the ACR and the SBI, as these organizations are governed by experts in the field of diagnosing breast cancer,” Carver explained.

Additional helpful information can be found on the SBI website. For more information, visit www.endtheconfusion.org.

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