Mammograms may be the best first-line defense against breast cancer deaths in the medical arsenal, but they are increasingly under fire.
Concerns about false positives and overtreatment have moved some groups to dial back recommendations about when and how often women should be screened for breast cancer.
Tupelo radiologist and breast health specialist Dr. Susan Shamburger said it’s clear that screening mammograms are a key component in decreasing mortality from breast cancer.
“Since 1990, breast cancer mortality has decreased 30 percent in the United States,” Shamburger said. “Before that, there was no change in 50 years.”
Mammograms have limitations, and they won’t find every cancer, but they do a very good job of finding tumors before they can be felt.
“It’s been very successful at finding cancer at an earlier stage,” said radiologist Dr. James Thomas, who works with patients at the Imaging Center in Tupelo
Early detection means more treatment options for women, and better outcomes.
“Now the cure rate is 99 percent if the cancer is confined to the breast,” Shamburger said.
Over the past six years, some medical professional groups have started drawing different lines as they try to tailor screening guidelines to maximize the benefits and minimize costs and potential harm.
Earlier this month, the American Cancer Society adjusted its breast cancer screening recommendations, saying women 45 to 54 of average risk should have annual mammograms. Women 55 and over can stretch the interval to every two years. However, those guidelines called for continued access to annual mammograms for women 40 to 44 and women over 55 who want them.
In 2009, the U.S. Preventive Services Task Force made waves when they recommended screening mammograms start at 50 and continue every other year. Draft recommendations currently under review clarify that women and their physicians should consider the risks and benefits to make individual decisions on screening.
The American College of Radiologists and the American College of Obstetricians and Gynecologists still recommend annual mammograms starting at age 40 for women of average risk.
The bar for population screening is very high. A test or procedure needs to be effective, efficient and have very small risk of harm.
For every 1,000 women screened with mammograms, an average of 100 are called back to get more images, Shamburger said. Of that 100, 20 are sent for a biopsy. In the end, five are diagnosed with breast cancer.
It’s more common for women to be diagnosed with breast cancer after 50, which is a significant factor in why the U.S. Preventive Services Task Force and the American Cancer Society stepped back from recommending universal screening at age 40.
Focusing solely on incidence and mortality numbers miss a critical factor, Shamburger said.
“More than lives are saved if you do screenings at 40,” Shamburger said.
Women between 40 and 50 are in their prime earning years. They are often caring for growing children and aging parents.
“You may be supporting three generations financially and physically,” Shamburger said.
Stretching the interval between screening can be problematic, Thomas said.
“You can’t pick out who’s going to have aggressive disease,” Thomas said.
Putting into practice
It’s important for women to be partners with their health care providers as they consider screening, said New Albany obstetrician-gynecologist Dr. Leo Bautista.
“I always sit down with my patient and tell them about the risk and benefits of what I do, including these screening recommendations,” said Bautista, who expects most of his patients will want to continue starting mammogram screenings at age 40.
Tupelo family physician Anne Haire said she looks closely at the research driving the guidelines, and then walks her patients through their options.
“You have to take each patient individually,” Haire said. “We look at family history and their needs.”
As a matter of practice, she generally recommends most women start annual mammograms at age 40.
“Research is wonderful, but I’m afraid we’ll miss a cancer,” Haire said.