The Great Mammogram Debate
The U.S. Preventative Services Task Force (USPSTF) recently posted the draft of their most recent recommendations for screening mammograms suggesting that screening mammograms do not need to be performed as frequently or as early as is currently practiced by most healthcare providers.
In its draft, the USPSTF recommends the following:
See this link for more information on the grading definitions for the USPSTF recommendations.
Currently, most women begin annual screening mammograms at age 40 and repeat every year unless they have other risk factors – such as a family history of breast cancer – which may lead to them beginning their mammograms earlier than age 40.
The USPSTF, comprised of an independent panel of experts in prevention and primary care that are appointed by the federal Department of Health and Human Services, is recommending that mammograms for women not be performed until age 50 and repeated every 2 years up until age 74, unless there are other breast cancer risk factors that would indicate earlier and more frequent screening. These recommendations are not new – the task force had very similar recommendations in 2009, however, not all professional organizations agreed with their recommendations and they were not widely adopted.
If there is this much confusion amongst health care providers, how is the average gal supposed to decide what to do!? Let’s take a look at why the USPSTF is making the recommendations they are and what other groups who disagree with them are saying:
The USPSTF cites potential risks and lack of evidence of benefits from mammogram screening in certain age groups as the reasons not to support routine screening mammograms in women ages 40-49 years of age.
Controversy and Concerns about the USPSTF Draft Recommendations
What’s Right for You?
So now that you have the facts, what’s the right decision for you? For women aged 50-74, the benefits of mammography are clear and you should absolutely get a screening mammogram every 1-2 years. For women aged 40-49, while your risk of breast cancer is lower and it is true that screening does not come without potential harms, those potential harms have to be balanced with the potential benefits which in some cases will be life saving. The potential for overdiagnosis, overtreatment, and false positives are a reality for any screening test and must be balanced with the potential benefits and information that can be gained from the screening test. The chance of breast cancer increases over the age of 50 and thus the chance of detecting a breast cancer by mammography increases after age 50. While screening mammograms are going to catch many breast cancers in women under age 50, the ratio of breast cancers detected compared to the amount of normal screens is much lower. So from a standpoint of balancing benefits vs. risks as well as cost-effectiveness (which is a big factor when looking at any screening test), the recommendation of waiting to begin mammograms until after age 50 make sense, from a public health standpoint, but not necessarily from an individual/personal health standpoint. The USPSTF states that they are not recommending against mammograms in women of this age group, rather they say that are recommending that this be an individualized discussion and shared decision between a woman and her provider based on an informed decision considering potential risks and benefits. However, there is a concern that a C level recommendation could lead to insurers dropping coverage for mammograms for women in this age group taking away their choice of screening mammography should they and their providers come to that informed decision that they do indeed want screening.
For women aged 40-49 or for those over age 74, talk to your healthcare provider about screening mammograms. Together you can discuss your personal and family history risk factors, the potential benefits and risks of screening mammograms, and decide what’s best for you.
For more information on the mammogram debate and breast cancer screening recommendations for women at average and high risk, check out Komen’s article here
For a great breakdown on media articles that discuss the USPSTF draft recommendations check out this HealthNewsReview link