I’m sure by now you have all heard about the new report that came out suggesting that mammograms between the age of 40 and 50 may not be necessary. We’ve been having a lot of discussion among my co-workers at Cancer Services, and I know there’s been a lot of opinions shared on the news as well as in social circles.
I think there are a few important things to know about the most recent review process as well as the recommendations. And most importantly, STAY CALM! The decision on when and how to screen is still a decision between you and your doctor. Recommendations are not rules that will be enforced.
What are the new Recommendations?
Here is an overview of the recommendations released on Monday:
- For women between the ages of 50 and 74 years, the USPSTF recommends mammography every two years (rather than every year).
- The USPSTF notes that there is insufficient evidence to assess the benefit and harms of screening in women over the age of 74.
- The USPSTF recommends against teaching breast self-exam.
You will note that the recommended age to start mammogram is at 50 rather than 40, is recommdended every two years instead of every year, and we need more data on women getting mammograms over the age of 74.
Who Made These Recommendations?
These recommendations were made by the US Preventive Services Task Force (USPSTF). USPSTF is an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services. It is funded and appointed by the government of the United States.
The mission of the USPSTF is to evaluate the benefits of individual services based on age, gender, and risk factors for disease; make recommendations about which preventive services should be incorporated routinely into primary medical care and for which populations; and identify a research agenda for clinical preventive care.
NOTE that the aim for this group is to objectively review data and they are only funded by the government, not any industry.
Weighing the Risks and Benefits
What you may not realize is that there has ALWAYS been debate about whether mammography for women in their 40s was worth recommending. YES, there are risks to having a mammogram. Risks include:
- False-positive tests: if you’ve ever thought you might have cancer, the worry and stress of having to go through extra tests is NOT a piece of cake!
- False-negative tests: I know many breast cancer survivors who had normal mammograms and come to find out that they had cancer that the mammogram missed.
- Overdiagnosis: I think many people don’t realize that there are some cancers that will never cause health problems during the life of a patient. In the case where someone has a cancer, but it’s not going to cause any health problems, treatment would be unnecessary. When would this happen? Possibly it is extremely slow growing or the patient has more pressing health concerns. Cancer treatment is not a piece of cake either! You don’t want to take it unless it’s necessary.
The expected benefit from mammogram is that it would reduce breast cancer mortality. The data shows that mammograms under age 50 simply aren’t worth the cost to America’s women. These researchers have looked at all the data (studies to date) to compare results and determine: is there reduced mortality for people getting mammograms every year starting at the age of 40, and does the amount of decrease outweigh the risks stated above.
What Does This Mean for Me and My Loved Ones?
Again, I’m going to remind everyone to STAY CALM! These recommendations are not saying that you can’t have a mammogram before the age of 50. They are just saying that for women at average risk, it may not be necessary to screen every single woman every single year starting at age 40.
This has NOTHING to do with the decision that you make with your doctor! If you are at high risk because of a genetic condition (BRCA1 and BRCA2 positive), family history, your race (African Americans women have lower rates of breast cancer than Caucasian Americans, but higher rates of breast cancer under 40 and higher rates of aggressive breast cancer), or just because you are worried, the choice to get a mammogram is totally up to you and your doctor.
Also, it’s important to remember that women should be having a clinical breast exam (done by a trained nurse or doctor) at least every 3 years starting at 20, and every year starting at age 40. Usually, women get this done at their annual GYN appointment.
You will also note the recommendation against teaching self breast exam. There has always been a lot of debate on this topic as well, and I’m going to have to leave that for another day!!
What Will Julie Do?
Well, I’m 30 at this point. By the time I’m 40, they may have data which pushes the recommendation a totally different direction. Maybe we’ll even have better screening than a mammogram, who knows. If I were 40 right now, I would probably talk with my doctor, do clinical breast exams and possibly get a baseline mammogram.
Remember that 1 in 3 women will be diagnosed with cancer in their lifetime (all types), 1 in 8 will be diagnosed with breast cancer. Mammograms do not prevent cancer, they just detect it.
You can make a difference with your everyday choices. It is estimated that 30 – 40% of cancer can be prevented if people ate healthy and exercised. So get to the farmer’s market, eat your veggies and take a walk!
For more info on the new recommendations, check out these two articles by the Susan G. Komen for a Cure Foundation. I think they are excellent reviews!