When? Where? How often? What about Black women, who are not only more susceptible to developing breast cancer at earlier ages, but are also at a higher risk of having malignant tumors misdiagnosed…or diagnosed much later?
Especially if you’re a woman, you’ve probably been told to prepare for your first screening mammogram around the time of your 40th birthday and then to have one every year (in some cases, every other year) after that. Note: that’s just for routine mammograms; breast lumps always require a mammogram and/or other tests to start diagnosing whether it might be breast cancer.
The U.S. Preventive Services Task Force Controversy
But in November 2009, the U.S. Preventive Services Task Force (USPSTF) updated its screening recommendations and said that women of average risk for breast cancer could wait until age 50 to start getting mammograms and then follow up only every two years, rather than annually. The revised USPTF mammography screening guidelines marked a sea change
from the recommendations being made by nearly all major medical
associations, including the American Cancer Society, the American
Medical Association, and the American College of Obstetrics and
These new guidelines set off a heated debate within the medical community and don’t match up with most other mammogram recommendations from major medical organizations.
“We’re having the scientific arguments back and forth and in the meantime, women, in a sense, get caught in the middle,” says Len Lichtenfeld, MD, deputy chief medical officer of the American Cancer Society.
It was widely reported, however, that the USPSTF was against screening entirely for women with an average risk of breast cancer between the ages of 40 to 49. That wasn’t the case, says Diana Petitti, MD, professor of biomedical informatics at Arizona State University and vice chair of the 2009 USPSTF committee.
The actual recommendation was not communicated well, according to Petitti. “The decision about the age to start being screened at 40, 42, 44, 48, should be one that was more individualized,” she says, rather than a woman’s 40th birthday triggering an automatic authorization slip from her doctor to get a mammogram.
The Trouble With Statistics
The argument over when women should start breast cancer screening stems from a disagreement about the process the task force used to reach its conclusions. It relied on a sophisticated computer model rather than real-life, clinical, randomized studies to determine how many breast cancers are caught and treated in women ages 40-49.
Lichtenfeld says that the conclusions reached by multiple institutions using the same model were different. “So the reliability of that model to make a clinical decision, particularly when we have data from actual studies, we felt was not quite ready for prime time,” he says. “The task force did acknowledge at the time that mammography did reduce deaths for women between ages 40-49, Lichtenfeld says. “However, we said then, and I think it’s fair to repeat today, that the task force didn’t feel enough lives were saved for women in that age group, because breast cancer is more common as you get older.”
The American Cancer Society, Lichtenfeld says, disagrees and continues to recommend routine screening mammograms for women age 40 and older.
Is Too Much Testing A Bad Thing?
One of the central issues upon which the USPSTF based its recommendations had to do with the harm that can come from mammography testing: psychological harm, unnecessary imaging tests and biopsies, and false-positive mammogram results in which the patient is told there could be cancer, when in fact none exists. False-positive results are more common for women aged 40 to 49 than for older women.